beta Lactams

Question 1

What anti-staphylococcal drug should you never choose on a clinical stem because it is not used?

Answer 1

Methicillin

Question 2

What beta lactamase inhibitor is used with the extended spectrum drug, AMPICILLIN?

Route?

Answer 2

sulbactam

IV

Question 3

What beta lactamase inhibitor is used with the extended spectrum drug, AMOXICILLIN?

route?

Answer 3

Clavulanic acid

Oral

Question 4

Anti-Psudomanal Drugs + their combo with a beta lactamase inhibito

Answer 4

• Ticarcillin + clavulanic acid

- Pipericillin + Tazobactam

Question 5

What enzyme do penicillins block?

Answer 5

transpeptidases

Question 6

complication of penecillins

Answer 6

hypersensitivity type 4/anaphylaxis

Question 7

Drugs of choice for penicillin resistant but methicillin-sensitive organisms like S. aureus (MSSA)?

Answer 7

• Nafcillin
• Oxacillin
• Dicloxacillin

Question 8

If Methicillin is given to a human what is the result

Answer 8

interstitial nephritis

Question 9

Route of administration for Nafcillin?

Answer 9

IV so hospital setting

Question 10

Route of administration for oxacillin and Dicloxacillin

Answer 10

oral so outpatient

Question 11

What do Methicillin adn related anti-staphylococcal penicillins bind to

Answer 11

PBPs (penicillin binding proteins)

Question 12

What gets altered in S. aureus to confer high level resistance to Methicillin . .. MRSA

Answer 12

MecA gene and PBP2

Question 13

What is given to treat MRSA?

Answer 13

vancomycin

Question 14

What is given to someone who has severe allergic reaction to anti-staph drugs?

Answer 14

vancomycin

Question 15

What type of bacteria do you use Vancymycin for?

Answer 15

Gram +

• MRSA
• MRSE
• enterococci

Question 16

What can be used to treat C. Difficile if metronidazole fails

Answer 16

Vancomycin

Question 17

Is vancomycin a substitute to treat MSSA if no known allergies to penicillin?

Answer 17

NO. antistaphylococcal drugs are superior

Question 18

How does vancomycin and teicoplanin inhibit cell wall synthesis?

Answer 18

binding the D-ala-D-ala and sterically hindering TRANSGLYCOSYLATION and transpeptidation

Question 19

Rate of Vancomycin and route?

Answer 19

parenteral and slow (60-90) min

Question 20

Side effects that is exacerbated with other drugs that have same effects?

Answer 20

Nephro and oto toxicities

Question 21

Adverse effects of Vancomycin?

Answer 21

• erythroderma/shock
• nephro/oto toxicity
• rash
• phlebitis at injection site

Question 22

what drugs act by entering porins and binding to PBPs in the PERIPLASM to disrupt cell wall integrity

Answer 22

Extended spectrum penicillins

• Ampicillin
• Amoxicillin

Question 23

What drugs are more soluble and can cover gram negatives

Answer 23

Extended spectrum penicillins

• Ampicillin
• Amoxicillin

Question 24

What are the clinical indications for extended spectrum penicillins

Answer 24

• Respiratory infections (CAP, sinusitis, bronchitis, pharyngitis)
• Bronchitis from COPD
• Otitis media

Question 25

What is often used for pharyngitis in children because of taste

Answer 25

Amoxicillin

Question 26

Amoxicillin Absortption in gut approaches 100% which negates its use for what?

Answer 26

enteritis (shigella, salmonellla)

Question 27

is Ampicillin and Amoxicillin active against MRSA and MRSE?

Answer 27

No

Question 28

What situations are people at risk for pneuomonas infection?

Answer 28

- Burn - CYSTIC FIBROSIS - Injection drug users - Immunosuppressed

Question 29

Ticarcillin and piperacillin cover what?

Answer 29

- psuedomonas | - Gram negative rods (enterobacter spp., E. coli, Proteus mirabilis, Hemophilus influenza)

Question 30

What is more potent between piperacillin and Ticarcillin

Answer 30

Piperacillin

Question 31

Why do you pair and anti-pseudomonal drug with a Beta lactamase inhibitor?

Answer 31

For EMPIRICAL therapy - Severe pneumonia in hospitalized patient with a structural disease (COPD) - Aspiration pneumonia in hospitalized patients - NEUTROPENIC FEVER

Question 32

Stems that lead towards neutropenic fever and use of anti-pseudomonal drugs

Answer 32

- transplants - lots of steroid - cancer patient got chemo

Question 33

Generations 1-3 cephalosporins lack activity against what organisms?

Answer 33

- Listeria monocytogenes - Legionella - Atypical mycoplasma - MRSA - Enterococci

Question 34

1st gen cephalosporins

Answer 34

- Cefazolin - CEPHALEXIN - cephradrine

Question 35

What 1st generation cephalosporin is oral only

Answer 35

cephalexin

Question 36

What can 1st gen cephalosporin can be taken twice daily to treat pharyngitis

Answer 36

Cephalexin

Question 37

What generation of cephalosporins is used for surgical prophylaxis if skin flora are likely pathogens; soft tissue and skin infections due to S. aureus and S. pyogenes

Answer 37

1st generation

Question 38

What generation cephalopsporins are used for intra-abdominal and gynecological sepsis, surgical prophylaxis for intra-abdominal and colorectal surgery

Answer 38

2nd generation

Question 39

2nd gen cephs

Answer 39

- cefoxitin - cefotetan - cefaclor - cefuroxime axetil

Question 40

3rd gen cephs

Answer 40

- ceftriaxone - cefotaxime - cetazidime - cefaperazone

Question 41

What 3RD gen ceph is particularly active against P. aeruginosa

Answer 41

Ceftazidime

Question 42

What is the 4th gen ceph drug called that is pretty much equal to ceftazidime in treating P. aeruginosa?

Answer 42

Cefepime

Question 43

Adverse effects of cephalosporins?

Answer 43

- Hypersensitivity | - Disulfiram-like reaction

Question 44

if a patient has had a recent, severe hypersensitivity reaction to a penecillin, do you give a ceph?

Answer 44

no

Question 45

What two cephs reduce vitamin K-producing bacteria in GI and cause hypoprothrombinemia and bleeding so should be used with caution in patients taking warfarin or with coagulation abnormalities

Answer 45

Cefotetan and cefaperazone

Question 46

What is the one Monobactam?

Answer 46

Aztreonam

Question 47

What do Monobactams treat?

Answer 47

Gram (-) rods

Question 48

When do you used Aztreonam

Answer 48

substitute for extended spectrum penicillin or gen 3,4 cephs if these are contra-indicated because of hypersensitivity

Question 49

What is the carbapenems, Imipenem always administered with and why?

Answer 49

Cilastatin because it causes nephrotoxicity

Question 50

Adverse effects of Carbapenems?

Answer 50

- hypersensitivity and rash - CNS toxicity: seizures and confusion - Nephrotoxicity

Question 51

what enzyme does cilastatin inhibit to prevent the nephrotoxicity caused by imipenem?

Answer 51

dipeptidase