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pharm > Antimicrobials: PCNs/BLI > Flashcards

Antimicrobials: PCNs/BLI Flashcards

1
Q

Penicillins are what type of antibiotics?

A

cell wall active

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2
Q

Penicillins are what type of antibiotics?

A

cell wall active, beta lactam.

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3
Q

Penicillin MoA

A

Disrupts bacterial cell wall formation by inhibiting certain enzymes which create cross-linking, resulting in cell lysis and cell death.

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4
Q

Dose adjustments for PCNs (2)

A
  • dose adjust for CrCl < 50 ml/min

- may need hepatic adjustment

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5
Q

what do dose adjustments for PCN look like?

A

More often extending the interval between doses rather than decreasing the dose.

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6
Q

spectrum of activity for PCNs

A

mostly gram positive

some have gram negative activity

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7
Q

5 classes of penicillins

A
  • natural
  • aminos
  • pennicillinase resistant (aka anti staph)
  • ureidos (aka anti pseudomonal)
  • beta lactamase inhibitors
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8
Q

adverse events: PCNs (4)

A

hypersensitivity
neutropenia
interstitial nephritis
CNS toxicity (seizures)

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9
Q

caution of PCN use in the longterm

A

neutropenia

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10
Q

interstitial nephritis in PCN use

Symptoms and action

A

inc BUN
inc creatinine
inc in eiosiniphils
potential fever

will have to stop the drug.

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11
Q

absorption of PCNs is hindered by

A

susceptible to first pass effect

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12
Q

peak concentration of PCNs

A

1-2 hours

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13
Q

half life of PCNs

A

short

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14
Q

distribution of PCN

A

widely distributed to tissues/fluids

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15
Q

metabolism of PCNs

A

none to minimal hepatic metabolism

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16
Q

elimination of PCN (2)

A

kidneys

some biliary

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17
Q

natural PCNs are indicated for what organisms? (4)

A
  • streptococcal
  • enterococcus
  • t. pallidum

-some anaerobes like peptococcous / peptostreptococcus

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18
Q

natural penicillin drugs (4)

A

PCN G
PCN V
procaine PCN
benzathine PCN

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19
Q

distribution sites of PCNs (6)

A 
lungs
ascites
synovium
pericardium
ascitic fluid
soft tissues
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20
Q

drug of choice for Treponema pallidum (ie: syphilis)

A

natural PCN

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21
Q

natural PCN dose adjustment

A

for CrCl <50

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22
Q

Natural PCN is the drug of choice for (2)

A

syphilis

Strep

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23
Q

aminopenicillins MoA/activity

A

Same as natural PCN + extended gram negative spectrum.

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24
Q

Aminopenicillins do not do well with treating

A

Staph

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25
Q

Aminopenicillins are more active against ______ than other PCNs.

A

Enterococcus

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26
Q

drug examples of aminopenicillin (2)

A

amoxicillin

ampicillin

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27
Q

important point about aminopenicillins

A

they are not very beta lactamase stable and frequently are targeted by beta lactamase released by bacteria,

28
Q

distribution of aminopenicillins (4)

A

renal tissue
septic joints
ascites
CSF (if inflamed meninges)

29
Q

aminopenicillin is the drug of choice for?

A

for sensitive enterococcal infections.

30
Q

when circumstance may aminopenicillin be warranted?

A

UTIs while pregnant.

31
Q

penicillinase resistant PCNs (anti staph PCNs) are clinically effective for

A

staphylococcus aureus ***
streptococcal
peptrostreptococcal

32
Q

Penicillinase resistant PCN (anti staph) drug examples (3)

A

oxacillin
nafcillin
dicloxacillin

33
Q

Penicillinase resistant PCNS (anti staph) gram activity

A

gram positive only. no gram neg activity.

34
Q

Penicillinase resistant PCNs (anti staph) distribution

A 
bone
joint
cardiac tissue (endocarditis)
35
Q

Penicillinase resistant PCNs (anti staph) are the drug of choice for

A

MSSA

methicillin sensitive S aureus infections

36
Q

Why are Penicillinase resistant PCNs (anti staph) the drug of choice against MSSA?

