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Pharmacology Block III > Penicillins > Flashcards

Penicillins Flashcards

(37 cards)

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1
Q

Where in the body do the penicillins NOT distribute?

A
  1. Eye 2. Prostate
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2
Q

What factors affect the distribution of penicillins?

A
  1. Molecular configuration of the penicillin 2. Protein binding “Penicillins Meet Proteins”
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3
Q

When are adequate concentrations of penicillins in the CSF attained?

A

Only in the presence of INFLAMED MENINGES when HIGH DOSES of parenteral penicillins are used

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4
Q

Give 2 examples of penicillins that bind to serum proteins and their respective binding percentages.

A
  1. Aminopenicillins - 15% 2. Dicloxacillin (Penicillinase-Resistant) - 97%
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5
Q

List the penicillins that are NOT primarily eliminated by the kidneys, and list their appropriate route of elimination.

A
  1. Nafcillin (Penicillinase-Resistant Penicillin)
    - Elimination via liver
  2. Oxacillin (P-R-P)
    - Elimination via liver
  3. Dicloxacillin (P-R-P)
    - Renal with some hepatic
  4. Piperacillin (Ureidopenicillin)
    - Dual elimination: liver and kidneys
  5. Piperacillin-Tazobactam (Beta-lactamase Inhibitor Combination)
    - Dual elimination
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6
Q

Which penicillins are NOT removed during hemodialysis?

A
  1. Nafcillin (P-R-P) 2. Oxacillin (P-R-P) 3. Dicloxacillin (P-R-P) THINK: “N.ot O.ut from D.ialysis”
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7
Q

What is the general half-life characteristic for ALL penicillins?

A

-Relatively short elimination half-life -2 hours half-life

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8
Q

Which penicillins do NOT require dosing changes for renal insufficiency?

A
  1. Nafcillin (P-R-P) 2. Oxacillin (P-R-P) 3. Dicloxacillin (P-R-P) THINK: “N.O. D.ose changes”
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9
Q

In what situation would you use aqueous penicillin G (IV)?

A

-Serious infections in hospitalized patients (rapid effect and high serum concentrations)

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10
Q

What situation would call for penicillin VK (oral)?

A

-Mild to moderate infections (pharyngitis or prophylaxis) due to low serum concentrations of the drug

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11
Q

Natural penicillins are a drug of choice for which infection types?

A
  1. S. pneumoniae (IV or IM): penicillin susceptible or intermediate strains
  2. Neisseria meningitis (IV)
  3. Clostridium perfringens or tetani
  4. Actinomycosis
  5. Viridans streptococci pharyngitis (PO or IM)
  6. Treponema Pallidium: syphillis

“Pen CAN Stop The Virulence”

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12
Q

For what type of infection would Benzathine penicillin or aqueous penicillin be a drug of choice?

A

Streptococci like S. pyogenes

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13
Q

Bacteremia treatment and endocarditis prophylaxis could be accomplished with what classes of penicillins as a drug of choice?

A
  1. Natural penicillins (along with an aminoglycoside) 2. P-R-Ps
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14
Q

In treating Treponema pallidum, or syphilis, what would be the drug(s) of choice?

A

Benzathine penicillin or IV (aqueous) penicillin

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15
Q

What is another name for the Penicillinase-Resistant Penicillins?

A

Antistaphylococcal Penicillins

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16
Q

What agents are useful for the treatment of infections due to methicillin-susceptible Staphylococcus aureus (MSSA)?

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A

Penicillinase Resistant Penicillins (Antistaphylococcal Penicillins)

17
Q

Give some examples of diseases caused by MSSA?

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A

-Skin and soft tissue infections -Septic arthritis -Osteomyelitis -Bacteremia -Endocarditis

18
Q

Oral dicloxacillin is useful for treatment of type of infection?

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A

-Mild to moderate skin and soft tissue infections -As a follow-up therapy after parenteral therapy for the treatment of more serious infections (i.e. osteomyelitis and septic arthritis)

19
Q

What class of penicillins work best for pathogens of the respiratory tract (i.e. mild to moderate pharyngitis, sinusitis, otitis media, bronchitis)?

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A

Aminopenicillins (PO)

20
Q

Parenteral Ampicillin is used for treatment of what types of infections?

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A

-Enterococcal infections (with an aminoglycoside for endocarditis) -Listeria monocytogenes (meningitis) “Ampicillin Eats Listeria” or “AmpLE”

21
Q

Due to their enhanced activity against gram-negative bacteria, which classes of penicillins are useful towards hospital-acquired infections?

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A

Carboxypenicillins and Ureidopenicillins active against: P. Aeruginosa

22
Q

List some examples of hospital acquired infections.

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A

Serious infections such as:

  • Bacteremia
  • Pneumonia
  • Complicated UTIs
  • Peritonitis
  • Skin and soft tissue infections
  • Bone and joint infections
  • Meningitis
23
Q

What is the most active penicillin for infections due to Pseudomonas aeruginosa?

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A

Piperacillin (Ureidopenicillin class)

24
Q

Amoxicillin-clavulanate (Augmentin-PO) is useful for treatment of what diseases?

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A
  • Otitis media
  • Sinusitis
  • Bronchitis
  • Lower Respiratory Infections
  • Bites (human or animal)

“BLOBS”

25
What group of penicillins are utilized in the treatment of polymicrobial infections (i.e. intra-abdominal infections, gynecological infections, diabetic foot infections)?
Parenteral combination agents (Beta-lactamase Inhibitor Combination Products)
26
Ampicillin-sulbactam (IV) is useful for the treatment of which type of infections?
Mixed aerobic/anaerobic infections (limited gram-negative coverage)
27
What is the treatment option for infections caused by Stenotrophomonas maltophilia?
Ticarcillin-clavulanate (IV)
28
Why is Piperacillin-tazobactam more tolerable than Ticarcillin-clavulanate?
Ticarcillin has a higher sodium load
29
What does Piperacillin-tazobactam (IV) treat?
- Polymicrobial infections - Gram-negative, hospital-acquired infections - Empiric therapy for febrile neutropenia
30
What is the most frequently occurring side effect of penicillins?
Hypersensitivity (3-10%) -less frequent with oral administration
31
What causes cross-allergenicity among natural and semi-synthetic penicillins?
- Their common nucleus - If allergic to one type of penicillin = allergic to other members of the penicillin family (and caution used with other beta-lactams)
32
What are some neurologic adverse effects of penicillins?
-Seizures -Irritability -Jerking -Confusion
33
List some gastrointestinal adverse effects of penicillins?
- Nausea, vomiting - Diarrhea (esp. amoxicillin-clavulanate) - Pseudomembranous colitis (C. difficile diarrhea)
34
What types of penicillins typically cause interstitial nephritis (immune-mediated damage to renal tubules)?
-Methicillin (PRP) -Nafcillin (PRP)
35
What are some physical manifestations of interstitial nephritis?
- Fever - Eosinophiluria - Abrupt increase in serum creatinine
36
How does Ticarcillin cause hypokalemia?
It acts as non-reabsorbable anions resulting in increased excretion of potassium
37
What types of penicillin cause sodium overload and fluid retention?
Ticarcillin and piperacillin

Pharmacology Block III (8 decks)

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