Penicillins, Carbapenems, Aztreonam, Cephalosporins

Front 1

What is the route of administration of penicillin G?

Back 1

i.v, not given p.o. b/c it's acid labile

Front 2

95% of strains of this bug are resistant to Pen G?

Back 2

Staph aureus

Front 3

Penicillin G is the DOC for:

Back 3

Beta-hemolytic streps

(group A,B,C,F,G)

Front 4

Suceptile Strep pneumo should always be treated with:

Back 4

Pen G

Front 5

If Strep pneumo is highly resistant to Pen G then the bug is also resistant to:

Back 5

3rd generation cephalosporins

Front 6

At low levels of resistance, what drugs are effective in treating Pen G-resistant Strep pneumo?

Back 6

1. Cefotaxime
2. Ceftriaxone
3. Cefepime

Front 7

What is effective in the treatment of Syphilis and Neisseria meningitides infections?

Back 7

Penicillin G

Front 8

What is the dosing interval for Penicillin V?

Back 8

Every 6 hours

Front 9

____________ is a better p.o. drug to treat Group A Strep than Penicillin V b/c it has a higher ___________.

Back 9

1. Amoxicillin
2. Bioavailability

Front 10

What are two Depot Penicillins?

Back 10

1. Procaine penicillin G
2. Benzathine penicillin G

Front 11

What is the route of administration of Depot Penicillins?

Back 11

i.m. injection for slow release

Front 12

What are the therapeutic uses of Depot Penicillins?

Back 12

1. Prophylaxis for group A beta-hemolytic Strep

2. Used to treat Syphillis, but NOT neurosyphilis

Front 13

What two drugs kill penicillin resistant, beta-lactamase producing Staph aureus?

Back 13

1. Oxacillin
2. Nafcillin

Front 14

What is the route of administration of Oxacillin & Nafcillin?

Back 14

i.v.

Front 15

What are the the therapeutic uses of Oxacillin, Nafcillin, Cloxacillin, Dicloxacillin?

Back 15

Used to treat soft tissue infections caused by MSSA and susceptible strains of streptococci

Front 16

Skin and soft tissue infections are always considered to be caused by _________ or ________ unless proved otherwise by culture.

Back 16

1. Staph
2. Strep

Front 17

What is the route of administration of Cloxacillin and Dicolxacillin?

Back 17

p.o.

Front 18

What is the dosing interval of Oxacillin/Nafcillin or Cloxacillin/Dicloxacillin?

Back 18

Every 4 to 6 hours because of their short half-life

Front 19

What three drugs can be used to treat outpatient SSTIs caused by MRSA?

Back 19

1. Clindamycin
2. Trimethoprim-sulfamethoxazole
3. Doxacycline

Front 20

What is the current inpatient regimen for SSTIs at UH?

Back 20

Doxycycline + Cefazolin

(Cefazolin covers group B Strep)

Front 21

Inpatient MRSA infections are treated with:

Back 21

i.v. Vancomycin

Front 22

Why is oxacillin, nafcillin, dicloxacillin always superior to Vancomycin?

Back 22

They kill quickly

Front 23

The coadministration of a ________________ inhibitor protects certain Penicillins from inactivation.

Back 23

Beta-lactamase

Front 24

What are the three beta-lactamase inhibitors?

Back 24

1. Clavulanate
2. Sulbactam
3. Tazobactam

Front 25

What two drugs are Aminopenicillins?

Back 25

1. Amoxicillin
2. Ampicillin

Front 26

Ampicillin & Amoxicillin are "extended spectrum" Penicillins in what regard?

Back 26

Extended to cover the gram (-) bugs:
1. E. coli
2. Haemophilus influenzae

*better able to penetrate the outer membrane of gram (-) bacteria

Front 27

What must Ampicillin or Amoxicillin be combined with to treat infections against beta-lactamase producing bufs?

Back 27

beta-lactamase inhibitor

Front 28

What is the DOC for infections caused by Listeria spp. & Enterococcus spp.?

Back 28

Ampicillin

Front 29

What other drugs are active against enterococci?

