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A-DAD IV - Test 2 > Chapter 5 notes > Flashcards

Chapter 5 notes Flashcards

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1
Q

transglycosylase

A

couples the disaccharide of one peptidoglycan unit to the disaccharide unit of another peptidoglycan unit via a glycosidic bond between the sugars

builder

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2
Q

transpeptidase

A

couples the penultimate D-alanine moiety of one peptido- glycan unit to the terminal glycine residue of another peptidoglycan unit via a peptide bond

builder

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3
Q

carboxypeptidase

A

cleaves the terminal alanine of an peptidoglycan unit that is not cross-linked to another unit

clean up

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4
Q

endopeptidase

A

breaks the peptide bond crosslinks forms by transpeptidase

degradation

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5
Q

peptide bond via transpeptidase

A

terminal amino group of one peptidoglycan is bound to the interior pen-ultimate-D-Ala of another

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6
Q

beta lactam ring is needed for

A

PBP acylation

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7
Q

inhibition of PBP by beta lactams is what kind of bond

A

pseudo-irreversible bond

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8
Q

Mechanism of PBP acylation by Penicillins: step 1

A

recognition of active site (transpeptidase)
Amide is electrophilic because the ring is sterically compressed which eliminates resonance. This allows the amide to be reactive

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9
Q

Mechanism of PBP acylation by Penicillins: step 2

A

pseudo-irreversible inhibition of PBP

Pseudo refers to the fact that this inhibition is weak and can be overcome by: hydrolysis, oxidation, reduction, displacement, or addition

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10
Q

conditions that open the beta lactam ring

A

acid
base
nucleophile (PBP)
enzyme

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11
Q

beta lactam is chemically reactive for two reasons

A
  1. ring strain (4 membered ring)
  2. fusion of 5 membered ring on to the 4 membered ring destroys resonance and co-planarity
    ie carbonyl is electrophilic and nitrogen is basic
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12
Q

MRSA, MRSE, stenotrophomonas maltophilia, chlamydia, mycoplasma, fungi, parasites, viruses, and legionella are resistant to

A

all penicillins

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13
Q

All streps (except pneumonia) and peptostreptococcus susceptible to

A

all penicillins

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14
Q

Rickettsii and chlamydia are intracellular parasites so penicillin cannot

A

gain access to them

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15
Q

Drugs do not diffuse through the lipid bilayer of the outer membrane. They need…

A

porins

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16
Q

capsules and cell walls do not typically represent barriers for…

A

drug exposure

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17
Q

mutant beta lactamases that tend to survive and spread over time have what kind of affinity or catalysis for beta lactam rings

A 
increased affinity (lower Km)
increased catalysis (higher Kcat)
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18
Q

mutant beta lactamases that tend to die over time have what kind of affinity or catalysis for beta lactam rings

A 
decreased affinity (higher Km)
decreased catalysis (lower Kcat)
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19
Q

