Abx- part 1

Question 1

_____ layer - provides structural integrity of the cell wall

Answer 1

Peptidoglycan (PG)

Question 2

______ - found in the periplasmic space function to crosslink the peptidoglycan chains

Answer 2

Transpeptidase Enzymes

Question 3

_____ binding layers are kept together by transpeptidase enzymes

Answer 3

penicillin

Question 4

_______ MOA involves breaking down cell wall synthesis

Answer 4

Beta lactams

Question 5

Beta lactams include what 4 types of abxs?

Answer 5

Question 6

What generation of cephalosporin?

Answer 6

1st generation

Question 7

What generation of cephalosporin?

Answer 7

2nd generation

Question 8

What generation of cephalosporin?

Answer 8

Question 9

Cefepime is what generation of ceph?

Answer 9

4th generation

Question 10

Ceftaroline is what generation of cephalosporin?

Answer 10

5th generation

Question 11

What kind of abx class have a ring in their structure?

Answer 11

Beta-Lactam

Question 12

This inhibits bacterial peptidoglycan synthesis preventing bacterial replication is known as _____

Answer 12

bacteriostatic

Question 13

Binding to PBP activates bacterial autolytic enzymes that cause cell wall lysis is known as ______

Answer 13

bactericidal

Question 14

How are gram + bacteria becoming more resistant?

Answer 14

reduced binding affinity to PCN binding proteins

production of B-lactamases

Question 15

How are beta lactamase increasing their methods of resistance?

Answer 15

Breaks PCN ring

Question 16

What are the 2 most commonly prescribed abxs?

Answer 16

Azithromycin and amoxicillin are MC prescribed

Question 17

PCN are indicated for gram (+/-) bacteria

Answer 17

mostly Gram +

Question 18

PCN are first line treatment for ______ and ______

Answer 18

Strep throat and Syphilis

Question 19

**What is the bacteria that causes strep throat?

Answer 19

Group A Beta-Hemolytic Streptococcus

Question 20

** What is the bacteria that causes Syphilis?

Answer 20

Treponema pallidum

Question 21

Which PCNs are considered Antistaphylococcal PCN’s?

Answer 21

dicloxacillin, nafcillin, oxacillin

Question 22

**When are Antistaphylococcal PCN’s indicated? Are they effective against MRSA?

Answer 22

Only indicated in the treatment of skin and soft tissue staphylococcal infections

Not effective against MRSA infections

Question 23

Which Antistaphylococcal PCN’s are PO only? IV only?

Answer 23

dicloxacillin PO only

nafcillin IV only
oxacillin IV only

Question 24

What is the coverage of an aminopenicillin?

Answer 24

same as natural PCN plus better gram - coverage

Question 25

**What 3 bacteria are the likely source of otitis media?

Answer 25

Haemophilus influenzae Streptococcus pneumoniae Moraxella catarrhalis

Question 26

What is the first line treatment for otitis media?

Answer 26

amoxicillin

Question 27

What are the advantages of using an aminopenicillin vs a natural PCN?

Answer 27

Higher oral absorption and longer half life = less frequent dosing Better penetration through Gram - cell wall porins (superior gram - coverage)

Question 28

PCN/Beta-Lactamase Inhibitors include ____ and _____

Answer 28

Augmentin and Unasyn

Question 29

What is the first line treatment for sinusitis?

Answer 29

Augmentin

Question 30

What is the first line treatment for Pneumonia?

Answer 30

Augmentin

Question 31

What is the first line treatment for COPD exacerbations?

Answer 31

Augmentin

Question 32

**Augmentin is first line treatment for what 3 bacterial infections? (give the bacteria names)

Answer 32

S. pneumo H. flu S. aureus

Question 33

**______ has good pseudomonas coverage. What forms does it come in?

Answer 33

piperacillin/tazobactam IV ONLY!

Question 34

What abx has the same as PCN plus increased Gram - coverage including Pseudomonas and Proteus (Broad Spectrum)?

Answer 34

piperacillin

Question 35

What would you give a pt who has a severe polymicrobial infection?

