Inhibitors of bacterial cell wall synthesis 1

Question 1

Two forms of long-acting penicillin G and their administration

Answer 1

Procaine penicillin G and Benzathine penicillin G

Intramuscular administration

Question 2

Benzathine penicillin G plasma concentration

Answer 2

Low plasma concentration of the drug for a few weeks

Question 3

Procaine penicillin G plasma concentration

Answer 3

Higher plasma concentrations of penicillin for about 24 hours

Question 4

Extended spectrum Carboxypenicillins

Answer 4

Carbenicillin

Ticarcillin

Question 5

Extended spectrum Ureidopenicillins

Answer 5

Piperacillin
Mezlocillin
Azlocillin

Question 6

Extended spectrum Aminopenicillins

Answer 6

Ampicillin

Amoxicillin

Question 7

Extended spectrum Ureidopenicillins active against

Answer 7

In addition to P. aureginosa, Selected gram-negative bacilli, such as Klebsiella pneumoniae

Question 8

Penicillinase-Resistant Antistaphylococcal Penicillins

Answer 8

Methicillin
Nafcillin
Oxacillin (Isoxazolyl penicillin)
Cloxacillin (Isoxazolyl penicillin)
Dicloxacillin (Isoxazolyl penicillin)

Question 9

Narrow-Spectrum Penicillins

Answer 9

Penicillin G

Penicillin V

Question 10

First-generation cephalosporins

Answer 10

Cefazolin

Cephalexin

Question 11

Second-generation cephalosporins

Answer 11

Cefuroxime
Cefprozil
Cefoxitin
Cefotetan

Question 12

First-generation cephalosporins active against

Answer 12

Gram-positive cocci, such as pneumococci, streptococci, and staphylococci. They are also active against a few gram-negative enteric bacilli including E. coli and K. pneumoniae

Question 13

Second-generation cephalosporins active against

Answer 13

Similar activity against gram-positive cocci as the first-generation while demonstrating increased activity against gram-negative bacilli

Question 14

Avibactam active against

Answer 14

Several types of b-lactamases, including AmpC b-lactamases and other extended-spectrum b-lactamases expressed by cephalosporin-resistant gram-negative bacteria

Question 15

Penicillin G - Clinical use

Answer 15

Gram-positive cocci
Syphilis-Treponema pallidum
Endocarditis- Viridans, streptococci, enterococci
Meningitis - Meningococci
Pneumonia -Pneumococci
Streptococci 
Enterococci
Gas gangrene – Clostridium perfringes
Actinomyces

Question 16

Penicillin G and V - Adverse effects

Answer 16

High dose: seizures
Diarrhea
Superinfections
Psuedomembranous colitis 
Hypersensitivity:
Uritcaria (hives)
Anaphylactic shock
Serum sickness
Interstitial nephritis
Hepatitis
Rashes
Fever
Joint swelling
Angioneurotic edema
Pruritus, oral lesions, respiratory compromise,eosinophilia, hemolytic anemia, vasculitis
Seizures (renal failure)

Question 17

Penicillin G - Interactions

Answer 17

Probenecid: inhibits renal secretion – increased serum concentration
Benzathine: prolonged half-life.

Question 18

Penicillin V - Clinical use

Answer 18

Gram-positive cocci

Pharyngitis – Streptococcus pyogenes

Question 19

Dicloxacillin - Clinical use

Answer 19

Milder infections of penicillinase positive staphylococci (oral)

Question 20

Dicloxacillin, Nafcillin - Adverse effects

Answer 20

High dose: seizures
Diarrhea
Superinfections
Psuedomembranous colitis 
Hypersensitivity:
Uritcaria (hives)
Anaphylactic shock
Serum sickness
Interstitial nephritis
Hepatitis
Rashes
Neutropenia

Question 21

Nafcillin - Clinical use

Answer 21

Osteomyelitis
Endocarditis
Pneumonia
Skin and soft tissue infections
UTIs (All above by s. aureus - MRSA)

Question 22

Nafcillin - Special considerations

Answer 22

IV adm for serious infections

Excreted in bile

Question 23

Nafcillin - Interactions

Answer 23

Probenecid: inhibits renal secretion – increased serum concentration

Question 24

Metchicillin - Clinical use

Answer 24

Seldom used because of resistance and adverse effects

Question 25

Metchillin - Adverse effects

Answer 25

``` High dose: seizures Diarrhea Superinfections Psuedomembranous colitis Hypersensitivity: Uritcaria (hives) Anaphylactic shock Serum sickness Interstitial nephritis Hepatitis Rashes ```

Question 26

Amoxicillin - Clinical use

Answer 26

``` Otitis media Upper respiratory tract infections Skin and soft tissue infections UTI’s Sinusitis Bronchitis Community acquired pneumonia ``` Prophylaxis of bacterial endocarditis in persons with heart valve defects Pneumococci, streptococci, staphylococci, Haemophilus influenzae, Moraxella catarrhalis, Escherichia coli, Pasteurella multocida Bite wound infections – Pasteurella multocida, S. aureus(with clavulanate) Impetigo (with clavulanate) - S. aureus, S. pyogenes