Back 29

Vancomycin, Pen G, Piperacillin, Doxycycline, Tigecycline, Linezolid, Daptomycin

Front 30

Ampicillin or Ampicillin + Sulbactam are given _____ and NOT _____ because they cause ____________.

Back 30

1. i.v.
2. p.o.
3. Diarrhea

Front 31

What is the route of administration of Ampicillin or Ampicillin + Clavulante?

Back 31

p.o.

(Clavulanate--also causes diarrhea)

Front 32

What oral PCNs kill Psuedomonas?

Back 32

NONE

Front 33

Anitpseudomonal Penicillins can kill:

Back 33

1. Pseudomonas Aerguinosa
2. Enterobacteriaceae

Front 34

Anitpseudomonal Penicillins are often given in combination with the aminoglycoside ______________ because strains of Pseudomonas may develop resistance during monothearpy.

Back 34

Gentamicin

Front 35

Antipseudomonal Penicillins are often given via a _________ line.

Back 35

PICC

Front 36

What drugs are Antipseudomonal Penicillins?

Back 36

1. Ticarcillin + Clavulanate
2. Piperacilln
3. Piperacillin + Tazobactam (pip/tazo)

Front 37

What is the DOC for beta-hemolytic strep? (A,B,C,F,G)

Back 37

Penicillin G or V

Front 38

What is the DOC for Penicillin susceptible Strep Pneumo?

Back 38

Amoxicillin

Front 39

What is the DOC for meningococcal meningitis?

Back 39

Penicillin G at higher doses

Front 40

What are the DOC for MSSA infections that cause cellulitis, abscesses, endocarditis, meningitis?

Back 40

I.V. Oxacillin or Nafcillin

P.O. Cloxacillin or Dicloxacillin

Front 41

What is the DOC of otitis media?

Back 41

Amoxicillin

*Amoxicillin + Clavulanate if Amoxcillin doesn't work

Front 42

What is the best PCN versus Pseudomonas?

Back 42

Piperacillin

Front 43

What are the broadest spectrum beta-lactam antibiotic drugs?

Back 43

Carbapenems

Front 44

What is the MOA of Carbapenems?

Back 44

Same as PCN's, but given i.v. only

Front 45

What is the spectrum of coverage for Carbapenems?

Back 45

VERY BROAD

Many gram (-) rods including Pseudomonas spp, anaerobes, and gram (+)

Worst beta-lactams for the treatment of Pseudomonas infections

Front 46

What is the mutation that Pseudomonas undergoes that allows the organism to develop resistance to Carbapenems?

Back 46

Mutation that eliminates the porins which allow Imipenem to enter into Pseudomonas.

Front 47

What are Carbapenems degraded by?

Back 47

metallo-beta-lactamases
(carbapenamases)

Front 48

What carbapenemase is a big problem in the U.S. and is found in a variety of enterobacteriacea?

Back 48

KPC
(Klebsiella pneumoniae carbapenemase)

Front 49

What carbapenem is metabolized by renal dihydropeptidases (DHP)?

Back 49

Imipenem

Front 50

Imipenem must be given in combination with ___________ that inhibits DHP in the Kidney

Back 50

Cilastatin

Front 51

Which Carbapenem is most likely to cause seizures?

Back 51

Imipenem "seizurecillin"

Front 52

Which is better against gram (+) bugs, Imipenem or Meropenem?

Back 52

Meropenem

Front 53

Which Carbapenem is better for gram (-) bugs? Imipenem or Meropenem.

Back 53

Meropenem

Front 54

Which Carbapenem is used for meningitis?

Back 54

Meropenem

Front 55

What Carbapenem is similar to Meropenem but not yet widely used?

Back 55

Doripenem

Front 56

What Carbapenem does NOT cover Pseudomonas, Acinetobacter, or Enterococci?

Back 56

Ertapenem

Front 57

Carbapenems are the drugs of last resort for patients infected with ________________ bugs.

Back 57

Multi-drug resistant

Front 58

Carbapenems are given to patients infected w/ MDR bugs who have failed therapy with _______________ or ______________.

