B-Lactams

Question 1

B-Lactam Mechanism

Answer 1

Selectively interfere with bacterial cell wall synthesis

Question 2

Categories B-Lactam

Answer 2

• Penicillins
• Cephalosporins
• Carbapenems
• Monobactam

Question 3

Penicillins

Answer 3

• Bactericidal
• Penicillin G: Inactive against Gram (-)
• Interfere during transpeptidation; Inactivate PBPs

Question 4

Four classes of Penicillins

Answer 4

Standard (G, V, + PK)

Antistaphylococcal (Nafcillin, Oxacillin, Dicloxacillin)

Extended-Spectrum (Amoxacillin/Ampicillin)

Antipseudomonal (Piperacillin)

Question 5

Pen G

Answer 5

• Streptococci, enterococcus, P-susceptible pneumococci (Gram + Cocci)
• Neisseria (Meningococci) (Gram - Cocci)
  Gram Positive Bacilli: Bacillus anthracis; Listeria Monocytogenes; Corynebacterium
• Clostridium Perfringens
• Actinomyces Israeli
• Treponema Pallidum
• Leptospira

Question 6

Pen V

Answer 6

• Oral Pen G
• Phayngitis, Scarlet Fever, URI
• Children

Question 7

Benzthine Penicillin G

Answer 7

• B-Hemolytic streptococcal pharyngitis
• Sinusitis/Otitis due to strep/pneumococci
• Syphilis

Question 8

Antistaph Pens General

Answer 8

• B-Lactamase staphylococci

- Serious systemic staph infections (endocarditis, meningitis)

Question 9

Dicloxacillin

Answer 9

• Acid stable
• UTIs + RTIs
• 1 H before meals

Question 10

Amoxicillin/Ampicilin

Answer 10

Anaerobes, enterococcus, susceptible gram (-) cocci, and bacilli:

• E. Coli, Proteus, Haemophilus influenzae, Moraxella, PAsteurella, Shigella, Salmonella, Campylobacter fetus
• NOT Klebsiella, Enterobacter, Pseudomonas, Citrobacter, Serratia, and other gram (-) aerobes
• UTIs, Sinusitis, Otitis Media, Lower RTIs

Question 11

Piperacillin

Answer 11

• First Line Pseudomonas
• active against some gram (-) bacilli
• Combined with Taxobactom (Zosyn)

Question 12

Mechanism of acquired Pen resistance

Answer 12

1. Inactivation by B-Lactamase (Penicilinase)
2. