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Neonatal Pharmacology > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Name the 4 types of Penicillins

A
  1. Natural Penicillins
  2. Aminopenicillins
  3. Penicillinase-resistant Penicillins
  4. Extended spectrum Penicllins
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2
Q

Name the 3 Natural Penicillins

A
  1. Pen G
  2. Pen G Procaine
  3. Pen B
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3
Q

Name the 2 Aminopenicillins

A
  1. Amoxicillin

2. Ampicilllin

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4
Q

Name the 4 Penicillinase-resistant Penicillins

A
  1. Cloxicililn
  2. Oxicillin
  3. Nafcillin
  4. Mehtycillin
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5
Q

Name the 3 extended spectrum Penicillins

A
  1. Tigercillin
  2. Pepercillin
  3. Azocillin
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6
Q

All Penicillins contain a nucleus composed of a _-______ ring

A

B-Lactam

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7
Q

What is the MOA of Natural Penicillins?

A

They exert bactericidal action against penicillin-susceptible microorganisms during the stage of active replication
-interfere w/bacterial cell wall synthesis by reacting w/>1 Penicillin binding protein

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8
Q

Bacteria produce how many different types of Penicillin-Binding proteins?

A

4

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9
Q

How does Penicillin resistance happen?

A

Production of B-Lactamase; an enzyme intermediate that destroys Penicillin activity.

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10
Q

True/False: Metabolism and disposition vary significantly among Pencillins & w/age of pt.

A

True

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11
Q

Penicillins Are/Are not well absorbed from the GI tract?

A

Are NOT (except Pen-V)

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12
Q

Which Penicillin is used perenterally?

A

Pen G

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13
Q

Penicillins bind to proteins, mainly which one?

A

Albumin

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14
Q

Do Penicillins penetrate the CSF well?

A

No

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15
Q

Penicillin acts synergistically with what other meds?

Against many strains of?

A

Gentamycin & Tobramycin

Enterococci

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16
Q

Name the types (general) of bacteria Penicillins work against?

A 
Gram + cocci
Gram + bacilli (listeria)
Gram - Bacteria
Anaerobic
Spirochetes
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17
Q

Clinical uses of Penicillins are effective to treat?

A 
Group A streptococci
Group B streptococci
Meningococci
Actinomyces
T. Pallidium
Also: susceptible Streptococcus pneumoniae, Enterococci, & Gonococci
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18
Q

What Penicilin can be used for primary, secondary, early or late latent Syphilis (except for neuro-syphylis)?

A

IM Benzathine PCN

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19
Q

What Penicilins are used for Congenital Syphilis?

A

Pen G or Procaine Pen

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20
Q

What is considered the major s/e of Penicillins?

A

Severe/fatal anaphylaxis

0.01-0.05 % of people receiving PCN’s

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21
Q

Name the Adverse Reactions of Pencillins

A
  1. Allergic reactions
  2. Hematologic Toxicity (coombs + anemia, leukopenia, thrombocytopenia)
  3. Sodium Overload
  4. Hypokalemia
  5. Neurologic toxicity/seizures (following massive doses)
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22
Q

Pts given continuous IV tx w/PenG/K in high doesage may suffer?

A

Severe and fatal K+ poisoning..especially w/renal insufficiency

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23
Q

Concurrent administration of bacteriostatic Abx may ________ the bactericidal effects of PCN’s by slowing?

A

Decrease

Slowing rate of bacterial growth

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24
Q

Probenecid blocks renal tubular secretion of?

A

PCN’s (so may have increased blood levels w/concurrent admin)

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25
Q

Aminopenicillins contain a free ______ group at the Alpha position on the B-Lactam ring of the PCN nucleus–>incrasing ability to penetrate _____ _________ organisms

A

Amino

Gram Negative

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26
Q

What is the MOA of Aminopenicillins?

A

Exert bactericidal action against penicillin-susceptible microorganisms during the stage of active replication

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27
Q

How is Resistance to Aminopenicillins achieved?

A

They are inactivated by the B-Lactamases produced by Gram + or Gram - bacteria

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28
Q

Aminopenicillins achieve therapeutic levels in most body fluids including:

A

CSF, Pelural, Joint, Peritoneal

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29
Q

Aminopenicillins are cleared by?

A

Kidneys

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30
Q

Which Aminopenicillin has better absorption/bioavailability?

A

Amoxicillin–the preferred PO aminopenicillin. Absorption is not affected by food.

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31
Q

What is the spectrum of Aminopenicillins?

A

Increased efficacy against most Enterococci, L. Monocytogenes, H. Influenza, N. Gonorrhea

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32
Q

What strains are resistant to Aminopenicillins?

A

Some E-Coli, Shigella, Salmonella

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33
Q

What Aminopenicillin is drug of choice for Otitis media and Lyme’s dz?

