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68 Cards in this Set
- Front
- Back
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What are the beta-lactam antibiotics?
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penicillins, cephalosporins, monobactams, carbapenems
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What illnesses does natural penicillin treat?
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Streptococcus
Enterococcus (usually use ampicllin or amoxicillin instead) Syphilis Gram + anaerobes Sensitive Neisseria |
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Which generation of cephalosporins has the greatest effect on gram negatives?
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3rd and 4th
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What are the mechanisms by which organisms develop resistance to beta-lactams?
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Beta-lactamases
Low affinity of PBP for ABX Decreased entry through porin channels (only gram negatives) Efflux pumps |
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What do the aminopenicillins treat?
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Otitis media
Listeria monocytogenes Enterococcus (if sensitive) UTI caused by sensitive bugs Community acquired respiratory infections |
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Which natural penicillin is usually administered IV?
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penicillin G
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What is the activity of cefepine?
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like ceftazidime with better Strep coverage
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What are the drugs of choice for serious methicillin-sensitive infections?
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Nafcillin (IV)
Oxacillin (IV) Dicloxacillin (PO) |
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Which natural penicillin is given PO?
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penicillin V
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What is the activity of ceftriaxone & cefotaxime?
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Gram neg, except pseudomonas
Strep, especially pneumococcus Neisseria |
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What is Augmentin?
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PCN + Beta lactamase inhibitor (PO)
Amoxicillin + clavulanic acid |
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What is the chemical name for penicillin G?
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benzylpenicillin
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What are the most important anti-staph PCNs?
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Nafcillin (IV)
Oxacillin (IV) Dicloxacillin (PO) |
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What is the activity of Cefoxitin & Cefotetan?
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80% anaerobes
Some staph & strep Gram negatives, but not pseudomonas |
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What is the preferred antibiotic for Enterococcus?
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Ampicillin or amoxicillin
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What do nafcillin, oxacillin, and dicloxacillin treat?
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Staphylococcus
Most streptococcus Simple cellulitis |
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Which antibiotic in the aminopenicillin group is better absorbed orally?
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Amoxicillin
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What is the activity of 2nd generation IM & PO cephalosporins?
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Like 1st generation (Staph, Strep, PECK) plus H. influenzae, Moraxella catarrhalis, Neisseria
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What beta-lactams should you NOT reduce the dosage for in patients with decreased renal function?
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Ceftriaxone
Dicloxacillin Nafcillin Oxacillin |
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What natural penicillins are longer acting and can be given IM?
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penicillin G, benzathine & procaine
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What is Zosyn?
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PCN + Beta lactamase inhibitor (IV)
Piperacillin + tazobactam |
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What is Timentin?
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PCN + Beta-lactamase inhibitor (IV)
Ticarcillin + clavulanic acid |
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What to PCN + beta-lactamase inhibitors work on?
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MSSA
Anaerobes (great) Strep Enterococcus Gram-negatives |
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What do ticarcillin & piperacillin treat?
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Gram negative including pseudomonas
Adequate strep and enterococcal coverage |
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What is the order of PCN + betalactamase inhibitor antibiotics for treatment of Strep or Enterococcus, best to worst?
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Augmentin and Unasyn
Zosyn Timentin |
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What is the order of PCN + betalactamase inhibitor antibiotics for treatment of gram-negatives, best to worst?
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Zosyn = Timentin
Augmentin = Unasyn |
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What is the chemical name for penicillin V?
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phenoxymethyl
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When should you use inhibitor combinations?
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Mixed infections - intraabdominal, OB/GYN, diabetic foot infections
Augmentin - 2nd line for otitis media & respiratory tract infections Zosyn, Timentin - Nosocomial infections like hospital acquired pneumonia |
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What is the treatment for otitis media?
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1st line - Amoxicillin
2nd line - Augmentin |
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Which generation of cephalosporins has the greatest effect on gram positives?
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1st generation
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What is Unasyn?
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PCN + Beta-lactamase inhibitor (IV)
Ampicillin + sulbactam |
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Which generation of cephalosporins has the least effect on gram positives?
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3rd generation
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What are the uses of the 2nd generation IM & PO cephalosporins?
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Respiratory tract, sinusitis, otitis (if failed amox)
Community acquired pneumonia |
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What does the aminopenicillin group treat?
