Beta-Lactams Part 2 of 2 - Characteristics of Beta-Lactam Subclasses & Adverse Events

Question 1

Aminopenicillins

Answer 1

amoxicillin and ampicillin

Question 2

Antipseudomonal penicillins

Answer 2

ticarcillin and piperacilin

Question 3

Oldest penicillins developed in the 1940s

Answer 3

Penicillin A-Sensitive

Question 4

No activity against bacteria producing penicillinase enzymes

Answer 4

Penicillin A-Sensitive

Question 5

Active against gram-positive pathogens, but limited use due to resistance

Answer 5

Penicillin A-Sensitive

Question 6

Used rarely, e.g., for susceptible group A. streptococci, pneumococci, Treponema pallidum, Actinomyces spp.

Answer 6

Penicillin A-Sensitive

Question 7

Active against penicillinase-producing bacteria, especially Staphylococci

Answer 7

Penicillinase-Resistant Penicillins

Question 8

Drugs of choice for infections due to proven methicillin-susceptible Staphylococcus aureus (MSSA).

Answer 8

Penicillinase-Resistant Penicillins

Question 8

Penicillin A-Sensitive (treatment) example

Answer 8

Treatment of “strep throat” (caused by Streptococcis pyogenes)
Treatment of syphilis
Treatment of pneumonia caused by penicillin-sensitive Streptococcus pneumoniae

Question 9

Penicillinase-Resistant Penicillins drug example

Answer 9

Methicillin, oxacillin, dicloxacillin, nafcillin

Question 9

methicillin susceptibility is tested in vitro using _________

Answer 9

oxacillin

Question 10

(Penicillinase-Resistant Penicillins) used as oral choice

Answer 10

Dicloxacillin

Question 11

IV choice for methicillin-susceptible S. aureus (MSSA)

Answer 11

Nafcillin

Question 12

Penicillinase-Resistant Penicillins is active against

Answer 12

gram-positive cocci, including penicillinase

Question 13

Do not use if suspect methicillin-resistant S. aureus (MRSA)

Answer 13

Penicillinase-Resistant Penicillins is active against

Question 14

Extended Spectrum Penicillins (± BLI combos) drugs

Answer 14

Amoxicillin ± clavulanate
Ampicillin ± sulbactam
Ticarcillin ± clavulanate
Piperacillin ± tazobactam

Question 15

Common BLI used in clinical practice: _________________

Answer 15

clavulanic acid, tazobactam, and sulbactam

Question 16

Addition of ________________ to Extended Spectrum Penicillins (± BLI combos) extends activity to cover beta-lactamase-producing gram-negative bacilli

Answer 16

beta-lactamase inhibitors (e.g., clavulanate, tazobactam, sulbactam)

Question 16

Extended Spectrum Penicillins (± BLI combos)
has broader activity against _______________ rods and anaerobes

Answer 16

gram-negative

Question 17

Used for a wide range of infections

Answer 17

Extended Spectrum Penicillins (± BLI combos)

Question 18

Extended Spectrum Penicillins (± BLI combos)
that have variable anti-pseudomonal activity

Answer 18

Ticarcillin and piperacillin

Question 19

very commonly used in empiric treatment of severe, polymicrobial infections

Answer 19

Beta-lactam + BLI combos

Question 19

Clinical Uses of Penicillins
Limited use for __________ Penicillins due to resistance.
Penicillinase-Resistant Penicillins for proven ________ infections.
Extended Spectrum Penicillins for _____ infections.

Answer 19

• A sensitive;
• MSSA
  -broader

Question 20

Monobactams example

Answer 20

Aztreonam

Question 21

Narrow-spectrum activity against gram-negatives only, including some P. aeruginosa

Answer 21

Aztreonams

Question 22

Only active against gram-negative bacilli

Answer 22

Aztreonams

Question 23

Aztreonams are often needs to be used in combination with _____________ in the context of empiric broad-spectrum _________ coverage for severe of polymicrobial infections

Answer 23

anti-gram positive agents; IV

Question 24

Safe for use in penicillin/cephalosporin-allergic patients

Answer 24

Aztreonams

Question 25

has MRSA activity, and it’s spectrum of activity is otherwise more similar to the 3rd generation