A

Amoxicillin

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34
Q

What Aminopenicillin is widely used for septic neonates?

Why?

A

Ampicillin

D/t it’s coverage against Listeria

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35
Q

What are the adverse effects of Aminopenicillins?

A

Hypersensitivity reactions

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36
Q

Penicillinase-Resistant Penicillins are what derivitives?

A

Semisynthetic Penicillin Derivitives

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37
Q

What is the MOA of Penicillinase-Resistant PCN’s?

A
  1. Bind to Penicillin Binding Proteins and prevent cell wall synthesis
  2. Resistant to action of bacterial PCN-ases; prevents opening of B-Lactam ring
38
Q

What is the Spectrum of PCN-ase Resistant PCN’s?

A

Effective against B-Lactamase-producing isolates of Staphylcoccus Aureus & Coagulase-Negative Stahpylococci

39
Q

True/False: Ater Oral admin, PCN-ase resistant PCN’s are adversely affected by food?

How are they excreted?

A

True

Urinary/Biliary excretion

40
Q

What are PCN-ase resistant PCN’s used for?

A

Empiric tx of skin and skin-structure infections, bone, joit infections where Staphylococcus Aureus is likely

41
Q

What are the Adverse effects of PCN-ase resistant PCN’s?

A 
Interstitial Nephritis (Methicillin)
-C.M.'s= Fever, rash, eosinophilia, proteinuria, hematuria

Choestasis

  • Usually w/o Jaundice
  • Reported w/Oxicillin use (usually Liver enzymes return to normal after D/C use)
42
Q

With what 2 drugs might you have adverse effects when giving PCN-ase resistant PCN’s?

A

Warfarin

Cyclosporine

43
Q

Extended spectrum Penicillins have Broader/Narrower spectrum than both Natural and Aminopenicillins.

A

Broader

44
Q

Are Extended-spectrum PCN’s right for tx systemic infections?
Why/why not?

A

No

Serum and tissue levels are not adequate

45
Q

What are Extended-spectrum PCN’s good for?
Is there good CSF penetration?
Primary elimination is?

A

UTI’s (uncomplicated)

No
Renal

46
Q

What are the clinical indications of extended-spectrum PCN’s?

A

Effective: gram - organisms
In combo w/Gent, Gram - bacilli
Generally used w/B-Lactamase inhibitor

47
Q

What are the adverse effects of the extended-spectrum PCN’s?

A

Hypersensitivity reactions
Plt dysfunction–prolonged bldg times
Inhibition of Plt aggregation

48
Q

Extended-spectrum PCN’s have drug interactions with what 3 meds?

A
  1. Warfarin (decreases effect of it)
  2. Piperacillin (potentiates action of non-depolarizing blocking agents)
  3. Aminoglycosides (causes degradation of the aminoglycoside–why they are used in solution and separated by 30 min)
49
Q

Name the MOA of Celphalosporins

A
  • Possesses a B-Lactam ring
  • Interfere w/synthesis of peptidoglycan in the bacterial wall
  • Bind to and inactivate Penicillin Binding Proteins (enzymes for synthesis of bacterial cell wall)
50
Q

How many classifications of Cephalosporins are there?

A

4

1st-4th

51
Q

The first classification of Cephalosporin is good against?

A
  • Most Gram + cocci (excluding MRSA, Eterococci, Staph Epidermis)
  • Modest activity against many Gram - bacteria
52
Q

The second classification of Cephalosporin has increased activity against?

A
  • Gram - bacteria–but less so than 3rd generation
  • Variable activity against Gram + cocci
  • Improved activity against H-influenza, Gonnorhea, & N. Menengitits
53
Q

The 3rd classification of Cephalosporins are more active against?

A

Enterobacter Cinae, B-Lactamase producing strains & Staph Pneumoniae.

54
Q

The 4th classification of Cephalosporins have increased spectrum activity than 3rd generation and are more active against?

A

H-Influenza, Nisseria species, Psuedomonas, Gram + cocci, Staph Aureus, Staph Pneumoniae, other Stroptococci

55
Q

The classifications of Cephalosporins reflects increasing __________ of higher generations to various bacterial __-_______.

A

Stability

B-Lactamases

56
Q

None of the Cephalosporins are effective against:

A

MRSA
Enterococci
Listeria
Clostridium

57
Q

There are 3 mechanisms of resistance to Cephalosporins:

A
  1. Inactivation by B-Lactamases
  2. Alterations of Penicillin-binding Proteins
  3. Alteration of Bacterial Permeability
58
Q

True/False: there is good penetration into the tissues and fluid compartments including CSF of Cephalosporins

A

True

59
Q

First and Second generation Cephalosporins are used for?

A

Skin and Respiratory tract infections

60
Q

Third generation Cephalosporins are used for?

A

Empiric tx

61
Q

Fourth generation Cephalosporins are used for?

