D2 prework

Question 1

What is the class of Penicillin?

Answer 1

B-lactam

Question 2

What is the cellular target of B-Lactam?

Answer 2

Penicillin-binding proteins (PBPS) - transpeptidase.

Question 3

What cell structure is affected by B-Lactam?

Answer 3

Cell wall synthesis

Question 4

What are some of the toxicities of B-Lactam?

Answer 4

Hypersensitivity, anaphylaxis (Except Aztreonam), seizure, CDAD

Question 5

What are all the medications in Penicillin?

Answer 5

Penicillin G/VK,
(Anti-staphylococcal) Oxacillin/nafcillin/dicloxacillin,
ampicillin/amoxicillin and Ampicillin+sulbactam/amoxicillin+clavunate,
Ticarcillin+clavunate, PIP+TAZ

Question 6

What bacterias are covered by PenG?

Answer 6

Staph (Except SA), Strep/Pneumonia, Oral anaerobes, syphilis.

Question 7

What bacterias are covered by Pen VK?

Answer 7

Staph (Except SA), Strep/Pneumonia, oral anaerobes

Question 8

What bacterias are covered by Group 3 B-Lactam?

Answer 8

Staph/MSSA, Step/pneumo

Question 9

What bacterias are covered by Ampicillin/amoxicillin?

Answer 9

Strep/Pneumo, +VRE, PEK, Some PIDDLY, Oral anaerobes.

Question 10

What bacterias are covered by PIP+TAZ?

Answer 10

Staph/MSSA, Strep/Pneumonia, Enterococcus/VRE, PEK, PIDDLY, SPACE, Anaerobes

Question 11

What is the MOA of Penicillins?

Answer 11

Inhibition of cross linked peptidoglycan formation

Question 12

What are the 4 Stages of NAG-NAM polymer formation?

Answer 12

Stage 1: NAG-NAM
Stage 2: Monomer Export
Stage 3: Transglycosylation
Stage 4: Transpeptidase

Question 13

Explain the Stage 1 of NAM polymer.

Answer 13

NAG-NAM synthesis: NAG-NAM monomers are assembled and NAG is converted into pentapeptide

Question 14

Explain the Stage 2 of NAM polymer.

Answer 14

Monomer Export: Bactoprenol (BP) carrier transports and release the NAG-NAM monomer outside the cell

Question 15

Explain the Stage 3 of NAM polymer.

Answer 15

Transglycosylation: Transglycosylase catalyzes the transfer of the NAG-NAM monomer to the end of the growing peptidoglycan strand

Question 16

Explain the Stage 4 of NAM polymer.

Answer 16

Transpeptidation is cross linking step between petidoglycan strands. Enzymes that form peptide bonds between the a side chains of NAM are called Transpeptidase (PBPs).

Question 17

What is the purpose of B-Lactam ring?

Answer 17

The hydrolytic site in the PBP makes it more prone to by hydrolyzed

Question 18

How is Penicillin G pen formulated?

Answer 18

Na+ and K+ (Pfirzerpen)
Benzathine, or procain salts

Question 19

What are the type of bacteria that Penicillin G is effective against?

Answer 19

Non B-lactamase producing cocci, syphilis. most oral anaerobes.

Question 20

What makes Penicillin unstable to stomach acid?

Answer 20

IV (Na+/K+ salt) or IM (Procain/benzathine salt) injection

Question 21

How do you formulate Penicillin G to last longer and decrease the local pain?

Answer 21

IM injections of low H2O salt forms of PEN are used with Procain and benzathine Base

Question 22

(T/F) You can take long acting PEN by IV

Answer 22

False (can be fatal)

Question 23

How do penicillin cause anemia

Answer 23

The medication may react with proteins on the surface of RBC which can be read by immune system and it starts to destroy cells.

Question 24

What are some of the adv rx of Penicillins?

Answer 24

Immediate IgE-mediated anaphylaxis (type 1 hypersensitivity), Later allergic reaction (type IV) and CDAD

Question 25

What are some drug interactions of Penicillin?

Answer 25

No CYP450 interactions, can be placed form serum proteins by other drugs (Warfarin) Probenecid (for gout) could increase the time B-Lactam drugs stay in the system. B-lactamase could interfere with enterohepatic circulation of oral estrogens causing low levels of estrogen.

