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USMLE Step 2 > Infectious Disease: Penicillins > Flashcards

Infectious Disease: Penicillins Flashcards

(83 cards)

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1
Q

What is the MOA of Penicillins

A

Inactivates bacterial Transpeptidases causing inability to cross link cell walls leading to autolysis

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2
Q

What drugs share the same MOA as Penicillins

A

All Beta-Lactam Abx

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3
Q

What drugs are considered natural Penicillins

A

Penicillin G

Penicillin VK

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4
Q

What forms does Penicillin G come in

A

IM

IV

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5
Q

When form does Penicillin VK come in

A

Oral

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6
Q

What are Natural Penicillins susceptible to

A

Inactivation by bacterial beta-lactamase enzymes

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7
Q

What type of bacteria typically have beta-lactamase enzymes

A

Gram (-) Bacteria

Staph Aureus (gram +)

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8
Q

What is the main clinical of Penicillin G

A

Syphilis
-Treponema Pallidum

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9
Q

What are the other uses for Penicillin G and Penicillin VK

A

Sickle Cell Disease

Rheumatic Fever

Actinomycosis

Strep Pharyngitis

Pregnancy

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10
Q

What are natural penicillins used for in Sickle Cell Disease

A

Prophylaxis in children against Pneumococcal infection

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11
Q

What are natural penicillins used for in Rheumatic Fever

A

Secondary Prophylaxis against recurrent attacks

Pen G q21-28 days

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12
Q

What type of bacteria is Actinomycosis

A

Gram (+) Rod

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13
Q

What is Actinomycosis associated with

A

Neck or facial mass after dental work

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14
Q

Why are natural Penicillins used in Strep Pharyngitis

A

Group A strep are sensitive to Penicillin

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15
Q

What is the role of Natural Penicillins in Pregnancy

A

Intrapartum Prophylaxis for GBS

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16
Q

When is Intrapartum Abx Prophylaxis for GBS given

A

At least 4 hours prior to delivery

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17
Q

What is first line for Intrapartum Abx prophylaxis for GBS

A

Penicillin or Ampicillin

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18
Q

What drug is used for intrapartum GBS prophylaxis if the patient has a penicillin allergy with low anaphylaxis risk

A

Cefazolin

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19
Q

What drug is used for intrapartum GBS prophylaxis if the patient has a penicillin allergy with high anaphylaxis risk

A

Test for Clindamycin Sensitivity

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20
Q

What drug is used for intrapartum GBS prophylaxis if the patient has a penicillin allergy with high anaphylaxis risk and Resistance to Clindamycin