Back 58

1. Pip-tazo
2. Cefepime

Front 59

Polymicrobial, life-threatening infection, intra-abdominal trauma & nosocomial infections caused by Citrobacter & Enterobacter warrant the use of ________________

Back 59

Carbapenems

Front 60

Do you give febrile, neutropenic patients Carbapenems?

Back 60

NO, use Pip-tazo or Cefepime

Front 61

What is the MOA of Aztreonam?

Back 61

Same as the PCN's

Front 62

What is the spectrum of activity of Aztreonam?

Back 62

Very good gram (-) activity

No clinically useful activity against anaerobic bugs & gram (+) bugs including MRSA

Front 63

The antipseudomonal activity of Aztronam is comparable to that of _____________

Back 63

Cefepime

Front 64

Aztreonam has a spectrum of activity that resembles that of the ___________________

Back 64

Aminoglycosides (gentamicin)

Front 65

Aztreonam exhibits cross resistance w/ many of the:

Back 65

3rd generation cephalosporins, esp. Ceftazidime & Cefepime

Front 66

What is the route of administration of Aztreonam?

Back 66

i.v. only

Front 67

Is there allergic cross reactivity between Aztreonam and other beta-lactams?

Back 67

No

Front 68

A severe gram (-) infection in a patient w/ PCN allergy calls for the use of what drug:

Back 68

Aztreonam

Front 69

What is the MOA of Cephalosporins?

Back 69

Inhibit peptidoglycan cross-linking by binding to the active site of the PBP's

Front 70

What is the mechanism of resistance to Cephalosporins?

Back 70

1. Changes in the PBP binding site

2. Bugs are beginning to make Cephalosporinases

Front 71

Are Cephalosporins for the most part resistant to hydrolysis by the beta-lactamases?

Back 71

Yes

Front 72

What four bugs do Cephalosporins have no activity against?

Back 72

1. Enterococcus spp.
2. Listeria spp.
3. PCN-resistant Strep pneumo
4. MRSA

Front 73

What are the first generation Cephalosporins?

Back 73

1. Cefazolin
2. Cephalexin
3. Cephradine

Front 74

What is the DOC for surgical prophylaxis that has good tissue penetraation and good for skin & soft tissue infections?

Back 74

Cefazolin

Front 75

What drug is for tx of SSTIs and is safe to use in pregnant women?

Back 75

Cephalexin

Front 76

What are the second generation Cephalosporins?

Back 76

1. Cefoxitin
2. Cefotetan
3. Cefuroxime
4. Cefalcor

Front 77

What are the two Cephamycins which cover anaerobic bugs?

Back 77

1. Cefoxitin
2. Cefotetan

Front 78

What Cephalosporins are used to treat pedi & FP outpatients?

Back 78

1. Cefuroxime
2. Cefaclor

Front 79

What are the 3rd generation Cephalosporins?

Back 79

1. Cefotaxime (i.v.)
2. Ceftriaxone (i.v.)
3. Ceftazidime (i.v.)
4. Cefpodoxime (p.o.)
5. Cefdinir (p.o.)
6. Cefixime (p.o.)

Front 80

What 3rd gen Cephalosporin can be given i.m.?

Back 80

Ceftriaxone

Front 81

What is the only 3rd generation Cephalosporin that kills Pseudomonas?

Back 81

Ceftazidime

TAZ is destructive!

Front 82

What 3rd generation Cephalosporin has a bitter, nasty taste; kids spit it up!?

Back 82

Cefpodoxime

Front 83

What 3rd generation Cephalosporin turns feces brick red in children?

Back 83

Cefdinir

"Turns your dinner into red poop"

Front 84

What is the 4th generation Cephalosporin?

Back 84

Cefepime

Front 85

Cefepime has good activity against?

Back 85

Pseudomonas

Front 86

4th generation Cephalosporins resemble the spectrum of activity of what other two generations?

Back 86

1st --> moderate gram (+) activity
3rd --> moderate gram (-) activity

Front 87

Which four Cephalosporins have good CNS penetration and are used to treat bacterial meningitis?

