E2 Erdman Penicillins Flashcards
this is gonna have ppt and word doc notes in it (105 cards)
1
Q
3 mechs of resistance for b lactams
A
B lactamases
PBP alteration
Decreased penetration
2
Q
beta lactams:
cidal or static
A
cidal
3
Q
most b lactams have _____ half life of ______
A
short, 2 hours
4
Q
which 4 beta lactams ARE NOT eliminated in kidneys
A
Nafcillin
oxacillin
ceftriaxone
cefoperazone
5
Q
T or F:
all beta lactams have cross-allergenicity
A
false, aztreonam does not
6
Q
when are PBPs expressed?
A
only during cell division
7
Q
what bacteria are penicillins not bactericidal against?
A
enterococcus
8
Q
where are PBPs located
A
cell membrane
9
Q
PBP location:
GP
GN
A
GP cell surface
GN inner membrane
10
Q
there is only 1 GP bacteria that produces b lactamases, what is it?
A
penicillin-resistant staphylococcus aureus ****
11
Q
T or F:
b lactamase production is more efficient in GP organisms
A
false, GN
12
Q
there are 6 GN aerobic bacteria that produces b lactamases, what are they? (that she wants us to know)
A
Haemophilus
Moraxella
Neisseria
E coli
Klebsiella
Enterobacter
13
Q
only 1 GN anaerobe produces b lactamases, what is it?
A
Bacteroides fragilis
14
Q
Alteration in structure of PBP in penicillins leads to a decrease in what
A
binding affinity
15
Q
if you see alteration in PBP for penicillins, what 2 things should you think about?
A
MRSA + PRSP
16
Q
Chromosomally mediated PBP alteration:
A. MRSA
B. PRSP
A
B
17
Q
alteration of outer membrane porin proteins leads to decreased what
A
penetration
18
Q
alteration in porin proteins for b lactams is most common towards what class of b lactams
A
carbapenems
19
Q
T or F:
natural and semi-synthetic pens display the same antibacterial activity
A
false, different
20
Q
examples of natural penicillins
A
aqueous pen g
benzathine pen g
procaine pen g
phenoxymethyl pen VK
21
Q
main bacteria that natural pens are drug of choice for
A
treponema pallidum
SYPHILIS **
22
Q
natural penicillins have excellent activity against?
A
non b-lactamase producing GP cocci and bacilli
23
Q
6 GP organisms natural penicillins have activity against (2 at the bottom are mid)
A
- group strep
- viridans
- some strep pneumoniae
- most enterococcus spp*
- bacillus spp
- corynebacterium spp
24
Q
2 GN cocci natural penicillins have activity against
A
neisseria spp
pasteurella multocida
25
2 anaerobes natural pens have activity against
- above diaphragm (?)
- Clostridium
26
what are the 5 Penicillinase-Resistant Penicillins (AKA antistaphylococcal pens)
Naf
Ox
Meth
Diclox
Clox
27
what were the penicillin resistant penicillins developed in response to?
staph aureus
28
penicillinase-resistant penicillins are semi-synthetic derivatives of natural penicillins that contain a/an _____ side chain
acyl
29
if MSSA, use what beta lactam?
NAFCILLIN*
30
why do we not use methicillin anymore
interstitial nephritis
31
what are the 2 aminopenicillins and what are their dosage forms
Ampicillin: parenteral +oral
Amox: oral
32
aminopens developed to enhance activity against?
some GN aerobes
33
main bacterial spp aminopenicillins are good against
enterococcus spp ***
34
acronym to remember GN bacteria covered by aminopenicillins
S: salmonella, shigella
H: H. influenzae
E: some E. Coli
P: Proteus mirabilis
35
two GP bacteria we care about that aminopenicillins cover
enterococcus
LIsteria monocytogenes
36
T or F:
Amoxicillin is the drug of choice over ampicillin for enterococcus bacterial infections
false, ampicillin by far
37
2 carboxypenicillins and their dosage forms
Ticarcillin: parenteral
Carbenicillin: parenteral, oral
38
T or F:
carboxypenicillins cover more GN bacteria than aminopenicilllins
true
39
acronym for GN coverage of carboxypenicillins
SHEPMEPP
M: Morganella
E: Enterobacter spp *
P: Pseudomonas aeruginosa *
P: proteus mirabilis
40
target organism for ticarcillin
pseudomonas aeruginosa *
41
what are the 3 ureidopenicillins (but say the main one first)
Piperacillin
Azlocillin
Mezlocillin
42
Which type of penicillin is not used alone, and what is it used with?
- ureidopenicillins (piperacillin)
- used with b-lactmase inhibitors
43
acronym for ureidopenicillins (piper/azlo)
SHEPMEPP + KS
K: some Klebsiella
S: Serratia marcescens
44
which class of penicillins is the most broad w/out use of b-lactamase inhibtors
ureido
(piper/azlo)
45
Unasyn
ampicillin-sulbactam
46
Zosyn
Piperacillin-tazobactam
47
augmentin
amox/clav (oral only)
48
Timentin
Ticarcilin/clav
dont see this often
49
T or F:
b-lactamase inhibitor combos have activity against MRSA, excluding MSSA
false, they cover MSSA, not MRSA
50
target bacterial organism for the combo drugs
bacteroides spp
51
Which penicillin is considered a potential drug of choice for infections due to MSSA?
A. Penicillin G
B. Ticarcillin
C. Ampicillin
D. Nafcillin
E. Piperacillin
D
52
Which penicillin is considered a potential drug of choice for infections due to Pseudomonas aeruginosa?