A

Vancomycin

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21
Q

What drugs are considered Antistaphylococcal Penicillins

A

Oxacillin

Nafcillin

Dicloxacillin

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22
Q

What form does Dicloxacillin come in

A

Oral

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23
Q

What form does Nafcillin come in

A

IV

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24
Q

What form does Oxacillin come in

A

IV

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25
What unique about Antistaphylococcal Penicillins
Their side chain protects against staphylococcal beta lactamase
26
What do Antistaphylococcal Penicillins cover
MSSA -most streptococci -Good Gram + Coverage
27
What drugs are used to treat MSSAS
1st generation Cephalosporins Antistaphylococcal Penicillins
28
What drugs are used to treat MRSA
Vancomycin alternative drugs
29
What are common uses for Antistaphylococcal Penicillins
Community acquired cellulitis Impetigo
30
What is the alternative treatment for Community Acquired Cellulitis
1st generation cephalosporin
31
What are the drugs used to treat imipetigo
Dicloxacillin Cephalosporins
32
What drugs are Aminopenicillins
Amoxicillin Ampicillin
33
What is the form of Amoxicillin
Oral
34
What is the form of Ampicillin
IV
35
What feature is unique of Aminopenicillins
Penetrate gram (-) bacterial porin channels -increased gram (-) activity also covers gram (+)
36
Are aminopenicillins sensitive to Beta-lactamase
yes
37
What are common uses of Aminopenicillins
Otitis Media Listeria Gastroenteritis
38
What pathogens are commonly associated with Otitis Media
S. Pneumoniae Non-typeable H. Influenzae Moraxella Catarrhalis
39
How does Listeria Gastroenteritis present
Febrile, Diarrheal illness
40
What causes Listeria Gastroenteritis
Contaminated food -uncooked meat -unpasteurized milk
41
How do you treat listeria gastroenteritis in Immunocompetent, non-pregnant patients <65
no treatment
42
If you need to treat listeria gastroenteritis how do you treat
Amoxicillin or Ampicillin -pregnant -age >65
43
What drugs are Beta-Lactamase Inhibitors
Clavulanic Acid Sulbactam Tazobactam
44
What is the MOA of B-Lactamase Inhibitors
inhibit bacterial B-Lactamase to add coverage to some penicillins
45
What is the brand name for Amoxicillin-Clavulanic Acid
Augmentin
46
What is the dosage form of Augmentin
Oral
47
What is the brand name for Ampicillin-Sulbactam
Unasyn
48
What is the dosage form of Unasyn
IV
49
What do Combination Aminopenicillin-B-lactamase inhibitors cover
Increased coverage of -S. Aureus -H. Influenzae Anaerobes -B Fragilis
50
What drugs are Antipseudomonal Penicillins
Ticarcillin Piperacillin
51
What type of bacteria is Pseudomonas Aeruginosa
Gram (-) Rod
52
What diseases does Pseudomonas Aeruginosa lead to
Sepsis Pneumonia Urinary Infections
53
What conditions are Pseudomonas Infections associated with
Respiratory infections in CF Wound infections in burn patients Otitis Externa
54
Are Antipseduomal Penicillins susceptible to B-Lactamases
Yes
55
What is the brand name for Ticarcillin-Clavulanate
Timentin
56
What is the brand name for Piperacillin-tazobactam
Zosyn
57
What is the coverage benefit of Antipseudomonal Penicillins
Most Gram + Most Gram - Most anaerobic
58
What patients are Antipseudomonal Penicillins used in
Hospitalized pts with sepsis or critical illness
59
What are the different Anti-pseudomonal Abx
Ticarcillin-clavulanate Piperacillin-tazobactam Cephalosporins Aztreonam Fluoroquinolones Carbapenems
60
What Cephalosporins cover Pseudomonas
Ceftazidime Cefepime
61
What type of drug is Aztreonam
Monobactam
62
What Fluoroquinolone is used to cover Pseudomonas
Ciprofloxacin
63
What Carbapenems are used to cover Pseudomonas
Meropenem Doripenem
64
When do immediate hypersensitivity reactions to Penicillin occur
Within 1st hour Type I IgE mediated through histamine release
65
When do delayed (non-immediate) Hypersensitivity reactions to Penicillin occur
after multiple doses days into treatment
66
What are the immediate reactions to Penicillin
Urticaria Itching Bronchospasm Anaphylaxis
67
What type of Penicillin most commonly leads to a Maculopapular Rash
Aminopenicillins
68
What is the MOA behind the maculopapular rash in patients allergic to Penicillin
Cell-mediated
69
What conditions are associated with the maculopapular rash in penicillin allergic patients
Pt with Viral infection -classically EBV Pharyngitis
70
What are potential delayed mucocutaneous reactions to Penicillin
SJS TEN (>30% skin)
71
What Abx are associated with SJS and TEN
Sulfonamides (TMP-SMX) Aminopenicillins Cephalosporins
72
How can Penicillins cause Interstitial Nephritis
Drug acts as hapten leading to immune response in kidneys
73
What is the presentation of Penicillin induced interstitial Nephritis
Fever, Oliguria Increased Bun/Cr Eosinophils in urine Urine WBC and WBC Casts -sterile pyuria
74
What can high doses of Penicillin Cause
Autoimmune Hemolytic Anemia
75
How can Penicillins lead to autoimmune hemolytic anemia
PCN binds the surface of RBCS (hapten) Elicits immune response Ab against PCN bound to RBC Direct Coombs (+)
76
What is Serum Sickness
Immune complex disorder -circulating immune complexes of IgG and Drug -wide spread deposition in tissues and organs
77
How does Serum Sickness Present
Fever, Arthritis Urticaria, Lymphadenopathy
78
What drugs classically trigger a Jarisch-Herxheimer Reaction
Penicillin therapy for Spirochete Infection
79
What infection is classically associated with a Jarisch-Herxheimer reaction
Syphilis
80
What are the symptoms commonly seen in Jarish-Herxheimer reaction
Fever, chills Flushing Hyperventilation Syphilis rash may worsen
81
When does a Jarish-Herxheimer reaction typically occur
About 2 hours after starting therapy
82
What is the Trigger of the Jarish-Herxheimer Reaction
Bacterial cell death triggers an immune response
83
How long does it take for a Jarish-Herxhimer reaction to resolve
24 to 48 hours

USMLE Step 2 (40 decks)

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