Back 87

1. Ceftazidime
2. Ceftriaxone
3. Cefotaxime
4. Cefepime

Front 88

What is the major route of elimination for most Cephalosporins?

Back 88

Renally

Front 89

The dose of Cephalosporins must be ___________ in patients with impaired renal function.

Back 89

Decreased

Front 90

As the generation goes up for Cephalosporins, the allergic cross-reactivity in patients w/ PCN allergy goes ________.

Back 90

Down

Front 91

What generation of Cephalosporins have the most allergic cross-reactivity in patients with PCN allergy?

Back 91

1st (5-10%)

Front 92

Thrombophlebits is uncommon, but can occur when what Cephalosporin is given by i.v. push?

Back 92

Cefoxitin

Front 93

Cephalosporins may prolong the prothrombin time and cause bleeding via the inhibition ________________ which regenerated reduced Vitamin K for the synthesis of clotting factors

Back 93

Vitamin K epoxide reductase

Front 94

What Cephalosporin is most likely to cause an prolongation of prothrombin time?

Back 94

Cefotetan

Front 95

What is the coverage of Cefazolin?

Back 95

1. MSSA
2. Streptococci (except S. Pneumo)
3. E. coli
4. Klebsiella pneumoniae
5. Proteus sp.
6. H. flu.

Front 96

What can be used i.v. to treat pyelonephritis in pregnant women?

Back 96

Cefazolin

Front 97

What are the only Cephalosporins w/ significant activity against anaerobic bugs?

Back 97

1. Cefoxitin
2. Cefotetan (SEF-oh-TEE-tan)

Front 98

What drugs are used to treat PID and intra-abdominal infections?

Back 98

1. Cefoxitin
2. Cefotetan

Front 99

What is the DOC's for prophylaxis for intra-abdominal surgery?

Back 99

1. Cefoxitin
2. Cefotetan

Front 100

What 3rd generation Cephalosporin covers gram (-) bugs actively, including Psuedomonas and bugs that end in -bacter, but has very little activity against gram (+) bugs including Strep pneumo?

Back 100

Ceftazidime

Front 101

Which drug has a longer half-life. Cefotaxime or Ceftriaxone?

Back 101

Ceftriaxone

Front 102

What are the Cephalosporins of choice for the treatment of Step pneumo infections including meningitis?

Back 102

Cefotaxime & Ceftriaxone

Front 103

What drug is given in a single large i.m. dose for the treatment of cervical, urethral, orpharyngeal, or rectal gonorrhea?

Back 103

Ceftriaxone

Front 104

What is the CDC recommended oral alternative for uncomplicated Gonorrhea?

Back 104

Cefixime

Front 105

What Cephalosporins are used to treat meningitis caused by Neisseria spp.?

Back 105

Cefotaxime & Ceftriaxone

Front 106

What is a good treatment for otitis media after two failures w/ Amoxicillin or Amoxicillin + Clavulanate?

Back 106

Cefdinir p.o.

Front 107

What is the spectrum of activity, and therapeutic uses of Cefepime?

Back 107

Spectrum: moderate gram (+) activity and excellent gram (-) activity; resembles the spectrum of 1st gen + 3rd gen

Active against Pseudomonas; good CNS penetration so useful for gram (-) meningitis; Improved gram (+) activity over Ceftazidime

Front 108

If a patient has a Pseudomonas infection you would treat w/ what drug/drugs until the antibiotic susceptibility of the isolate is known?

Back 108

Ceftazidime + Gentamycin

Front 109

What can Cefotaxime & Ceftriaxone i.v. be used for?

Back 109

1. Strep pneumo infections including meningitis, b-hemolytic Strep
2. Community acquired meningitis
3. Inpatient CAP: h flu, strep pneumo, Moraxella
(add Clarithromycin to cover atypical bugs)
4. Uncomplicated gonorrhea; single i.m. dose of Ceftriaxone
5. Severe otitis media

Front 110

What can Cefepime i.v. be used for?

Back 110

1. Febrile neutropenic patients w/ gram (-) infections
2. Inpatient strep pneumo
3. Pseudomonas
4. Critically ill ICU patients
5. Mixed infections
6. Unknown infections