Antibiotics

Question 1

Beta lactam structure

Answer 1

Contains a beta lactam nucleus (four membered ring)

Question 2

Penicillins structure

Answer 2

5 membered ring

Question 3

Cephalosporins structure

Answer 3

5 membered ring

Question 4

Beta lactamase

Answer 4

Degrades the beta lactam nucleus so that it will no longer bind to the PBP

Question 5

Beta lactamase inhibitor

Answer 5

Similar structures to beta lactams but with no intrinsic activity.
Extends the spectrum
Bind to certain beta lactamases to prevent the enzyme from destroying the beta lactam

Question 6

Where do beta lactam antibiotics mimic the structure of bacteria and get incorporated into the cell wall? What does it do there?

Answer 6

D alanine tail

It inhibits cell wall synthesis

Question 7

MOA of beta lactams

Answer 7

Beta lactams are structurally analogous to D-Ala-D-Ala and bind to the PBP
They inhibit the third step of cell wall synthesis (cross linking)

Question 8

Beta lactams killing

Answer 8

Bactericidal

Time-dependent killing

Question 9

What is the target of all beta lactams?

Answer 9

PBPs

Question 10

Resistance to beta lactams

Answer 10

Beta lactamase breaks a bond in the beta lactam ring of penicillin to disable the molecule. Bacteria with this enzyme can resist the effects of penicillin and other beta lactam antibiotics.

Question 11

Which organisms are more resistant to beta lactams?

Answer 11

Gram negative

Question 12

Natural penicillins

Answer 12

Pen G

Pen VK

Question 13

Anti-staphylococcal penicillins

Answer 13

Nafcillin
Oxacillin (IV)
Dicloxacillin (PO)

Question 14

Amino penicillins

Answer 14

Ampicillin (IV)

Amoxicillin (PO)

Question 15

Ureido penicillin

Answer 15

Piperacillin

Question 16

Pen G spectrum and uses

Answer 16

Strep endocarditis, meningitis
Syphilis- benzathine Pen G
Narrow spectrum (streptococci, treponema)

Question 17

Pen VK spectrum and uses

Answer 17

Narrow (streptococci)

Strep throat

Question 18

Nafcillin, oxacillin, dicloxacillin sprectrum and uses

Answer 18

Narrow (MSSA only)

Serious MSSA infections (skin, blood, lung, etc. )

Question 19

Ampicillin. amoxicillin spectrum and uses

Answer 19

Broad spectrum (Gram +, some gram -, anaerobes)
Intra-abdominal, pelvic, skin, pulmonary, bite wounds, some STIs
NOT MRSA

Question 20

Piperacillin spectrum and uses

Answer 20

Very broad (enhanced gram negative including pseudomonas)
Pneumonia, bacteremia, IA, febrile neutropenia, diabetic foot, etc. )

Question 21

1st class cephalosporin

Answer 21

Cefazolini (IV)

Cephalexin (PO)

Question 22

Cefazolin spectrum and uses

Answer 22

Narrow spectrum (Gram +) streptococci, staphylococci
Surgical prophylaxis

Question 23

Cephalexin spectrum and uses

Answer 23

Narrow spectrum (Gram +) streptococci, staphylococci
Skin, UTI, RTI

Question 24

2nd class cephalosporins

Answer 24

Cefoxitin (IV)

Cefuroxime (IV,PO)

Question 25

2nd class cephalosporins spectrum and uses

Answer 25

Broader spectrum (gram + and anaerobes) Mixed infections IV- pediatric meningitis

Question 26

3rd class cephalosporins

Answer 26

Ceftriaxone (IV/IM) Ceftazidime (IV) Ceftibuten, Cefdinir (PO)

Question 27

Ceftriaxone, ceftazidime, ceftibuten, cefdinir spectrum and uses

Answer 27

Broad (Enhanced gram-) Psuedomonas (Ceftazidime only) Meningitis, gonorrhea, serious hospital infections

Question 28

4th class cephalosporins

Answer 28

Cefepime (IV) | Ceftolozane (IV)

Question 29

Cefepime and Ceftolozane spectrum and uses

Answer 29

Very broad spectrum Enhanced gram -, psuedomonas, some EBLs Serious hospital infections

Question 30

5th class cephalosporin

Answer 30

Ceftaroline (IV)

Question 31

Ceftaroline spectrum and coverage

Answer 31

Broad (MRSA) | Skin, blood (MRSA infections only)

Question 32

Cefiderocol

Answer 32

Chemical structure similar to both ceftazidime and cefepime. Avoids breakdown against PBPs Used for pyelonephritis

Question 33

Monobactams

Answer 33

Aztreonam Inhibits gram - only Used in pcn and cephalosporin allergies (no crossreactivity)

Question 34

Carbapenems

Answer 34

VERY stable to beta lactamases | VERY broad spectrum

Question 35

Beta lactams Absorption

Answer 35

PO forms have modest-good absorption but IV>>PO doses. | Best absorbed on an empty stomach, but taken with food because of AE (food does not effect AUC)

Question 36

Beta lactams distribution

Answer 36

Wide distribution- many beta lactams penetrate CNS with meningeal inflammation (primarily 3rd ceph) Penetration into uninflamed meninges is poor

Question 37

Beta lactam metabolism

Answer 37

minimal

Question 38

Beta lactam excretion

Answer 38

Excreted in urine | Needs to be renally dosed

Question 39

Augmentin use

Answer 39

RTI, UTI, skin, UTI, bite wounds

Question 40

Keflex use

Answer 40

RTI, UTI, skin

Question 41

Ceftin use

Answer 41

RTI, UTI, skin

Question 42

Omnicef use

Answer 42

RTI, UTI, skin