Beta-Lactams (Penicillins, Cephalosporins, Carbapenems)

Question 1

Cell Wall Antimicrobials

Answer 1

Vanco, Telavancin, Daptomycin

Question 2

Gram (+)

Answer 2

cell wall, thick layer of peptidoglycan

Question 3

Gram (-)

Answer 3

outer lipopolysaccharide membrane, porins, thin peptidoglycan layer

Question 4

Penicillin Binding Proteins (PBPs)

Answer 4

enzymes involved in the synthesis of the cell wall, form the cross-bridge in peptidoglycan layer, PBPs can differ

Question 5

Beta-lactams

Answer 5

bind PBPs and inhibit peptidoglycan layer formation, ONLY EFFECTIVE AGAINST GROWING BCTERIA THAT SYNTHESIZE THE CELL WALL

Question 6

Mechanisms of Bacterial Resistance

Answer 6

alter PBPs, beta-lactamase production, decreased permeability of AB, efflux pumps

Question 7

Beta-lactamase inhibitors

Answer 7

Clavulanic Acid, Sulbactam, Tazobactam, improved coverage against staph, anaerobes

Question 8

Natural Penicillins

Answer 8

G (iv), VK, benzathine LA (im), procaine, work on Strep, neisseria, and syphilis (pallidium)

Question 9

Anti-staph penicillins

Answer 9

Nafcillin, Oxacillin, Dicloxacillin by resisting beta lactamases

Question 10

On Empty Stomach

Answer 10

Penicillin, dicloxcillin, ampicillin, available to CSF with inflammation

Question 11

Biliary Excretion

Answer 11

N.O.D.

Question 12

Beta Lactam Killing

Answer 12

Cidal and exhibit time dependent killing (conc. that AB remains about MIC for percentage of time)

Question 13

Type 1 Hypersensitivity Reaction

Answer 13

IgE, occurs within 1-2 hours anaphylaxis hives bronchospasm, less acute reaction- 7-10 days hives and fever arthritis, from IgG

Question 14

Cephalosporins

Answer 14

similar to penicillin structure and mechanism, more resistant to beta lactamases

Question 15

1st Gen. Cephalosporin

Answer 15

Kefzol (cefazolin)

Keflex (cephalexin)

Question 16

Cephalosporin Kinetics

Answer 16

well absorbed, w/ or w/out food, CSF penetration: cefuroxime, 3rd, 4th, 5th w/ inflam.

Question 17

Cephalosporin Kinetics

Answer 17

minute metabolism, renal excretion. (biliary excretion with ceftriaxone)

Question 18

Disulfiram-like Rxn

Answer 18

Cefotetan

Question 19

Carbapenems

Answer 19

drug of choice for ESBL’s

Question 20

Carbapenem

Answer 20

Gram (+) Good staph and strep, Gram (-) excellent pseudomonas (not ertapenem), Anaerobes Excellent

Question 21

Carbapenem Kinetics

Answer 21

all IV, penetrate CSF w/ inflamm, minimal metabolism, renal excretion

Question 22

Cabapenem ADE

Answer 22

similar to penicillins, seizures especially with imipenem, GI (NVD)