- cellulitis caused by staph aureus-produces pencillinases - chlamydia trachomatis-does not have PBP

Beta Lactams Flashcards by Miriam Garcia

Ex of beta-lactams

PCN
Cephs
Glycopeptides:Vanco
Lipoglycopeptide

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Mnemonic for bacteriocidal

Very Finely Proficient At Cell Murder

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inhibits cell wall synthesis of batercia by inhibiting PBP-causes lysis of bacteria and release of intracellular contents

MOA of PCN

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uses of PCN

pharyngitis-GABHS
Syphillis-DOC
chemoprophylaxis against diphtheria

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PCN not used for

cellulitis caused by staph aureus-produces pencillinases

- chlamydia trachomatis-does not have PBP

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issues with Aqueous PCN G

IV/IM only

issues hyperkalemia

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Procaine PCN G issues

IM only

- if used for neurosyphillis give with probenecid

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-blocks renal tubular secretion of PCN-2x fold increase in AUC

MOA of probenic

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PCN V Potassium

PO-give on empty stomach

compliance issue given Q6-8hrs

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Benzathine PCN G ( Bicillin LA)

IM only. IV causes CV death
duration of action 1-4wks
peak 12-24 hrs

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Benzathine PCN plus PCN G Procaine

IM only

-not for syphillis

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SE of PCN

anaphylaxis
rash, nausea
-Pts with condylommata kata-give IM PCN can develop Jarish-Herxheimer rxn (fever, muscles aches, HA)

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3 Penicillinase resistant PCN drugs

-Dicloxacillin, Nafcillin, Oxacillin

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Aminopenicillans drugs

Amp’ed up PCN

Ampicillin

Amoxicillan

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mnemonic for use of aminopenicillans

HELPSS

H.influenza
E.coli
Listeria
Proteus mirabilis
Salmonella
Shigella
-kills enterococcus

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DOC for listeria caused meningitis

ampicillin

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Extended spectrum PCN issues

coverage i/c pseudomonas and enterobacter
-only given parenterally
combined with beta-lactamese inhibitor (BLI) to combat bacterial resistance

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Beta lactamase inhibitor (BLI) drugs

mnemonic CAST

Clavulanic Acid, Sulbactam, Tazocatam

-act like suicide, protecting the abc

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Extended spectrum PCN drugs

Amoxicillin/CA
Ampicillin/SUB
Ticarcillin/CA
Pipercillin/TZ

all Preg cat B/Lact Cat L1

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2 extended spectrum PCN that cover pseudomonas

Pipercillin/TZ-best

Ticarcillin/CA

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which extended spectrum PCN gives best enterococcus coverage

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ampicillin/SUB

-no pseudomans coverage

1st generation PO Cephs

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-great affinity to PBP’s in s. aureus
PO-only drugs with “ph”
Cephalexin (Keflex)
Cefadroxil (Duricef)

2nd gen Cephs coverage

HEN PECKS

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H.influenza
E.coli
N. meningitis & gono
Proteus spp
enterobacter aerogenes
klebsiella spp
serratia marcescens

2nd gen PO cephs meds

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cefamodole (Mandol)
cefaclor (Ceclor)
cefurozine acetil (ceftin)
cefprozil (ceflin)
loracarbef (lorabed)

2nd gen cephs IV meds

cefoxitin (mefoxin) cefotetan (cefotan) cefuroxime (zinacef, kefurox)

uses of 1st gen Cephs

MSSA, s.pneumoniae, s.pyogenes, h.influenza

issue with cefotetan

cause hypoprothrombinemia and bleeding disulfiram-like rxns give Vit K 1mg 2x/wk

3rd gen oral cephs

``` cefdiner (omnicef) cefditoren (spectracef) cefixime (suprax) cefpodexime ( vantin) ceftibuten (cedax) ```

3rd gen IV cephs

cefotaxime (claforan) ceftazidime (fortaz) ceftriaxone (rocephin)

reduction in gram positive coverage better against PCN-resistant s.pneumoniae gram neg coverage increases against enterobacteriaceae

3rd gen cephs

- improved gram positive and negative coverage - used in complicated/uncomplicated UTIs, febrile neutropenia, skin infection, mod-severe pneumonia, complicated intra-abdominal infxn (give IV flagyl)

4th gen cephs

4th gen ceph

IV only | cefepime (Maxipime)

5th gen ceph

IV only | Ceftaroline (teflaro)

uses of ceftaroline

CA pneumonia completed skin and soft tissue infections MRSA-only ceph approved improved gram positive coverage

- high affinity for PBP3 (necessary in septum formation) - "mono"- only covers for 1 type of bacteria (gram negative) - can be used in PCN allergy patients

MOA of monobactams | aztreonam

aztreonam SE

pain, phlebitis, rash, n/v, eosinphila, increases liver enzymes

- high affinity for PBP1 and 2- resistant to beta-lactamases & ESBL - coverage: MDR pathogens, good for gram positive and negative, anaerobic coverage

MOA of carbapenems

used for complicated and uncomplicated UTIs, febrile neutropenia, soft tissue infections, complicated intra-abdominal infection, bacterial meningitis (>3months)

carbapenems

ADR of imipenem

seizures nephrotoxic-requires renal dose adjust not for PCN allergy patients

monobactam drugs

impimenem/Cilastin meropenem (merrem) Ertapenem (invanz) Doripenem (Doribax)

inhibits cell wall synthesis by inhibiting peptiglycan synthesis binds to amino acids within cell wall preventing the addition of new units to peptidoglycan

MOA of vanco

1st gen IV cephs

Cefazolin (ancef) Cephalothin (Keflin) Cephradine (velosef)

uses of vanco

MRSA | c-diff PO only

vanco trough

MRSA 15-20mg/l 10-20mg/l

Treatment of C-diff

Flagyl 500mg PO TID 10-14 days (mild-mod) Vanco 125 mg POQIDx1014-days severe +/- IV flagyl Fidaxomian (difid) 200mg PO BID x 10 days

uses of Telavancin

adults with complicated skin and skin structure infections (cSSSI) caused by MRSA, strep progenies, strept agalactiae, enterococcus faecalis

issues with Penicillinase resistant PCN drugs

- narrowed spectrum to s.aureus and staph epidermitis-cellulitis and endocarditis * naf is for staph *NO gram neg coverage, not to treat MRSA or enterococci

abc associated with thrombocytopenia

vanco and zyvox

which two ceph drugs are used to treat pseudomonas

ceftazidime (fortaz) | cefepime (maxipime)

ceph used to treat gram positive

cephalexin

Beta Lactams Flashcards

(50 cards)