A. Penicillin G
B. Ampicillin/sulbactam
C. Amoxicillin
D. Nafcillin
E. Piperacillin
E
53
clinically useful synergy:
Viridans strep
penicillin, or ampicillin + gentamicin
54
clinically useful synergy:
Enterococcus spp
ampicillin + gentamicin
OR
streptomycin
55
clinically useful synergy:
Staphylococcus spp
naf+gent
56
clinically useful synergy:
GN bacteria
ticarcillin or piper+gent, tobra, amikacin
57
many penicillins aree degraded by?
gastric acid
58
T or F:
oral penicillins are preferred over IV penicillins for mod/sev infection
false, only used in mild/mod
59
T or F:
amp is orally absorbed more than amox
false, other way around
60
oral carbenicillin with low F of 30-40% is used for what
UTIS*
61
which antistaphylococcal penicillin is absorbed best
diclox
62
what is the only way adequate concentrations of penicillins reach the CSF
presence of inflamed meninges with HIGH DOSE parenteral admin
63
which 2 (from this particular slide i think) penicillins are eliminated primarily by the liver
nafcillin and oxacillin
64
T or F:
ALL penicillins have short half lives
yes
65
T or F:
beta lactamase inhibitors reach the CSF
false
66
parenterally administered penicillins contain ______ which should be used with caution in pts with ____ or _____
- sodium
- CHF
- renal insufficiency
67
Sodium content:
Nafcillin
A. 2.0 mEq per 1 mil units
B. 2.9 mEq per gram
C. 5.2 mEq per gram
D. 1.85 mEq per gram
B
68
Sodium content:
Piperacillin
A. 2.0 mEq per 1 mil units
B. 2.9 mEq per gram
C. 5.2 mEq per gram
D. 1.85 mEq per gram
D
69
Sodium content:
sodium pen G
A. 2.0 mEq per 1 mil units
B. 2.9 mEq per gram
C. 5.2 mEq per gram
D. 1.85 mEq per gram
A
70
Sodium content:
Ticarcillin
A. 2.0 mEq per 1 mil units
B. 2.9 mEq per gram
C. 5.2 mEq per gram
D. 1.85 mEq per gram
C
71
clinical uses for penicillins:
natural penicillins
- potential drug of choice for Pen-Susceptible S pneumoniae, streptococci, Neisseria meningitis, SYPHILIS****, Clostridium perfringens or tetani, Actinomyces, Bacillus anthracis
72
clinical uses for penicillins:
Penicillinase-Resistant Pens
infections due to MSSA
73
primary oral drug for mild/mod MSSA infections
diclox
74
primary drug for mod/sev MSSA infections
NAFCILLIN
75
clinical uses for penicillins:
Aminopenicillins
Enterococcal infections
Listeria Monocytogenes infections
76
clinical uses for penicillins:
Carboxy and Ureido pens (3)
- serious infections due to GN aerobic bacteria
- empiric therapy for hospital-acquired infections
- Infections due to PSEUDOMONAS AERUGINOSA
77
clinical uses for penicillins:
B-lactamase inhibitor combos
augmentin: (2 highlighted)
sinusitis, otitis media
78
clinical uses for penicillins:
B-lactamase inhibitor combos
Unasyn, Zosyn, Timentin (1 highlighted)
polymicrobial infections
79
clinical uses for penicillins:
B-lactamase inhibitor combos
zosyn only (2)
- empiric therapy for febrile neutropenia
- hospital-acquired infections
80
T or F:
cross-allergenicity exists among ALL penicillins and even some other b-lactams
true
81
T or F:
hypersens rxns have a higher incidence with oral pens
false, parenteral
82
1 highlighted neurologic AE for penicillins
seizures
(this is a DIRECT toxic effect)
83
2 highlighted hematologic AE for penicillins
neutropenia
thrombocytopenia
84
T or F:
hematologic AEs from penicillins are reversible
tru
85
random other AE for penicillins
interstitial nephritis
ABRUPT increase in serum creatinine which can lead to renal failure
86
concern for interstitial nephritis is highest with which 2 pens
METH and NAF
87
why do natural penicillins have very little activity against staphylococcus spp
penicillinase production
88
T or F:
(ignore GP coverage for this)
natural penicillins primarily have activity against some GN bacilli
false, if its covering GN it will be GN COCCI
89
drug of choice for viridans, group strep, neisseria, corynebacterium, anthrax, syphilis
pen G
90
T or F:
penicillinase-resistant penicillins have no activity against GN
true
91
what type of penicillin good for enterococcus spp
aminopenicillins
92
drug of choice for listeria and entero
amp
93
what type of pen for coverage against Pseudomonas aeruginosa
carboxy (just ticar basically)
94
T or F:
carboxypens have activity against Kleb and Serratia
false, none
95
what bacteria are penicillins bacteriostatic against (1)
enterococcus spp
96
IM benzathine and IM procaine pen G are formulated to do what regarding absorption
delay absorption resulting in prolonged low serum and tissue concentrations
97
which penicillin undergoes dual elimination
piperacillin
98
what are the two penicillins that are exceptions for penicillins being removed during hemodialysis
nafcillin and oxacillin
99
3 penicillins that dont require dose change for renal insufficiency
diclox
naf
oxa
100
MOST ACTIVE penicillin against pseudomonas aeruginosa
piperacillin
101
combo choice for lower RTIs and human or animal bites*
augmentin
102
combo type for intraabdominal, gynecological, and diabetic foot infections
zosyn and unasyn
103
most frequent AE for penicillins
hypersens duh
104
weird GI AE for penicillins
pseudomembranous colitis (c diff diarrhea)
105
3 AEs under "other" for penicillins
phlebitis, hypokalemia, sodium overload and fluid retention (ticar/piper)