A

Febrile Neutropenia and Nosocomial infections

62
Q

Name some adverse effects of Cephalosporins

A
  • Maculopapular rash, drug fever, positive Coombs
  • Anaphylactic rxn varies 0.0001-0.1%
  • Renal insufficiency may need doseage adjustments
63
Q

What are the advantages of Aminoglycosides? (4)

A
  1. Effective against Gram - organisms
  2. Synergism w/B-Lactam Abx
  3. Limited bacterial resistance
  4. Low-cost
64
Q

Successful use of Aminoglycosides has been complicated by what 2 side-effects in a significant number of treated pts?

A

Nephrotoxicity

Ototoxicity

65
Q

What is the MOA of Aminoglycosides?

A
  • Alter the integrity of the bacterial wall membrane by disturbing protein synthesis.
  • Binds to the bacterial cell membrane and may play role in rapid bacterial cell death.
66
Q

What are the indications of Aminoglycoside use?

A
  1. Tx of serious Gram - infections caused by Enteric Bacilli
  2. Act synergistically w/Cephalosporins & Penicillins
  3. Used in Combo w/Vanco for S.Aureus (both Methicillin-Sensitive and Methicillin-Resistant)
67
Q

After PCN’s, what are the most commonly used meds in the NICU?

A

Aminoglycosides

68
Q

In general, emergence of an Aminoglycoside resistant strain (other than Coag. Neg Streptococci) is relatively?

A

Slow (a definite advantage over 3rd gen Cephalosporins)

69
Q

What are the indications of Aminoglycosides? (2)

A
  1. Septicemia

2. UTI

70
Q

How do Aminoglycosides tx Septicemia?

A
  • Gram - bacteria: E-Coli, Klebsiella, Enterobacter, Pseudomonas
  • Synergistic w/B-Lactam Abx in tx GBS and Coag neg. Staph infections
  • Important in initial empiric tx of neonatal Septicemia
71
Q

W/UTI, how do Aminoglycosides work?

A

They are excreted by glomerular filtration and partly actively reabsorbed–>high tissue and urine concentrations

72
Q

True/False: then known s/e of Ototoxicity and Nephrotoxicity a/w Aminoglycoside use can happen months later.

A

True

-Studies show it’s r/t high trough levels (high renal accumulation). Probably r/t total dose and duration rather than serum concentrations.

73
Q

Aminoglycoside dosing has been revised toward?

A

Larger doses in extended intervals

74
Q

Dosage and intervals of Aminoglycosides are dependent on?

A

GA & PNA

75
Q

Routine therapeutic drug monitoring is usually around which doses?

A

3rd-4th

76
Q

True/False: Complications are common in courses shorter than 7 days.

A

False, this is rare.

77
Q

Name the most common Glycopeptide in NICU.

A

Vancomycin

78
Q

Vancomycin is used for?

A

Gram + infections

79
Q

Vancomycin can be inactivated by?

A

Heparin in high concentrations

80
Q

What is the MOA of Vanco?

A

Bactericidal activity is based on the inhibition of bacterial cell wall synthesis

81
Q

Resistance to Vanco is seen in?

A

Enterococci, S. Aureus, S. Epidermis

82
Q

True/False: there is increasing concerns of Vanco intermediate resistant strain of Staph Aureus (VIRSA).

Why/why not?

A

True

D/t thickened & aggregated cell walls

83
Q

Infection w/VIRSA is a/w?

A

Tx failure of Vanco

84
Q

A mechanical factor in clinical resistance of S. Aureus infections to Vanco is production of what?

A

Biofilm of bacteria, shielding it from the Antibiotic

85
Q

What are the indications for use of Vanco?

A

Methicillin-Resistant strains of Staphylococcal infections

86
Q

Vanco is widely used for empiric tx of? (2)

A
  1. Line-related infections

2. Late-Onset Setpicemia

87
Q

Vanco is eliminated via?

A

Glomerular filtration

88
Q

True/False: Vanco cannot be relied upon to adequately tx Gram + meningitis alone.

A

True

89
Q

What has the ability to alter the pharmacokinetics of Vanco?

A

GA, PNA, Post-conceptual age (this has a stronger influence on Vanco pharmacokinetics than GA or PNA)

90
Q

Toxicity of Vanco includes:

A
  • Infusion-related effects (Red-man’s syndrome= Histamine mediated rash of puritis, flushing, tingling, tachycardia, shock)
  • Drug-Related effects (Thrombocytopenia, Neutropenia, Eosinophilia, Cihlls, Fever, Rash, Nephrotoxicity, Ototoxicity)
91
Q

Redman’s syndrome is r/t what?

A

The rate of infusion (< 1 hr)

92
Q

The incidence of s/e’s w/Vanco admin decreased significantly when what happened?

A

Impurities were removed from early preparations in the 1960’s.

Neonatal Pharmacology (17 decks)

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