Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
58 Cards in this Set
- Front
- Back
|
List the subclasses of B-lactams
|
Penicillins
Cephalosporins Carbapenems Monobactams |
|
|
MoA of B-lactams?
|
PBP/cell wall transpeptidase inhibitor (mimics the D-alanine D-alanine tail of a NAM)
Prevents crosslinking of NAG-NAM polysaccharide chains Bacteria autolyses (drugs are bactericidal) |
|
|
What bugs are natural penicillins good against?
|
Mostly gram + (some gram -)
Only the non B-lactamase producers within: Gram + cocci: viridans strep, group A strep, Strep pneumo, anaerobic strep(Peptostreptococci, Peptococci), Enterococci, S. aureus Gram +: Clostridium (not incl difficile), Actinomyces Gram - cocci: N. gonorrhea, Pasteurella multocida Gram - spirochete: Treponema pallidum(cause of syphilis) |
|
|
List some penicillinase resistant pcns
|
Nafcillin
Oxacillin Dicloxacillin |
|
|
List some aminopenicillins
|
Ampicillin
Amoxicillin Bacampicillin |
|
|
What are penicillinase resistant pcns mainly used for? And have no activity against?
|
Used against Staph aureus that produces penicillinase.
They lack activity against enterococci, gram - bugs, and have almost no anaerobic activity. |
|
|
What are the aminopenicillins mainly used for? List some bacteria.
|
Gram +: strep, enterococci, Listeria monocytogenes
Gram -: H.influ, E. coli, P. mirabilis, Salmonella all, Shigella all. |
|
|
Aminopenicillins are not resistant against _____?
|
Aminopenicillins are not resistant against staphylococcal penicillinases or gram - B-lactamases
|
|
|
List the carboxypenicillins
|
Carbenicillin
Ticarcillin |
|
|
What are the carboxypenicillins mainly used for? List some bacteria.
|
Includes that of the Aminopenicillins (less Enterococci)
But enhanced gram - due to good penetration Including these facultative anaerobic gram -: Enterobacter, Providencia, Morganella, indole+Proteus Including the strict aerobic gram - : P. aeruginosa "Enter all ye cocci and bacter to the Providence of Morganella and her god Proteus as depicted on her Rug" |
|
|
Carboxypenicillins are not resistant against ____?
|
Carboxypenicillins are not resistant against penicillinases/B-lactamases
|
|
|
List the ureidopenicillins
|
Azlocillin
Mezlocillin Piperacillin |
|
|
What are the ureidopenicillins mainly used for? List some bacteria.
|
Includes coverage of the carboxypenicillins(see that list)
Including even more anaerobic gram - coverage: Klebsiella, Serratia Plus it brings back Entercoccus activity (that was lessened with caboxys) wiki: primarily gram - bacteria, especially Pseudomonas aeruginosa |
|
|
Ureidopenicillins are not resistant against ____?
|
B-lactamases/penicillinases
|
|
|
In general, list the coverage (from greatest to least) between
Aminopenicillins Carboxypenicillins Ureidopenicillins |
Ureidopenicillins > Carboxypenicillins > Aminopenicillins
|
|
|
List 3 B-lactamase inhibitors
|
Sulbactam
Clavulanic acid Tazobactam |
|
|
Whats augmentin?
|
Oral combination drug with amoxicillin & clavulanic acid
(aminopenicillin + B-lactamase inhibitor) |
|
|
Whats Unasyn?
|
IV combination drug with ampicillin & sulbactam
(aminopenicillin + B-lactamase inhibitor) |
|
|
Whats Timentin?
|
IV combination drug with ticarcillin & clavulanate
(carboxypenicillin + B-lactamase inhibitor) |
|
|
Whats Zosyn?
|
IV combination drug with piperacillin & tazobactam
(ureidopenicillin + B-lactamase inhibitor) |
|
|
What is the structure of a B-lactamase inhibitor?
|
Similar to a B-lactam (since it must irreversibly bind to B-lactamase, which would normally bind to B-lactams itself)
|
|
|
Name some bacteria that produce B-lactamase
|
S. aureus (90% produce B-lactamase, considered pcn resistant)
E. coli (30-50% are resistant to ampicillin and amoxicillin) H. influenza, Moraxella catarrhalis, N. gonnorhea, K. pneumo |
|
|
Which type of bacteria produces B-lactamase that current B-lactamase inhibitors have trouble binding to?
|
Richmond Skyes/Bush Class 1 bacteria are B-lactamase inhibitor resistant
|
|
|
Is dosage adjustment necessary with most penicillins during renal impairment?
|
Yes because most penicillins are renally eliminated.
|
|
|
Is dosage adjustment necessary with most penicillins during hemodialysis?
|
Yes because many penicillins are cleared during HD
|
|
|
Is dosage adjustment necessary with most penicillins during hepatic impairment?
|
No because most penicillins are renally eliminated.
|
|
|
Exception(s) with dosage adjustment of penicillins during hepatic impairment?
|
Nafcillin and mezlocillin DO require dosage adjustment during hepatic impairment.