E coli non-beta lactamase producer susceptible to

A

those Pens that can penetrate the OM and bind to target PBP

AP and ESP

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20
Q

E coli BSBL producers relatively resistant to

A

all pens when used alone

susceptible to AP + BLI , ESP + BLI

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21
Q

E coli BSBL hyperproducer with modified porins resistant to

A

all pens when used alone

Relatively resistant to AP + BLI and ESP + BLI

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22
Q

E coli IRBSBAL producer resistant to

A

all pens when used alone

Resistant to AP + BLI and ESP + BLI

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23
Q

E coli ESBL producers resistant to

A

all pens when used alone

susceptible to AP + BLI and ESP + BLI

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24
Q

P. aeruginosa pinicillinase producers resistant to

A

ALL but ESP

Use ESP + BLI

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25
P. aeruginosa chromosomal BLase resistant to
all pens when used alone INDUCED by ESPS All BLI are ineffective EXCEPT tazobactam
26
Will BLI work with NSBL
All work
27
Will BLI work with `BSBL
All work except IRBSBLI
28
Will BLI work with ESBL
only clavulanate
29
Will BLI work with AmpC
only tazobactam
30
Will BLI work with carbapenemases
NONE
31
streptococci, enterococci, listeria, corynebacteria, clostridium, peptostreptococci, propioni, N. meningitidis, pasturella, eikenella are NOT likely to produce
beta lactamases that can inactivate penicillin
32
E. faecalis is more suspectible than
E. faecium Most effective pens against enterococci: Ampicillin, Pen G. Aminoglycoside is also used. Will probably use NP, ureido, or AP
33
ampicillin and Pen are also effective against
listeria | Aminoglycoside can also be added
34
All BLI inhibit
NSBL
35
ESP are used on
G (-) Bacilli
36
Pens that are effective against MSSA and MSSE
ASP + Pen + BLI No pen is effective against MRSA or MRSE Cannot use amoxicillin alone because it is not an ASP
37
pseudomona exclude
NP, ASP, AP | can only use ESP + BLI
38
alpha amino group makes pen
amphoteric, so they can cross more membranes
39
General spectrum of Pen
ESP > AP > NP > ASP
40
``` MSSA Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective Vanco effective Dapto effective Tela effective FQ effective ```
Susceptibility profile: Beta-lactamase producers (nearly all strains) pens effective: ASP or Pens+BLIs ceph effective: 1st gen, 2nd gen Azetreonam effective: no Carbapenem effective: All, dorip esp Vanco effective: only if pt is allergic to BL Dapto effective: yes Tela effective: yes FQ effective: 2.5-4th gen work, but you won't use
41
``` MRSA Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective Vanco effective Dapto effective Tela effective FQ effective ```
``` Susceptibility profile: Modified PBP (CA- and HA-MRSA) +BLase pens effective: NONE ceph effective: ceftaroline Azetreonam effective: no Carbapenem effective: no Vanco effective: YES Dapto effective: yes Tela effective: yes FQ effective: NO ```
42
``` MSSE Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective Vanco effective Dapto effective Tela effective FQ effective ```
``` Susceptibility profile: >90%Beta-lactmase producers pens effective: ASP or Pens + BLI ceph effective: 1st gen, 2nd Azetreonam effective: no Carbapenem effective: all Vanco effective: only if pt has allergy Dapto effective: work but wont use Tela effective: work but wont use FQ effective: work but not best choice ```
43
``` MRSE Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective Vanco effective Dapto effective Tela effective FQ effective ```
``` Susceptibility profile: Modified PBP (most strains) + BLase pens effective: NONE ceph effective: ceftaroline Azetreonam effective: no Carbapenem effective: no Vanco effective: YES Dapto effective: yes Tela effective: yes FQ effective: no ```
44
``` PSSP/PSIP Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective Vanco effective Dapto effective Tela effective FQ effective ```
``` Susceptibility profile: most susceptible pens effective: ALL pens ceph effective: 1st > 2nd (NON ACIDIC AKI GROUP) Azetreonam effective: no Carbapenem effective: all Vanco effective: only if allergy Dapto effective: work but dont use Tela effective: work but dont use FQ effective: resistant b/c bug doesnt bind PAR ```
45
``` PRSP Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective Vanco effective Dapto effective Tela effective FQ effective ```