A

Their structure prevents the B-lactamase made by S. aureus from attacking the B-lactam nucleus.

37
Q

Penicillinase resistant PCNs (anti staph) dosing and half life

A

very short half life

give q4 hrs

38
Q

Penicillinase resistant PCNs (anti staph) dosage adjustment

A

for severe hepatic impairment

39
Q

drawback of nafcillin, a Penicillinase resistant PCNs (anti staph)

A

large sodium content when given IV

40
Q

elimination of Penicillinase resistant PCNs (anti staph)

A

hepatic, not renal

41
Q

Penicillinase resistant PCNs (anti staph) in the renal patient

A

safe b/c this drug is eliminated by the liver

42
Q

Ureidopenicillins (Anti Pseudomonal PCNs) product

A

piperacillin

43
Q

Ureidopenicillins (Anti Pseudomonal PCNs) known as Piperacillin is indicated in

A

gram negatives:
pseudomonas
bacteroides

44
Q

Ureidopenicillins (Anti Pseudomonal PCNs) known as Piperacillin may also be used for

A

some enterococcal

45
Q

Ureidopenicillins (Anti Pseudomonal PCNs) known as Piperacillin works against aerobes or anaerobes?

A

Mainly aerobes

slight coverage of anaerobes

46
Q

Ureidopenicillins (Anti Pseudomonal PCNs) known as Piperacillin and staphylococcus

A

no efficacy

47
Q

beta lactamase stability of Ureidopenicillins (Anti Pseudomonal PCNs) known as Piperacillin

A

piperacillin not very beta lactamase stable.

48
Q

piperacillin is always given with what and why?

A

a BLI (beta lactamase inhibitor)

49
Q

Ureidopenicillins (Anti Pseudomonal PCNs) known as Piperacillin distribution

A

pleural
ascities
wounds

50
Q

dose adjustment for Ureidopenicillins (Anti Pseudomonal PCNs) known as Piperacillin

A

dose adjust for CrCl <50mL/min

51
Q

Beta-Lactam/Beta Lactamase Inhibitors active against

A

H influenza
M Catarrhalis
N gonorrhoeae
B fragilis

52
Q

Beta-Lactam/Beta Lactamase Inhibitors gram activity

A

gram negative (including anaerobes) and gram positive

53
Q

Beta-Lactam/Beta Lactamase Inhibitors are very useful in what two scenarios

A

“mixed” infections

or broad empiric coverage as a single agent

54
Q

Beta-Lactam/Beta Lactamase Inhibitors - how do they work?

A

Act as a decoy against the beta lactamase being produced by organism. BLIs block the attack on the B lactam nucleus by absorbing the attack themselves, thus allowing binding to transpeptidase enzymes and disruption of cell wall formation. They have no antimicrobial activity.

55
Q

Beta-Lactam/Beta Lactamase Inhibitors examples

A
  • Ampicillin/Sulbactam
  • Amoxicillin/Clavulnic Acid
  • Pipercillin/Tazobactam
56
Q

Beta-Lactam/Beta Lactamase Inhibitors distribution

A

high

57
Q

Beta-Lactam/Beta Lactamase Inhibitors dose adjustment

A

CrCl < 50 mL/min

58
Q

Piperacillin/Tazobactam is the only combo indicated for

A

psuedomonas

59
Q

Amoxicillin/Clavulanic Acid (Augmentin) main side effect

A

diarrhea

60
Q

General monitoring for PCNs

A

C&S
CBC c diff
LFTs
RFTs

61
Q

Pregnancy and lactation considerations for PCNs (3)

A

Category B
Crosses Placenta
Excreted in milk

62
Q

What population is most susceptible to the side effects of PCNs?

A

newborns and geriatric

63
Q

Which natural PCN requires hepatic dose adjustment?

A

PCN G

64
Q

In general, PCNs are great against

A

staph
strep
& some PCNs have broader activity

65
Q

likely to see interstitial nephritis in what combo?

A

PCN with vanco

pharm (31 decks)

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