Answer 25

5th generation

Question 26

First Generation Cephalosporins

Answer 26

Cefazolin, cephalexin

Question 27

Narrow spectrum, mostly gram-positive coverage

Answer 27

First Generation Cephalosporins (Cefazolin, cephalexin)

Question 28

Limited gram-negative activity

Answer 28

First Generation Cephalosporins (Cefazolin, cephalexin)

Question 29

Used for mild skin infections and surgical prophylaxis

Answer 29

First Generation Cephalosporins (Cefazolin, cephalexin)

Question 30

Primarily for skin/soft tissue infection caused by suscpetible organisms (e.g., MSSA)

Answer 30

First Generation Cephalosporins (Cefazolin, cephalexin)

Question 31

Second Generation Cephalosporins

Answer 31

Cefaclor Cefuroxime Cefoxitin Cefotetan

Question 32

Slightly more gram-negative activity with variable anaerobic activity

Answer 32

Cefaclor, Cefuroxime, Cefoxitin, Cefotetan (Second Generation Cephalosporins)

Question 33

2nd Gen Cephalosporins are active against some beta-lactamase-producing organisms such as __________ and ___________, but not _______

Answer 33

Klebsiella & H. influenzae; AmpC beta-lactamase)

Question 34

Used for mild community-acquired pneumonia (CAP)/sinusitis (e.g., cefuroxime) and other mild community-acquired infections

Answer 34

Cefaclor, Cefuroxime, Cefoxitin, Cefotetan (Second Generation Cephalosporins)

Question 35

Third Generation Cephalosporins

Answer 35

Ceftriaxone Ceftazidime

Question 36

Expanded gram-negative coverage

Answer 36

Third Generation Cephalosporins (Ceftriaxone, Ceftazidime)

Question 37

Used for serious infections requiring IV therapy

Answer 37

Third Generation Cephalosporins (Ceftriaxone, Ceftazidime)

Question 38

Used for hospitalized community-acquired pneumonia (CAP), meningitis, neutropenic fever

Answer 38

Third Generation Cephalosporins (Ceftriaxone, Ceftazidime)

Question 39

the only 4th generation drug used clinically

Answer 39

Cefepime

Question 40

4th gen cephalosporins have better activity against _________________ and ______________ family

Answer 40

Pseudomonas aeruginosa; Enterobacteriaceae

Question 41

5th gen cephalosporins

Answer 41

Ceftaroline

Question 42

Very active against MRSA

Answer 42

Ceftaroline

Question 43

Ceftaroline is not active against

Answer 43

P. aeruginosa

Question 44

Restored activity against beta-lactamase-producing gram-negative pathogens

Answer 44

Cephalosporin + BLI Combinations

Question 45

a novel BLI that has activity against many beta-lactamases including many AmpC-producing pathogens

Answer 45

Avibactam

Question 46

Carbapenem drugs

Answer 46

-Imipenem-cilastatin -Ertapenem -Meropenem -Doripenem

Question 47

deactivated by renal dehydropeptidases, thus is manufactured with a dehydropeptidase inhibitor called cilastain

Answer 47

Imipenem

Question 48

Carbapenem that is not active against P. aeruginosa or Acinetobacter spp.

Answer 48

Ertapenem

Question 49

Often reserved for severe infections thought to be polymicrobial or involving multidrug-resistant pathogens

Answer 49

Carbapenems

Question 50

Used for complicated intra-abdominal infections, nosocomial pneumonia, etc

Answer 50

Carbapenems

Question 51

last line of defence

Answer 51

carbapenem

Question 52

Beta-Lactams: Adverse Effects

Answer 52

-Hypersensitivity -Gastrointestinal Events -Renal Abnormalities (rare) -Hematological Abnormalities (rare) -Seizures (Rare)

Question 53

Hypersensitivity reaction of Beta lactams on 1-5% patients

Answer 53

rash

Question 54

Hypersensitivity reaction of Beta lactams on <0.05% patients

Answer 54

serious reactions (anaphylaxis)

Question 55

This ADE is less common between penicillins and cephalosporins

Answer 55

Hypersensitivity

Question 56

There is no cross-reaction with__________

Answer 56

aztreonam

Question 57

Beta lactams impose Possible risk of ___________-associated disease

Answer 57

C. difficile