``` Susceptibility profile:Modified PBP: reduced affinity for Pens pens effective: high dose if used ceph effective: non-acidic AKI group Azetreonam effective: no Carbapenem effective: all; dorip > imip Vanco effective: yes Dapto effective: yes Tela effective: yes FQ effective: 2.5 - 4th ```
46
``` all other strep Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective Vanco effective Dapto effective Tela effective FQ effective ```
Susceptibility profile: Most susceptible: viridians less than others pens effective: All pens : use NP ceph effective: 1st gen, 2nd gen non acidic AKI must be used Azetreonam effective: no Carbapenem effective: all Vanco effective: especially for viridans Dapto effective: yes Tela effective: yes FQ effective: never use cipro, 2.5- 4 gen work
47
``` E. faecalis Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective Vanco effective Dapto effective Tela effective FQ effective ```
``` Susceptibility profile: Lower Affinity PBPs: no sign BLase pens effective: NP, APs (best)> Others ceph effective: NONE Azetreonam effective: no Carbapenem effective: ALL except Erta Vanco effective: yes Dapto effective: yes, but not indicated Tela effective: yes FQ effective:no ```
48
``` E. faecium Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective Vanco effective Dapto effective Tela effective FQ effective ```
``` Susceptibility profile: very Lower Affinity PBPs: no sign BLase pens effective: AP > NP ceph effective: NONE Azetreonam effective: no Carbapenem effective: no Vanco effective: yes Dapto effective: yes Tela effective: yes FQ effective: no ```
49
``` Listeria Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective Vanco effective Dapto effective Tela effective FQ effective ```
``` Susceptibility profile: Lower Affinity PBPs: no sign BLase pens effective: NP and AP > others ceph effective: NONE Azetreonam effective: no Carbapenem effective: no Vanco effective: yes Dapto effective: yes Tela effective: yes FQ effective: no ```
50
``` Acinetobacter Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective FQ effective ```
Susceptibility profile: Modifed PBP, BSBL producers, etc. pens effective: Pen not reliably effective ceph effective: maybe 3rd gen, but not reliable Azetreonam effective: no Carbapenem effective: all except erta FQ effective: yes but want to recommend combo therapy
51
``` moraxella catarrhalis Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective FQ effective ```
``` Susceptibility profile: Most strains BSBL producers (>70%) pens effective: Pen+BLI: Amox/Clav ceph effective: 2nd gen Azetreonam effective: yes Carbapenem effective: all FQ effective: all ```
52
``` N. gonorrhoeae Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective FQ effective ```
Susceptibility profile: Many strains BSBL producers (>40%) pens effective: AP/ESP + BLI ceph effective: 2nd, 3rd is best; ceftriaxone is AOC Azetreonam effective: yes Carbapenem effective: all FQ effective: resistance
53
``` N. Meningitides Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective FQ effective ```
Susceptibility profile: Most strains suscept; some modified PBP pens effective: NP and AP ceph effective: third gen, esp. ceftriaxone Azetreonam effective: yes Carbapenem effective: all, but not imipen FQ effective: no seizure
54
``` E. Coli Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective FQ effective ```
Susceptibility profile: Many BSBL producers (40%), some ESBL pens effective: AP+ BLI if not ESBL ceph effective: 2nd (least likely), 3rd gen if not ESBL Azetreonam effective: yes Carbapenem effective: yes miro and dori are best FQ effective: all
55
``` P. Mirabilis Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective FQ effective ```
``` Susceptibility profile: Few produce BSBLs pens effective: AP ceph effective: 3rd Azetreonam effective: yes Carbapenem effective: all FQ effective: all ```
56
``` Salmonella Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective FQ effective ```
Susceptibility profile: About 20% BSBL Producers pens effective: Ampicillin is AOC or APs+BLI or ESP + BLI ceph effective: 3rd gen Azetreonam effective: yes Carbapenem effective: all FQ effective: all
57
``` shigella Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective FQ effective ```
``` Susceptibility profile: About 20% BSBL Producers pens effective: APs or APs+BLI ceph effective: 3rd gen Azetreonam effective: yes Carbapenem effective: all FQ effective: all ```
58
``` Klebsiella Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective FQ effective ```
