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Pharmacology > L22: Penicillins > Flashcards

L22: Penicillins Flashcards

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1
Q

True or False: Penicillin G and Penicillin V/K are natural penicillins

A

True

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2
Q

Which four drugs are anti-staphylococcals?

A

1) Nafcillin
2) Oxacillin

3) Cloxacillin
4) Dicloxacillin

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3
Q

Ampicillin and Amoxicillin belong to which class?
A. Natural Penicillins
B. Anti-Staphylococcals
C. Anti-pseudomonals
D. Aminopenicillins

A

D. Aminopenicillins

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4
Q

Clavulanate, Tazobactam, and Avibactam belong to which group?
A. Natural Penicillins
B. Anti-Staphylococcals
C. Anti-pseudomonals
D. Aminopenicillins
E. Beta-lactamase Inhibitors

A

E. Beta-lactamase Inhibitors

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5
Q

True or False: Amoxicillin-clavulanate and Piperacillin-tazobactam are combination drugs

A

True

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6
Q

β-lactams antibiotics include which 4 major subgroups?

A
  1. Penicillins
  2. Cephalosporins
  3. Monobactams
  4. Carbapenems
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7
Q

Features shared by: 1) Penicillins, 2) Cephalosporins, 3) Monobactams, and 4) Carbapenems??

A

1) four membered lactam ring
2) can cause SJS
3) commonly used during pregnancy

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8
Q

What are two reasons for major resistance of β-lactams antibiotics?

A

1) Resistance to bacterial lactamase enzymes
2) Altered penicillin binding proteins

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9
Q

True or False: Lactamase inhibitors are co-formulated with penicillinsand other beta-lactams, to protect against degradation by lactamase enzymes

A

True

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10
Q

β-lactams inhibit _____ peptidoglycan cross-linking

A

transpeptidase-mediated

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11
Q

True or False: Transpeptidase reaction
site centers are found on D-alanyl-D-alanine, which β-lactam resembles

A

True

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12
Q

With β-lactam, transpeptidase mistakenly uses ___ as substrate, results in
irreversible inhibition

A

lactam

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13
Q

β-lactams inhibit transpeptidase-mediated peptidoglycan crosslinking.

Inhibition of peptidoglycan synthesis weakens ___, making it vulnerable to osmotic stress and rupture

A

cell well

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14
Q

β-lactams inhibit transpeptidase-mediated peptidoglycan crosslinking.

In this case, only ___ cells die – mechanism of cell death not completely understood

A

replicating

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15
Q

____: bacterial proteins that bind to penicillins & cephalosporins

A

penicillin binding proteins (PBP’s)

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16
Q

True or False: Only some bacteria with cell walls contain PBPs (penicillin binding proteins)

A

False - ALL bacteria with cell walls
contain PBPs (penicillin binding proteins)

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17
Q

True or False: Gram (-) strains contain B-lactamase while Gram (+) strains contain PBP

A

False –

Both Gram (+)/(-) contain PBP and B-lactamase

  • However, B-lactamase is more externally located in Gram (+) while it is in more internal in Gram (-)
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18
Q

Structural differences & mutations in PBPs mean…?

A

They do not bind β-lactam drugs

  • 4 of 5 PBPs in highly resistant Strep
    pneumoniae have lower affinity for
    penicillins
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19
Q

Alterations of PBP’s result in resistance typical of ___

A

MRSA

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20
Q

_____ commonly describes
organisms resistant to many beta-lactams

A

“Methicillin-resistant”

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21
Q

MRSA/ORSA refers to resistance to virtually all β-
lactams, including nearly all cephalosporins except 5th
gen agent ____

A

ceftaroline

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22
Q

___ is the leading cause of surgical site infection in
both tertiary and community hospitals
A. MRSA
B. ORSA

A

B. ORSA

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23
Q

____ is a β-lactamase with spectrum limited to
penicillins

A

Penicillinase

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24
Q

____ can hydrolyze a wide
variety of β-lactams; exclusive to gram(-) nosocomials

A

Extended Spectrum β-lactamases (ESBLs)

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25
____: A few lactamase-producing individuals can protect an entire community; this effect is commonly seen in Gram (+) microbes
Inoculum Effect
26
Which test uses substrate that changes color when degraded by lactamase?
Nitrocefin
27
Penicillins are more effective in ___ vs. stationary growth phase
Logarithmic
28
Which four factors influence antibiotic efficacy?
1) Growth Phase 2) Population 3) Extracellular Biofilms 4) Location
29
True or False: Resistant minority microbes secrete lots of lactamase, which can protect neighbors
True
30
True or False: Bacteria persisting inside host cells are inaccessible to β-lactams + Adherent bacteria secrete polysaccharide substrate
True
31
True or False: Penicillins are concentration-dependent, bacterialstatic agents
False - penicillins are TIME-DEPENDENT, BACTERICIDAL AGENTS
32
True or False: Penicillins kill power generally unaffected by low pH, low O2, or presence of proteins/constituents of pus
True
33
Where do penicillins distribute to? Where do they not distribute to?
Does: Joint, pleural, pericardial & bile fluids Does NOT: Intraocular space, prostate, phagocytes, or CSF when meninges are normal
34
When penicillins are used and meninges are inflamed, the drugs get into __
CNS
35
Penicillin dose is adjusted during renal failure. What is the exception?
Anti-staphylococcal penicillins are exceptions - Rely on significant biliary elimination
36
____ organic acid transport inhibitor; keeps drugs such as penicillins in the circulation longer
Probenecid
37
True or False: Originally, Penicillin G was useful against many gram-positive organisms
True
38
___ and ____ remain sensitive to Penicillin G
Gram (+) Cocci Gram (-) Neisseria
39
True or False: Many anaerobes are sensitive to Penicillin V and K, which makes them useful for abscesses, gangrene, tetanus
False - many anaerobes are sensitive to Penicillin G!!!! which makes them useful for abscesses, gangrene, tetanus
40
Treatment for syphilis?
Penicillin G
41
Why is penicillin is used more rarely now?
Due to resistance
42
True or False: Penicillin G can be administered via IM or IV. Penicillin G is acid instable while Penicillin V/K has greater acid stability
True
43
True or False: Penicillin G was the first of the "oral penicillins"
False - Penicillin V/K were
44
Anti-staphylococcal penicillins are stable toward Staph penicillinases. What type of infections do they treat?
Staph infections (skin, osteomyelitis, endocarditis)
45
Anti-staphylococcal penicillins have bulky ____ group that inhibits Staph ___ ___ enzymes
R group; beta lactamase
46
True or False: Anti-staphylococcal penicillins have significant biliary clearance, meaning NO need for dosing adjustments in renal failure
True
47
True or False: Anti-staphylococcal penicillins are superior to penicillin against penicillin-sensitive strains
False - Anti-staphylococcal penicillins are INFERIOR to penicillin against penicillin-sensitive strains
48
True or False: Anti-staphylococcals have been weakened by altered PBP resistance schemes: MRSA/ORSA organism
True
49
Aminopenicillins extend penicillin spectrum to include ____ organisms
gram-negative
50
True or False: Ampicillin & amoxicillin have nearly identical spectrum
True
51
Ampicillin & amoxicillin are effective against.... HELPS ME?
Haemophilus influenzae E. coli Listeria; Proteus mirabilis Salmonella Moraxella E. faecalis
52
True or False: Aminopenicillins are not effective for gram(-) nosocomials, which frequently possess β-lactamases that destroy aminopenicillins
True Klebsiella, Enterobacter, P. aeruginosa
53
The amino group of aminopenicillins carries a ___ charge that facilitates passage through porins of gram negatives A. neutral B. positive C. negative
B. positive
54
Amoxicillin is better than ___ for oral therapy
Ampicillin
55
True or False: Both Amoxicillin and Ampicillin are adjusted in renal failure + can be combined with β-lactamase inhibitors to prevent β-lactamase breakdown
True
56
True or False: There is a current shortage of amoxicillin suspension – using pills, penicillin, or cephalosporins
True
57
β-lactamase inhibitors protect penicillins from ___
hydrolysis
58
Some β-lactamase inhibitors mimetics lack antibacterial activity – instead, function as _____ _____ of bacterial β-lactamase
irreversible “suicide” inhibitors
59
_____: A β-lactamase inhibitor that is useful for UTI's and infections of respiratory tract, ear, skin (not affected by current shortage) A. Clauvulanic Acid B. Augmentin
B. Augmentin = amoxicillin + clavulanate
60
True or False: β-lactamase inhibitors inhibit many plasmid encoded beta-lactamases, but usually do not inhibit chromosomal beta lactamases
True
61
_____ is an example of a non-beta lactam, beta-lactamase inhibitors
Avibactam
62
Other new non-beta lactam, beta lactamase inhibitors include ____ and _____ (also: Avibactam)
vaborbactam; relebactam
63
____ is an antipseudomonal carboxypenicillin, works to treat Pseudomonas (known for drug resistance) -- but also good for penicillin-resistant anaerobes (B. fragilis)
Ticarcillin
64
Ticarcillin can lead to high sodium, which is bad for __ and cause ___ ___
heart; kidney failure
65
True or False: Ticarcillin is good for penicillin-resistant anaerobes, e.g. B. fragilis, and mixed aerobic/anaerobic infections
True
66
Ticarcillin can interact with platelets, leading to increased __
bleeding
67
True or False: Penicillin is a better anti-pseudomonal than Piperacillin
False - Piperacillin is a better anti-pseudomonal than Penicillin
68
What advantage does piperacillin have over ticarcillin?
Greater activity against: Pseudomonas aeruginosa, Klebsiella
69
Piperacillin is inactive against most ___, but it is vulnerable to _____
Staph; Gram (+) β-lactamases
70
____ + _____ (Zosyn®) has the widest spectrum of the penicillins
Piperacillin + Tazobactam
71
True or False: Piperacillin + Tazobactam can treat: bacteremia, pneumonias, burn infections
True
72
True or False: Zosyn may not work on piperacillin-resistant P. aeruginosa
True
73
For S. aureus strain without resistance schemes....
Penicillin > oxacillin > vancomycin
74
Incidence of penicillin are common cause of drug allergy and are influenced by route of administration. What is the order?
topical > IM > IV > oral
75
Penicillin allergies can manifest in ___, ____, ____, _____
skin (90%) ; respiratory (70%) ; GI (45%); cardiovascular (45%)
76
When fatal, β-lactam allergies involve ___ or ____ failure
respiratory; cardiovascular
77
Penicilloyl-polylysine (Pre-Pen) is ____ while several minor determinants include: ____, ____
major determinant; penicilloate, penilloate
78
True or False: All beta lactams can cause serum sickness-like reaction
True - May involve deposition of antigen or drug immune complexes, causing inflammation
79
Amoxicillin and ampicillin may cause non-allergic ___
rash - Also associated with viral infection; very common in those receiving amoxicillin who are also infected with cytomegalovirus
80
True or False: Amoxicillin and ampicillin may cause non-allergic rash - This phenomenon IS antibody-mediated, and DOES increase risk of true penicillin allergy
False - this phenomenon is NOT antibody-mediated, and does NOT increase risk of true penicillin allergy
81
Why should you generally avoid avoid combination of penicillins with bacteriostatics (especially tetracyclines or chloramphenicol)???
82
True or False: The transfer of plasmid DNA between different strains of bacteria can transfer resistance to different microbes
True - Example: resistant Strep sanguis + Strep viridans acquired PBP's from S. pneumo
83
True or False: In IV solution, penicillins can inactivate aminoglycosides
True - sometimes combo still given though - beta lactams can "help" aminoglycosides enter target bacteria
84
____ and ___ are classes associated with C. Diff
Cephalosporins Penicillins
85
Why will failure rate for combination oral contraceptives go up after anti-biotic therapy?
Enterohepatic recirculation of OTC's
86
True or False: Failure rate for combination oral contraceptives will go up after antibiotic therapy
True

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