Question 26

What penicillin do we use instead of PEN G for oral use?

Answer 26

Penicillin VK is more acid-stable

Question 27

What bacteria are covered by Penicillin VK?

Answer 27

it is a narrow spectrum drug that covers Staph/strep and oral anaerobes

Question 28

How are Penicillin group 3 more stable?

Answer 28

Due to the presence of C-6 side chains.

Question 29

What are some of the examples of Penicillin group 3?

Answer 29

Methicillin, Oxacillin, Dicloxacillin, Nafcillin

Question 30

How to increase the Short half-life of Oxacillin?

Answer 30

Blood levels may be prolonged by concurrent administration of probenecid which blocks the renal tubular secretion of penicillin

Question 31

How is Dicloxacilin excreted?

Answer 31

POO POO

Question 32

Which group 3 member of penicillin have erratic absorption?

Answer 32

Dicloxacillin (Dynapen) MOTHA FUKA

Question 33

What are some of the adverse reaction of Dicloxacillin?

Answer 33

Metallic taste and belching may cause poorly tolerated drug FOKA MOTHA

Question 34

How is Nafcillin excreted?

Answer 34

Through feces

Question 35

Why shouldn’t you give Group 4 penicillins by itself?

Answer 35

It is unstable to B-lactamase, (must be given with B-Lactamase inhibitor for MSSA and B. Fragilis

Question 36

What is a risk that is associated with Ampicillin?

Answer 36

higher risk of rash in patients with mononucleosis and diarrhea

Question 37

Which group IV have better Bioavailability than ampicillin?

Answer 37

Amoxicilin (Also causes less diarrhea)

Question 38

Adverse reaction of AMP?

Answer 38

Rashes occur more often with AMP and AMX than with other penicillins

Question 39

What are some of the examples of Group V penicillin?

Answer 39

Ticarcillin, Piperacillin

Question 40

Who should be cautious while taking Ticarcillin?

Answer 40

pts with restricted Na intake. Disodium formulated

Question 41

Is ticarcillin weak to B-lactamase?

Answer 41

Yes which is why it is dispensed with Clavulanic acid (Timentin)

Question 42

What is the administration requirement of Pipercillin?

Answer 42

admin with B-Lactamase inhibitor (tazobactam) Zosyn

Question 43

What is the MOA of B-lactamase inhibitor?

Answer 43

the inhibitors bind irreversibly to the B-lactation allowing B-al tam antibiotics to reach the PBPs unhindered

Question 44

Why are majority of of B-lactamase inhibitors require another antibiotic to go along with it?

Answer 44

Most B-lactamases inhibitors do not bind PBPs and most have no antibiotic effects alone.

Question 45

Which Antibiotic would go with Clavulanic acid (CA)?

Answer 45

Amoxicillin (Augmentin) Ticarcillin (Timentin)

Question 46

Which Antibiotic would go with Sulbactam (SUL)?

Answer 46

Ampicillin (Unasyn)

Question 47

Which Antibiotic would go with Tazobactam (TAZ)

Answer 47

Piperacillin (Zosyn) Ceftolozane (Zerbaxa)

Question 48

Which Antibiotic would go with Avibactam (AVI)?

Answer 48

Ceftazidime (Avycaz)

Question 49

Which Antibiotic would go with Vaborbactam (VAB)?

Answer 49

Meropenem (Vabomere)

Question 50

Both Gram (+) and Gram (-) may produce _________.

Answer 50

Penicillinase

Question 51

only in Gram (-) bacteria can produce __________ and _________.

Answer 51

Cephalosporinases (TEM) and Carbapenemases (KPC)

Question 52

Which antibiotic is the only one that is not effected by Extended Spectrum B-Lactamases (ESBL) in PEK and SPACE?

Answer 52

Carbapenamase

Question 53

Cephalosporinases is the most common ESBL form in Gram (-) and can be inhibited by:

Answer 53

Clavulanic acid Sulbactam Tazobactam

Question 54

ALl ESBLs are inhibited by:

Answer 54

Avibactam Vaborbactam

Question 55

Klebsiella pneumoniae carbapenemase is inhibited by

Answer 55

Avibactam Vaborbactam