Susceptibility profile: Most BSBL producers (90%); some ESBL pens effective: ESP+BLI if not ESBL ceph effective: 3rd, 4th gen if not ESBL Azetreonam effective: yes if not ESBL, AmpC, Carbapenamase producing Carbapenem effective: all if not making c'ases FQ effective: all, cipro is worst
59
``` citrobacter Susceptibility profile pens effective ceph effective Carbapenem effective FQ effective ```
Susceptibility profile: Most BSBL producers (80%); some AmpC pens effective: ESP+BLI if not ESBL ceph effective: 3rd - 4th gen if not ESBL Carbapenem effective: all FQ effective:work best! cipro worst
60
``` enterobacter cloacaea Susceptibility profile pens effective ceph effective Carbapenem effective FQ effective ```
Susceptibility profile: Most BSBL producers (70%); some AmpC pens effective: ESP+BLI if not ESBL ceph effective: 3rd - 4th gen if not ESBL esp. cefepime, ceftazidime Carbapenem effective: all FQ effective: all
61
``` serratia Susceptibility profile pens effective ceph effective Carbapenem effective FQ effective ```
Susceptibility profile: Most BSBL producers (90%); some AmpC pens effective: ESP+BLI if not ESBL ceph effective: 3rd - 4th gen if not ESBL Carbapenem effective: all FQ effective: cipro > levo > gati/moxi
62
``` p. vulgaris Susceptibility profile pens effective ceph effective FQ effective ```
Susceptibility profile: Many BSBL producers and modified PBP pens effective: Pens not reliable when used alone ceph effective: NONE FQ effective: all
63
``` P. aeruginosa Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective FQ effective ```
Susceptibility profile: Many BSBL producs (>30%); some AmpC pens effective: ESP + tazobactam ceph effective: ceftazidime, cefepime (add tazo if AmpC is producing) Azetreonam effective: yes (inhalation product for CF pts) Carbapenem effective: All carbapenems (EXCEPT erta) (MERO highest affinity for the PBPS) FQ effective: Cipro is the FQ with the BEST activity for this bug…However all FQs could work…just seeing more and more resistance to the others
64
``` Stentrophomonas maltophilia Susceptibility profile pens effective ceph effective FQ effective ```
Susceptibility profile: Carbapenemase producer pens effective: pens not effective ceph effective:NONE FQ effective: resist
65
``` Burkholderia cepacia Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective FQ effective ```
``` Susceptibility profile: multiple mech of resistance pens effective: pens not effective ceph effective: NONE Azetreonam effective: NO Carbapenem effective: meropenem works!! FQ effective: resistant ```
66
``` H. influenza Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective FQ effective ```
Susceptibility profile: Many BSBL producers (>35%) pens effective: AP + BLI or ESP + BLI ceph effective: 2nd, 3rd work, but want to use 2nd (use 3rd gen if it is MENINGITIS) Azetreonam effective: yes Carbapenem effective: all FQ effective: all
67
``` Legionella Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective FQ effective ```
``` Susceptibility profile: low affinity PBP pens effective: Pen not reliable ceph effective: NONE b/c mPBP Azetreonam effective: no Carbapenem effective:no FQ effective: moxi/gati > levo > cipro ```
68
``` Pasturella multocida Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective FQ effective ```
``` Susceptibility profile: Rare BLases pens effective: NPs ceph effective: 5th gen works best, but you won't use ceph for this bug Azetreonam effective: yes Carbapenem effective: all FQ effective: all ```
69
``` Eikenellla corrodens Susceptibility profile pens effective ceph effective Azetreonam effective Carbapenem effective FQ effective ```
``` Susceptibility profile: Rare BLases pens effective: APs ceph effective: 5th gen works best, but you won't use ceph for this bug Azetreonam effective: yes Carbapenem effective: all FQ effective: all ```
70
``` B. fagilis Susceptibility profile pens effective ceph effective Carbapenem effective FQ effective ```
Susceptibility profile: Most BSBL Producers (>70%) pens effective: AP + BLI ceph effective: cephamycin Carbapenem effective: all FQ effective: no, if an absolute must - use moxi
71
``` Clostridium (except dificile) Susceptibility profile pens effective ceph effective Carbapenem effective Vanco effective Dapto effective Tela effective FQ effective ```
``` Susceptibility profile: all pens pens effective: all pens effective ceph effective: 1st gen work best! Carbapenem effective: all Vanco effective: yes Dapto effective: yes Tela effective: yes FQ effective: NO for C. dificile use oral VANCO that is it!! ```
72
