B lactams and monobactam

Question 1

What is the hallmark sign of infection?

Answer 1

fever, above 38C

Question 2

What are noninfectious causes of fever?

Answer 2

malignancy, drug fever, blood transfusions

Question 3

What is the level of leukocytosis?

Answer 3

4000-10,000 cells/mm

Question 4

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

Answer 4

poor prognosis

Question 5

What are bacterial infections associated with?

Answer 5

elevated neutrophils and bands

Question 6

What is associated with lymphocytosis?

Answer 6

viral infections, TB or fungal infection

Question 7

What is empiric therapy?

Answer 7

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

Question 8

What is important in determining the right antimicrobial?

Answer 8

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

Question 9

What is concentration dependent abx?

Answer 9

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

Question 10

What is time dependent abx?

Answer 10

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

Question 11

When using combo abx, what are the effects?

Answer 11

synergy, additive, antagonist

Question 12

What does date support for treatment of pseudomonas?

Answer 12

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

Question 13

Natural PCNs options

Answer 13

penicillin G, penicillin benzathine, penicillin VK

Question 14

Aminopenicillin options

Answer 14

ampicillin, amoxicillin (amoxil)

Question 15

penicillinase resistant PCNs (anti-staphylococcal)

Answer 15

nafcillin, dicloxacillin, oxacillin

Question 16

Carboxypenicillins

Answer 16

ticarcillin

Question 17

Ureidopenicillins

Answer 17

piperacillin

Question 18

B lactamase inhibtors

Answer 18

taxobactam, sulbactam, clavulanate

Question 19

B lactam/B lactamase inhibitor combos

Answer 19

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

Question 20

What is MOA of penicillins

Answer 20

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

Question 21

What account for penicillin antimicrobial activity

Answer 21

the B lactam ring

Question 22

What are the pk of penicillin

Answer 22

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

Question 23

Spectrum of natural penicillins

Answer 23

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

Question 24

What do natural penicillins not cover?

Answer 24

staphlococcus since most staph produce A beta lactamase

Question 25

Clinical uses of natural penicillins?

Answer 25

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

Question 26

Anti-staphlococcal penicillin spectrum of activity

Answer 26

penicillinase resistant, MSSA

Question 27

What do anti-staphlococcal penicillins not cover?

Answer 27

MRSA, not as good for strep, no gram -

Question 28

Clinical use of anti-staphlococcal penicillins

Answer 28

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

Question 29

Spectrum of aminopenicillins

Answer 29

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

Question 30

Clinical use aminopenicillins

Answer 30

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

Question 31

What do aminopenicillins not cover?

Answer 31

alone, they do not cover S. Aureus

Question 32

Aminopenicillins PK

Answer 32

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

Question 33

Beta lactamase inhibitors antimicrobial activity

Answer 33

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

Question 34

What SE is high in beta lactamase inhibtors

Answer 34

abx associated diarrhea

Question 35

Aminopenicillins+ B lactamase inhibitor spectrum

Answer 35

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

Question 36

Clinical use of aminopenicillins + B lactamase inhibitor

Answer 36

abd infxn (anaerobes, gram -, enterococcus)

Question 37

Clinical use of augmentin

Answer 37

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

Question 38

Clinical use of Ampicillin/sulbactam (Unasyn)

Answer 38

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

Question 39

Spectrum of carboxypenicillins

Answer 39

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

Question 40

Clinical use of carboxypenicillins

Answer 40

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

Question 41

Dose of Zosyn

Answer 41

IV 3.375 gm Q 6hrs

Question 42

Spectrum of ureidopenicillins

Answer 42

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

Question 43

What is the DOC against pseudomonas

Answer 43

piperacillin/tazobactam (Zosyn)

Question 44

Clinical use of ureidopenicillins

Answer 44

Multi-drug resistant gram -, many conditions

Question 45

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

Answer 45

Ureidopenicillins, Zosyn

Question 46

ADRs of penicillins

Answer 46

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