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Flashcards in B lactams and monobactam Deck (46):
1

What is the hallmark sign of infection?

fever, above 38C

2

What are noninfectious causes of fever?

malignancy, drug fever, blood transfusions

3

What is the level of leukocytosis?

4000-10,000 cells/mm

4

What does a low WBC in the setting of confirmed infection indicate?

poor prognosis

5

What are bacterial infections associated with?

elevated neutrophils and bands

6

What is associated with lymphocytosis?

viral infections, TB or fungal infection

7

What is empiric therapy?

directed against suspected organism before identification of the pathogen, outcomes will always be better if initial therapy was later found to provide adequate coverage

8

What is important in determining the right antimicrobial?

the PK, causative organism for site of infxn, host factors, drug factors, resistance

9

What is concentration dependent abx?

efficacy and extent of killing is directly related to the [drug] compared to the MIC, give higher doses less frequently

10

What is time dependent abx?

efficacy and extent of killing is directly to time the [drug] is greater than MIC, give lower doses more frequently

11

When using combo abx, what are the effects?

synergy, additive, antagonist

12

What does date support for treatment of pseudomonas?

double empiric coverage- always use different classes, 1 time dependent 1 concentration dependent

13

Natural PCNs options

penicillin G, penicillin benzathine, penicillin VK

14

Aminopenicillin options

ampicillin, amoxicillin (amoxil)

15

penicillinase resistant PCNs (anti-staphylococcal)

nafcillin, dicloxacillin, oxacillin

16

Carboxypenicillins

ticarcillin

17

Ureidopenicillins

piperacillin

18

B lactamase inhibtors

taxobactam, sulbactam, clavulanate

19

B lactam/B lactamase inhibitor combos

piperacillin/tazobactam (Zosyn), ampicillin/sulbactam (Unasyn), amoxicillin/clavulanate (augmentin)

20

What is MOA of penicillins

inhibition of bacterial cell wall synthesis by binding to and inactivating binding proteins

21

What account for penicillin antimicrobial activity

the B lactam ring

22

What are the pk of penicillin

time dependent, rapid bactericidal, short T1/2, onlly penetrates CNS in inflamed meninges, renally eliminated

23

Spectrum of natural penicillins

viridans strep, Group A strep, S. pneu, neisseria meningitidis, oral anaerobes, trepnema pallidum, clostridium

24

What do natural penicillins not cover?

staphlococcus since most staph produce A beta lactamase

25

Clinical uses of natural penicillins?

s. pneu, syphilius, prophylactic dental procedures, oral anaerobes, labor and delivery, strep pharyngitis

26

Anti-staphlococcal penicillin spectrum of activity

penicillinase resistant, MSSA

27

What do anti-staphlococcal penicillins not cover?

MRSA, not as good for strep, no gram -

28

Clinical use of anti-staphlococcal penicillins

any infection with confirmed MSSA, skin, bacteremia, pneu, osteoarthritis, septic arthritis

29

Spectrum of aminopenicillins

gram +, DOC for enterococci and listeria, adds gram - coverage not seen with naturals, H. influenzae, E. coli, proteus mirabilis, salmonella, shigella

30

Clinical use aminopenicillins

upper RTI, dental prophylaxis, enteroccal UTI, endocarditis, Meningitis

31

What do aminopenicillins not cover?

alone, they do not cover S. Aureus

32

Aminopenicillins PK

decreases effectiveness of birth control pills, amoxicillin better absorbed than ampicillin so higher doses of ampicillin required, ampicillin penetrates inflamed meninges

33

Beta lactamase inhibitors antimicrobial activity

alone do not have antimicrobial activity, gives stability to other penicillins, provides additional activity against anaerobes

34

What SE is high in beta lactamase inhibtors

abx associated diarrhea

35

Aminopenicillins+ B lactamase inhibitor spectrum

improves activity against H influ, e coli, proteus mirabilis, s aureus (MSSA), moraxella catarrhalis, anaerobes

36

Clinical use of aminopenicillins + B lactamase inhibitor

abd infxn (anaerobes, gram -, enterococcus)

37

Clinical use of augmentin

otitis media, sinusitis, chronic bronchitis, skin and soft tissue, lower resp tract infxn, human or animal bite

38

Clinical use of Ampicillin/sulbactam (Unasyn)

otitis media sinusitis, chronic bronchitis, skin and soft tissue, lower RTI, human or animal bite, better for enterococci

39

Spectrum of carboxypenicillins

pseudomonas, drug resistant proteus, morganella, enterobacter, MSSA, anaerobes, enterobacteriasceae

40

Clinical use of carboxypenicillins

multi-drug resistant gram -, many conditions, IV only

41

Dose of Zosyn

IV 3.375 gm Q 6hrs

42

Spectrum of ureidopenicillins

even more broad spectrum than carboxypenicillins, better reliability against klebsiella, serratia, enterobacter, enterobacteriaeceae, enterococcus faecalis, pseudomonas, MSSA

43

What is the DOC against pseudomonas

piperacillin/tazobactam (Zosyn)

44

Clinical use of ureidopenicillins

Multi-drug resistant gram -, many conditions

45

What is the drug of choice for empiric therapy for any severe infection?

Ureidopenicillins, Zosyn

46

ADRs of penicillins

N/V/D, rash, allergic rxns, hematologic effects, seizures