``` Peptostreptococcus Susceptibility profile pens effective ceph effective Carbapenem effective Vanco effective Dapto effective Tela effective FQ effective ```
``` Susceptibility profile: typically susceptible pens effective: all pens effective ceph effective: 1st gen Carbapenem effective: all Vanco effective: yes Dapto effective: yes Tela effective: yes FQ effective: NO ```
73
``` treponema pallidum Susceptibility profile pens effective ceph effective Carbapenem effective ```
Susceptibility profile: susceptible pens effective: All pens: pen G ceph effective: 3rd gen Carbapenem effective: work but use pen
74
``` chlamydia Susceptibility profile pens effective ceph effective FQ effective ```
Susceptibility profile: obligate intracellular pathogen pens effective: NO pens effective ceph effective: NONE FQ effective: moxi/gate > levo > cipro
75
``` rickettsia Susceptibility profile pens effective ceph effective FQ effective ```
Susceptibility profile: obligate intracellular pathogen pens effective: NO pens effective ceph effective: NONE FQ effective: moxi/gati > levo > cipro
76
``` Mycoplasma pneumonia Susceptibility profile pens effective ceph effective FQ effective ```
Susceptibility profile: No cell wall: intrinsic resistance pens effective: NO pens effective ceph effective: NONE FQ effective: Moxi/Gati > Levo > Cipro
77
``` mycobacteria tuberculosis Susceptibility profile pens effective ceph effective FQ effective ```
Susceptibility profile: mycolic acid cell wall pens effective: NO pens effective ceph effective: NONE FQ effective: Moxi/Gati > Levo > Cipro
78
need to look at page
25 in depth
79
Protozoa, fungi, viruses, and atypical bacteria examples of bugs: Penicillins used:
``` No cell wall or PDG examples of bugs: mycoplasma chlamydia, ricketsii, mycobacteria (no access b/c intracellular obligate pathogen ie virus, ectoparasite, isospora, giardia,ect) non-bacteria Penicillins used: no pen! ```
80
G (+) bacteria and non-BL producers examples of bugs: Penicillins used:
``` examples of bugs: unlikely BL producers strep enterococci listeria G (+) anaerobes (peptostreptococcus, C. botulium, C. perfringens, C. tetani, and propionibacterium) Penicillins used: NP or AP ASP also cover strep/anaerobes PBP resistance possible with MRSA, MRSE, PRSP ```
81
G (+) bacteria/ BL producers examples of bugs: Penicillins used:`
examples of bugs: staphylococci (MSSA) Penicillins used: ASP or Pen + BLI Cannot use on MRSA
82
G (-) bacteria/ non-enterobacteriaceae and non-pseudomonads/non-BL producers examples of bugs: Penicillins used:
examples of bugs:N. meningitides, pasturella, eikenella | Penicillins used: NP or AP (unless BL producer)
83
G (-) bacteria/most non-enterobacteriaceae and non-pseudomonads/BL producers examples of bugs: Penicillins used:
NSBL and BSBL producers examples of bugs: H. Influenza, M. Catarrhalis, N. gonorrhoeae, P. mirabilis, and some community E. Coli Penicillins used: AP + BLI
84
G (-) bacteria/ enterobacteriaceae/ pseudomonads/ BL producers examples of bugs: Penicillins used:
``` Some ESBL, AmpC, Cabapenemases examples of bugs: Enerobacteriaceae, pseudomonads Penicillins used: ESBL: ESP + BLI AmpC: Piperacillin + tazobactam Carbapenemases: NONE ```
85
Water soluble penicillin salt
Sodium and potassium necessary for water soluble injection, orally dissolve faster monovalent cations absorb faster, eliminate faster, have shorter plasma levels, and higher drug levels
86
Water insoluble penicillin salt
procaine and benzathine necessary for IM injection or slow release product organic base salts are absorbed slower, have lower plasma levels, and a more prolonged action (5x that of monovalent cation salt)
87
Pen G drug products available: Important facts:
Free acid - oral water soluble salt- oral, IM, IV Free acid and monovalent cation salts oral bioavailability is limited by acid-catalyzed beta-lactam ring hydrolysis in the gut. water insoluble salt - Oral, IM Lower solubility and greater stability in gut. Prolonged absorption from administration sites.
88
Pen V drug products available: Important facts:
water soluble salt: oral | Oral bioavailability higher due to increased acid stability and beta-lactam stability (-I effect on of oxygen)
89
Nafcillin drug products available: Important facts:
``` water soluble salt: oral, IM, IV Greater acid instability than PenG (+R effect of naphthyl ring and ethoxy) and lower bioavailability. Most used by injection, but even these solutions are somewhat unstable. more reactive b/c of EDG. prefer IV route hospital MSSA treatment. ```
90
Isoxazole drug products available: Important facts:
``` Oxacillin sodium salt: Oral, IM, IV Clox and Diclox sodium salt: oral Greater acid stability than PenG and higher oral bioavaility due to -R/-I effects of isoxazole ring on side chain. But lower solubility in gut leading to variable bioavailability. Only oxacillin is available for parental administration. have slower rate of decomposition. have higher log P value. have solubility limited absorption. ```
91
ampicillin drug products available: Important facts:
Free amino acid: oral water soluble salt: IM, IV Greater acid stability than PenG due to –I effect of side chain amino group. Bioavailability is limited by low solubility in gut due to amphoteric/zwitterion nature. Thus a large fraction of this drug remains unabsorbed and in active form in the gut upon oral admin (not systemic infection). Not soluble in intestines because of neutral pH
92
amoxicillin drug products available: Important facts:
Free amino acid: oral Greater acid stability than PenG due to –I effect of side chain amino group. Better GI solubility than ampicillin due to OH group on aromatic ring which lowers the pI and is polar> Oral drug!!!
93
ticarcillin drug products available: Important facts:
Di sodium salt: IM, IV Lower acid stability than PenG but for a different reason!! Contains a beta-keto acid which decarboxylkates in GI acid. Injection only! (IV solutions also unstable)
94
piperacillin drug products available: Important facts:
sodium salt: IM, IV Lower acid stability than PenG but for a different reason!! Contains a ureide group which is acid unstable and lower solubility. Injection only! (IV solutions also unstable)
95
Rate of hydrolysis of Pens
Nafcillin > Pen G > others
96
CYP is not an issue...
because of hydrolysis Pens are renally cleared by tubular secretion
97
Rank PPB for Pens
isoxazole > aroylpen > NP > CarboxyPen > aminopen > ureidoPen
98
You dont reduce dose even in patient with decreasing renal fxn
You don't want to go below MIC90. | You would culture resistance if you decrease the dose
99
There is no change in dosing for renally impaired pt when giving them these 4 Pens
cloxacillin dicloxacillin oxacillin nafcillin
100
you give supplemental dose after hemodialysis or peritoneal dialysis when giving these 6 Pens
``` carbenicillin indanyl ticarcillin ticarcillin/clavulanate mezlocillin piperacillin piperacillin/tazobactam ```
101
Which pens require dose reduction in hepatic impairement?
Nafcillin and Isoxazole
102
HSR ADR that occur with any Pen
``` anaphylaxis urticaria angiodema hemolytic anemia interstitial nephritis (methicillin in particular) ```
103
Probably immune mediate ADR that occurs with Ampicillin or Pen G
stevens-johnson syndrome or toxic epidermal necrolysis
104
Gastrointestinal ADR that occur with ampicillin
GI upset | C. difficile associated colitis
105
Hematologic ADR that occur with any pen
neutropenia hemolytic anemia thrombocytopenia inhibition of platelet ADP (ticarcillin in particular)
106
hepatotoxic ADR that occurs with pen
Pens that are used in conjunction with clavulanate
107
interstitial nephritis ADR that occurs with pen
methicillin b/c it is most reactive and therefore toxic
108
electrolyte imbalance ADR that occurs with pen
ticarcillin = di-acid pulls more sodium carbenicillin Pens are non-resorbable anions so they get in to the nephron --> not reabsorbed --> the anions associate with Na+ --> Na+ gets exchanged with K+ toward the end of nephron --> you get hypokalemia
109
CNS ADR that occur with pen
Any Pen (esp Pen G, Pen V) Can cause seizure especially in high dose pt is more at risk if they have a seizure disorder If pt has renal impairment, pen accumulate and then you have CNS effects as well as other issues
110
Anaphylaxis s/s
``` hypotension, tachycardia, arrhythmia bronchospasm diarrhea angioedema urticaria metallic taste ```
111
DDI allopurinol
inc frequency of ampicillin rash
112
DDI aminoglycoside
avoid pen and AG in same IV mixture | form insoluble precipitates, salt formation rxn = toxic
113
DDI oral contraceptives
ampicillin and Pen V may reduce efficacy due to decreased hepatic recycling
114
DDI cyclosporine
inc toxicity with ticarcillin and naf
115
DDI lithium
inc hypernatremia (non-resorbable anion phenomenon)
116
DDI methotrexate
inc toxicity
117
DDI probenecid
competitively inhibit TS of Pens in renal tissue, extending half life and inhibits he efflux of pens from CNS
118
Pen + aminoglycoside when killing these three bugs
enterococci, listeria, pseudomonas

A-DAD IV - Test 2 (11 decks)

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