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Everything that natural PCN does plus:
E.coli 60% Proteus mirabilis H.influenza 70% |
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Put the cephalosporin generations in order by greatest-lowest action against gram positives.
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1st generation
2nd = 4th 3rd |
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What is the 4th generation cephalosporin?
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Cefepine
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Which generation of cephalosporins has the least effect on gram negatives?
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1st generation
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What is the activity of Ceftazidime?
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Gram neg including pseudomonas
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Name the first generation cephalosporins.
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Cephalexin (Keflex) - PO
Cefazolin (Ancef, Kefzol) - IV/IM also Cefadroxil (PO) (not as important) |
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What are the uses of first generation cephalosporins?
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Simple skin/soft tissue (ex. cellulitis)
Surgical prophylaxis (usually cefazolin - best for small intestine, up) Sensitive UTIs Strep pharyngitis |
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Put the cephalosporin generations in order by greatest-lowest action against gram negatives.
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3=4, 2, 1
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What are the 3rd generation cephalosporins?
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Cefotaxime (Claforan)
Ceftriaxone (Rocephin) Antipseudomonal: Ceftazidime (Fortaz) |
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What are beta-lactams NOT effective against?
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MRSA
Atypical organisms: Mycoplasma, Legionella, Chlamydophyla & Chlamydia |
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What is the most widely used PCN + beta-lactamase inhibitor?
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Zosyn
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What are the IV/IM 2nd generation cephalosporins?
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Cefuroxime (Zinacef) (IM)
Cefoxitin (IV) Cefotetan (IV) |
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What are the uses of cefoxitin & cefotetan?
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intra-abdominal, pelvic/GYN, prophylaxis for GI & OBGYN surgery
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What are the uses for ceftriaxone & cefotaxime?
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Community acquired pneumonia
Gram neg infections except pseudomonas (like community acquired pyelonephritis) Meningitis |
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How do beta-lactam antibiotics work?
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They bind to PCN binding proteins; inhibit cell wall synthesis
Generally bacteriocidal |
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What is the most important monobactam?
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Aztreonam
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What do the first generation cephalosporins cover?
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Staph, Strep, PECK
PECK = Proteus mirabilis, E. coli, Klebsiella |
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What is the most important oral 3rd generation cephalosporin?
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Cefpodoxime (Vantin)
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What do cephalosporins NOT kill?
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Enterococcus
Listeria monocytogenes MRSA Atypicals |
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What is the activity of oral 3rd generation cephalosporins?
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Much like oral 2nd generations, with poor staph coverage
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What are oral 3rd generation cephalosporins used for?
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Respiratory tract infections
Otitis media Not used often |
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What are the antibiotics in the aminopenicillin group?
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Ampicillin IV/PO
Amoxicillin PO |
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What are the uses of ceftazidime?
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Nosocomial infections, febrile neutropenia, pseudomonas infections
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What is the activity of aztreonam?
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gram-negative aerobes incuding Pseudomonas
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What is the use of aztreonam?
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Can be used in penicillin allergic patients
Serious gram-negative infections Expensive! |
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What is the most important 2nd generation cephalosporin, PO?
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Cefuroxime (Ceftin)
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Name the carbapenems.
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Imipenem (Primaxin)
Meropenem (Merrem) Doripenem (Doribex) Most broad spectrum agents available Ertapenem (Invanz) - limited activity (similar to cefoxitin) |
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What do the carbapenems NOT treat?
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Stenotrophomonas
C. difficile Atypicals Methicillin-resistant |
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What are the carbapenems used to treat?
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Serious nosocomial & mixed infections
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Which carbapenem is currently restricted?
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Ertapenem
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What does Ertapenem treat?
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Staph, strep, gram negatives (except Acinetobacter or Psedomonas), Anaerobes
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What are the beta-lactams that treat Pseudomonas?
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Piperacillin, Piperacillin/tazobactam
Ticarcillin, Ticarcillin/clavulante Ceftazidime Cefepime Aztreonam Meropenem Imipenem Doripenem |
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What drug is the drug of choice for MRSA?
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Vancomycin
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What type of antibiotic is Vancomycin?
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Glycopeptide
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What syndrome is caused by Vancomycin?
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Red Man Syndrome
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