Nafcillin is an antistaphylococcal and these drugs are typically metabolized by the liver. |
|
|
List and give examples of AE(s) for penicillin?
|
Hypersensitivity (1-10%)
eg maculopapular rash, and (rarely) anaphylactic rxn Gastrointestinal effects eg diarrhea (oral ampicillin and amoxicillin), N&V, epigastric distress(upset stomach,heartburn) Skin effects eg rash (more so with ampicillin, amoxicillin) Hematologic effects eg neutropenia (3-8%), platelet aggregation (ticarcillin, carbenicillin) CNS effects eg seizures, encephalopathy(more so with high conc, history of seizures) Electrolyte disturbances eg hypokalemia, hypernatremia(ticarcillin is high in salt) Hepatic effects eg increased transaminases(transient), hepatitis/cholestasis(high dose oxacillin) Procaine pcn G IM can cause dizziness, audio/visual/taste disturbances, muscle twitching, and fear of imminent death |
|
|
List drug interactions with penicillins.
|
PCN inactivates aminoglycosides when mixed in soln (possibly both are inactivated)
Probenecid uses same renal transporter and competitively inhibits secretion of PCN (decs elim of PCN and incs its serum conc) |
|
|
List 5 bacteria that Cephalosporins lack activity against.
|
Highly pcn resistant S. pneumo
MRSA Enterococcus Atypicals Listeria monocytogenes Stenotrophomonas maltophilia (optional to remember) |
|
|
Whats the one exception of a B-lactam that is effective against MRSA?
|
Ceftaroline (5th gen cephalosporin)
|
|
|
List two 1st gen cephalosporins
|
Cefazolin (iv)
Cephalexin (po) |
|
|
What is cefazolin active against?
|
Gram + cocci (very good against)
Moderate activity against these gram -: Moraxella. catarrhalis E. coli Proteus. mirabilis K. pneumo Salmonella Shigella Enterobacteriaceae (but unpredictable) "MS SPEEK about your sofa violin" |
|
|
What is cephalexin active against?
|
Gram + cocci (very good against)
Moderate activity against these gram -: Moraxella. catarrhalis E. coli Proteus. mirabilis K. pneumo Salmonella Shigella Enterobacteriaceae (but unpredictable) "MS SPEEK about your sofa violin" |
|
|
Name a bacteria that is resistant to first gen cephalosporins, but not second gen.
|
B. fragilis
|
|
|
List three 2nd gen cephalosporins
|
True cephalosporins (eg cefuroxime)
Cephamycins (eg cefotetan, cefoxitin) |
|
|
What are the "true cephalosporins" good against?
|
Greater staph and strep activity (greater gram +)
Improved activity against following gram -: H. influenza M. catarrhalis N. meningitidis N. gonorrhea |
|
|
What are the cephamycins good and bad against?
|
Bad: staph and strep
Good: Enterobacteriaceae (some) Best cephalosporin against: Bacteroides (B. fragilis was resistant to 1st gens) |
|
|
List the 3rd gen cephalosporins
|
Ceftazidime
Cefoperazone Cefotaxime Ceftriaxone Cefixime |
|
|
What are the 3rd gen cephalosporins good and bad against?
|
Its primarily an anti-pseudomonas agent
Most potent cephalosporin against: facultative gram - rods Great for these gram -: H. influenza N. meningitidis N. gonorrhea Moraxella Great against these gram +: Strep. pneumo Strep. pyogenes some other strep as well Ok against: Staph aureus |
|
|
Which 3rd gens are not good against the bacteria that cephalosporins are typically good against?
|
Ceftazidime, not good against strep and S. aureus
Cefotaxime and Ceftriaxone have no activity against Pseudomonas aeruginosa |
|
|
List the 4th gen cephalosporins
|
Cefepime
|
|
|
What are the 4th gen cephalosporins good and bad against?
|
Good against same gram - as 3rd gen, eg:
Pseudomonas H. influenza N. meningitidis N. gonorrhea Moraxella Enhanced activity against SPICE organisms Gram +: Enhanced strep and MSSA |
|
|
List the 5th gen cephalosporins
|
Ceftaroline
Ceftobiprole |
|
|
What are the 5th gen cephalosporins good and bad against?
|
Good against same gram - as 4th gen, eg:
Pseudomonas H. influenza N. meningitidis N. gonorrhea Moraxella Enhanced activity against SPICE organisms Good against same gram + as 4th gen, eg: Enhanced strep and MSSA MRSA (breakthrough) |
|
|
Which gen cephalosporins can be used to treat meningitis?
|
3rd and 4th
no data on 5th |
|
|
Do cephalosporins require dosing adjustment in renal impairment? Exceptions?
|
Yes (most are excreted by kidneys)
Exceptions: Ceftriaxone and cefixime are excreted in bile (no dose adj needed) |
|
|
List AEs of cephalosporins
|
Similiar to PCNs (see that list)
Formation of (vit K dependent) clotting factors in liver (due to MTT side chain in cefamandole, cefotetan, cefoperazone, moxalactam) Increased risk of bleeding |
|
|
List DIs (drug interactions) with cephalosporins
|
Alcohol
Probenecid (dec elim of ceph) H2 antagonists, antacids (these inc gastric pH which dec's dissolution of ceph in stomach) |
|
|
Main bacteria that causes Meningitis?
|
Strep pneumo
|
|
|
Main bacteria that causes upper respiratory track infections?
|
Strep pneumo
|
|
|
Main bacteria that causes community acquired pneumonia?
|
Strep pneumo
|
|
|
Main bacteria that causes nosocomial acquired pneumonia?
|
Pseudomonas aeruginosa
|
|
|
Main bacteria that causes endocarditis(inflammation of inner layer of heart and heart valves)?
|
Staph aureus
|
|
|
Main bacteria that causes intra abdominal infections?
|
E. coli
|
|
|
Main bacteria that causes skin infections?
|
S. aureus
|
|
|
Main bacteria that causes UTIs?
|
E. coli
|
|
|
List some members of the family Enterobacteriaceae
|
Salmonella
Shigella Escherichia coli Yersinia Klebsiella Citrobacter Enterobacter Morganella Proteus Providencia Serratia Note: this family consists of gram - facultative anaerobic rods |
