Ravnan Penicillin Lecture

Front 1

Penicillins: cidal or static?

Back 1

cidal

Front 2

Penicillins: synergistic or additive with aminoglycosides?

Back 2

synergistic

Front 3

Penicillins: synergistic or additive with quinolones?

Back 3

additive for some (organism specific)

Front 4

What are the 3 mechanisms of resistance for penicillins?

Back 4

production of beta-lactamases, altered cell wall penetration, PBP affinity alteration

Front 5

Pen G, Pen G potassium or sodium, Pen VK, Pen G Benzathine, Pen G procaine are all examples of what kind of penicillin?

Back 5

natural penicillin

Front 6

True or False: natural penicillins are active against non-beta-lactamase/non-penase producing gram positive aerobic AND anaerobic organisms.

Back 6

true

Front 7

True or False: The gram negative spectrum of natural penicillins is very limited today.

Back 7

true

Front 8

Nearly all strains of Neisseria meningitidis are susceptible to which natural penicillin?

Back 8

Pen G.

Front 9

Which natural penicillin is still used today for the treatment of strep throat and syphilis?

Back 9

Pen G benzathine

Front 10

All penicillins penetrate most tissues except _____, _____, and ______, unless ______ exists.

Back 10

All penicillins penetrate most tissues except the prostate, the eye and the CSF unless inflammation exists.

Front 11

Can I give pencillins to a patient that has meningitis?

Back 11

Yes because there is inflammation.

Front 12

Do natural penicillins require dose adjustment?

Back 12

maybe, but some only do it if clearance is <10ml/min

Front 13

Penicillins: concentration independent or concentration dependent?

Back 13

concentration independent

Front 14

What is a major sign/symptom (1) of an overdose of Penicillin?

Back 14

seizures

Front 15

Natural Penicillins: with food or empty stomach?

Back 15

empty stomach to achieve the best area under the curve

Front 16

What is the max dose of natural penicillins?

Back 16

2.4 million units/day

Front 17

True or False: Natural penicillins are short-half life drugs.

Back 17

True. They must be dose q4-6 hours except for Pen G procaine which is given every 12-24 hours.

Front 18

Name the 5 penicillinase resistant penicillins.

Back 18

methicillin, nafcillin, oxacillin, cloxacillin, dicloxacillin

Front 19

Penicilliniase resistant penicillins: with food or empty stomach?

Back 19

empty stomach: food decreases absorption.

Front 20

Which 2 penicillinase resistant penicillins are associated with hepative function test elevation & thrombophlebitis?

Back 20

nafcillin, oxacillin

Front 21

Penicillinase resistant penicillins: renal or hepatic excretion?

Back 21

hepatic excretion, therefore no adjustment needed for renal dysfunction.

Front 22

Penicillinase resistant penicillins are generally used for what kind of infections?

Back 22

staphylococcal

Front 23

Penicillinase Resistant Penicillins will not be active against 2 specific bacteria listed in Ravnan's handout. What are those two bacteria?

Back 23

Enterococcus, Listeria

Front 24

Doctor wants to use a penicillinase resistant penicillin for a patient with MRSA. Go or no?

Back 24

No. Penicillinase resistant penicillins are only good for MSSA, not MRSA.

Front 25

What are the 2 aminopenicillins?

Back 25

amoxicillin and ampicillin

Front 26

Patient presents with Enterococcal infection. Doc wants to treat with an aminopenicillin. Go or no?

Back 26

Go. Both Ampicillina and Amoxicillin are active against Enterococcus.

Front 27

Amoxicillin: with food or empty stomach?

Back 27

doesn't matter

Front 28

Ampicillin: with food or empty stomach?

Back 28

empty stomach

Front 29

Aminopenicillins: is renal dose adjustment needed?

Back 29

yes

Front 30

What 3 side effects mentioned in Ravnan's lecture is more prominent with ampicillin than amoxicillin?

Back 30

diarrhea, yeast infections, allergic reactions

Front 31

What happens when a patient that is taking allopurinol gets put on ampicillin?

Back 31

rash will develop. stop allopurinol and rash will be gone.

Front 32

Name a carboxypenicillin.

Back 32

Ticarcillin

Front 33

True or False: Ticarcillin retains it's gram positive activity so it is just as good as ampicillin in combating Enterococcus.

Back 33

False. This class of agents loses some of their gram positive activity. Therefore, Ticarcillin will still have activity against Enterococcus but not as good as ampicillins.

Front 34

True or False: Ticarcillin has good activity against Klebsiella since it targets the Enterobacteriaceae family.

Back 34

False. Ticarcillin has no or limited activity against Klebsiella because it cannot penetrate it's capsule.

Front 35

Ticarcillin vs. Piperacillin: which one is better for Pseudomonas?

Back 35

Piperacillin

Front 36

Ticarcillin causes: hyper or hypo-natremia?

Back 36

hypernatremia because the drug is "ticarcillin sodium" and accumulates in renal dysfunction

Front 37

Ticarcillin causes: hyper or hypo-kalemia?

Back 37

Hypokalemia because sodium overload causes wasting of potassium.

Front 38

Ticarcillin: penetrates BBB well or not well?

Back 38

does not penetrate the BBB well.

Front 39

Ticarcillin has what kind of effect on platelets?

Back 39

anti-platelet effect

Front 40

Name the 2 ureidopenicillins.

Back 40

mezlocillin, piperacillin

Front 41

Patient is infected with Enterococcus. Doc wants to give piperacillin. Yay or nay?

Back 41

Yay!

Front 42

True or False: Piperacillin is most active against Pseudomonas.

Back 42

True. *remember they both start with P*

Front 43

Piperacillin: renal dose adjustment needed?

Back 43

yes

Front 44

As mentioned in Ravnan's lecture, long term doses of piperacillin can cause what?

Back 44

neutropenia

Front 45

Piperacillin is available as a combination product. Name this combination product and what other agent is used.

Back 45

Zosyn, Tazobactam

Front 46

True or False: Zosyn is much better than Piperacillin against Pseudomonas.

Back 46

False. Zosyn doesn't work any better than piperacillin.

Front 47

What are the 4 Godzilla Cillins (brand names)?

Back 47

Unasyn, Augmentin, Timentin, Zosyn

Front 48

Name the 2 agents that make up Unasyn.

Back 48

ampicillin, sulbactam

Front 49

Name the 2 agents that make up Augmentin.

Back 49

amoxicillin, clavulanic acid

Front 50

Name the 2 agents that make up Timentin.

Back 50

ticarcillin, clavulanic acid

Front 51

What drug is the only godzilla cillin that is available orally?

Back 51

Augmentin

Front 52

Augmentin: with food or empty stomach?

Back 52

with food to prevent diarrhea, NOT to increase absorption

Front 53

True or False: Unasyn is just as good as Ampicillin in treat intra-abdominal infections.

Back 53

False. Unasyn is better for intra-abdominal infections than ampicillin.