Answer 35

piperacillin/tazobactam

Question 36

_____ have the same MOA as PCN but tend to be more resistant to B-lactamase

Answer 36

Cephalosporins

Question 37

What phrase is true when talking about the generations of cephalosporins and their coverage?

Answer 37

The greater the generation, the better the Gram - coverage. The lower the generation, the better the Gram + coverage

Question 38

What are the 3 first generation cephalosporins?

Answer 38

cephalexin (Keflex) cefazolin (Ancef) cefadroxil (Duricef, Ultracef)

Question 39

What abx can you give to a pt with a E. coli infection who is preg?

Answer 39

cephalexin (Keflex)

Question 40

What are the 2nd generation cephalosporins?

Answer 40

cefuroxime (Ceftin, Zinacef) cefoxitin (Mefoxin) cefotetan (Cefotan) cefaclor (Ceclor) cefprozil (Cefzil)

Question 41

**____ have better Gram - coverage, can be used as surgical prophylaxis for "dirty" procedures

Answer 41

cefoxitin/cefotetan

Question 42

**_____ are often used as 2nd line for pharyngitis, sinusitis, OM, upper & lower respiratory tract infections

Answer 42

cefuroxime/cefaclor/cefprozi

Question 43

What are the 2 most common 3rd generation cephalosporins?

Answer 43

ceftriaxone (Rocephin) cefdinir (Omnicef)

Question 44

**_____ First line treatment for Neisseria gonorrhoeae

Answer 44

ceftriaxone (Rocephin)

Question 45

**_____ has good pneumococcal coverage, Often used in combination for pneumonia

Answer 45

ceftriaxone (Rocephin)

Question 46

____ and ____ are second line treatment for upper and lower respiratory tract infections

Answer 46

cefdinir(Omnicef) cefixime (Suprax)

Question 47

____ has the broadest spectrum Gram +, Gram -, Pseudomonas for cephalosporins. Only used in very sick people. IV/IM route only

Answer 47

cefepime (Maxipime)

Question 48

**_____ is the only Beta-Lactam with MRSA coverage. IV only

Answer 48

ceftaroline (Teflaro)

Question 49

Draw the cephalosporin coverage diagram

Answer 49

Question 50

____ have good gram - coverage, including Pseudomonas. Virtually no coverage against Gram + or anaerobes

Answer 50

Monobactams: aztreonam (Azactam)

Question 51

**____ are inhaled and are used in severe cystic fibrosis respiratory infections

Answer 51

Monobactams: aztreonam (Azactam)

Question 52

Why are monobactams not often used?

Answer 52

3rd & 4th generation cephalosporins with same/better coverage and less side effects

Question 53

In the combo abx imipenem/Cilastatin, why is cilastatin added?

Answer 53

cilastatin added to imipenem to prevent inactivation in renal tubule of kidney

Question 54

____ are very broad spectrum, Good Gram -, Gram +, and anaerobes, Susceptible to beta lactamase, Reserved for severe infections , IV/IM Only. NOT indicated for MRSA

Answer 54

Carbapenems (meropenem, ertapenem, doripenem)

Question 55

What are some common SE of beta-lactams? Which groups are the most common?

Answer 55

GI (N/V/D): more likely with Amoxicillin/Clavulanate and higher generation Cephalosporins Vaginal candidiasis

Question 56

If a patient has a hypersensitivity reaction to one beta lactam, will they react to all beta lactams?

Answer 56

Depends on how severe was the reaction, if it was just a rash. probably okay

Question 57

What is considered a true reaction to PCN?

Answer 57

-Occurs immediately or within an hour -Hives -Angioedema -Wheezing or SOB -Anaphylaxis

Question 58

What are the 3 PKs associated factors with beta-lactams?

Answer 58

Minimal liver metabolism Minimal interaction with CYP450 Renal Excretion: may need to dose adjust with renal impairments

Question 59

What labs do you need to monitor with Beta-lactams?

Answer 59

-CBC with prolonged treatment -Monitor kidney function with prolonged treatment -Pregnancy Category B -Drug Interactions: decrease effectiveness of oral contraceptives

Question 60

____ and ____ are considered to be more costly

Answer 60

PCN/Beta-lactamase inhibitors Higher generation cephalosporins