Question 27

Amoxicillin - Special considerations

Answer 27

Bec of resistance: use clavulanate for H. influenzae + M. catarrhalis. Uptake is not impaired by food, unlike the other penicillins

Question 28

Amoxicillin - Adverse effects

Answer 28

``` High dose: seizures Diarrhea Superinfections Psuedomembranous colitis Hypersensitivity: Uritcaria (hives) Anaphylactic shock Serum sickness Interstitial nephritis Hepatitis Rashes ```

Question 29

Amoxicillin - Interactions

Answer 29

Clavulanate: β-lactamase inhibitor Probenecid: inhibits renal secretion – increased serum concentration Contraceptive: Decreased effectiveness

Question 30

Amoxicillin - Similar drugs

Answer 30

Ampicillin Piperacillin Ticarcillin

Question 31

Ampicillin - Clinical use

Answer 31

Meningitis, listeriosis – Listeria monocytogenes Decubitus, diabetic foot ulcers – Gram-positive and anaerobic organisms Endocarditis – Streptococci, enterococci Lyme disease – Borrelia burgdorferi Shigellosis Uncomplicated salmonella Gastroenteritis E.coli Non b-lactamase producing strains of H. influenzae Bite wounds and diabetic foot ulcers (with sulbactam) Combined with aminoglycoside (E.g., gentamicin) to treat enterococcal infections, such as enterococcal endocarditis

Question 32

Ampicillin - Adverse effects

Answer 32

``` Maculopapular rash (viral inf. Like mononucleosis) High dose: seizures Diarrhea Superinfections Psuedomembranous colitis Vaginal candidiasis Hypersensitivity: Uritcaria (hives) Anaphylactic shock Serum sickness Interstitial nephritis Hepatitis Rashes ```

Question 33

Ampicillin - Interactions

Answer 33

Sulbactam: β-lactamase inhibitor

Question 34

Piperacillin, Ticarcillin - Clinical use

Answer 34

Gram-positive and gram-negative aerobic and anaerobic bacteria + some strains of Pseudomonas aeruginosa and Klebsiella pneumonia Intraabdominal, skin, soft tissue, lower respiratory tract, complicated urinary tract, gynecologic Febrile neutropenia pneumonia. Active against P.aeruginosa (UTIs)

Question 35

Piperacillin, Ticarcillin - Adverse effects

Answer 35

``` High dose: seizures Diarrhea Superinfections Psuedomembranous colitis Hypersensitivity: Uritcaria (hives) Anaphylactic shock Serum sickness Interstitial nephritis Hepatitis Rashes ```

Question 36

Piperacillin Ticarcillin - Interactions

Answer 36

``` Tazobactam: β-lactamase inhibitor Aminoglycosides Probenecid: inhibits renal secretion – increased serum concentration Contraceptivse: Decreased effectiveness Clavulanate: β-lactamase inhibitor Aminoglycoside ```

Question 37

Cephalexin - Clinical use

Answer 37

Skin and soft tissue infections (impetigo, cellulitis) caused by gram (+) UTIs -Streptococci, staphylococci

Question 38

Cephalexin, Cefazolin - Adverse effects

Answer 38

Hypersensitivity: (rare, cross-sensitivity to penicillins) Anaphylaxis, fever, skin rashes, nephritis, granulocytopenia, hemolytic anemia Local irritation: pain after IM injection, thrombophlebitis after IV Renal toxicity (intersitial nephritis, tubular necrosis)

Question 39

Cefazolin - Clinical use

Answer 39

Prophylaxis of surgical infections – Staphylococci, E. coli, K. pneumoniae Alternative to antistaph. penicillin

Question 40

Cefprozil, Cefuroxime - Clinical use

Answer 40

Otitis media – H. influenzae strains resistant to amoxicillin and other drugs Respiratory tract, skin and soft tissue infections (pneumococci, H. influenzae, M. catarrhalis)

Question 41

Cefprozil, Cefuroxime - Adverse effects

Answer 41

Hypersensitivity: (rare, cross-sensitivity to penicillins) Anaphylaxis, fever, skin rashes, nephritis, granulocytopenia, hemolytic anemia Local irritation: pain after IM injection, thrombophlebitis after IV Renal toxicity (intersitial nephritis, tubular necrosis)

Question 42

Cefotetan - Clinical use

Answer 42

Aerobic and anaerobic gram-negative bacilli, including Bacteroides fragilis Intra-abdominal, gynecological, biliary tract infections

Question 43

Cefotetan - Adverse effects

Answer 43

Platelet dysfunction Bleeding Hypersensitivity (rare, cross-sensitivity to penicillins): Anaphylaxis, fever, skin rashes, nephritis, granulocytopenia, hemolytic anemia Local irritation: pain after IM injection, thrombophlebitis after IV Renal toxicity (intersitial nephritis, tubular necrosis) Contains menthylthiotrazole gr. -> hypoprothrombinemia, bleeding disorders

Question 44

Cefotetan - Interactions

Answer 44

Anticoagulants: more potent effect (risk of bleeding!) Alcohol: disulfiram-like reaction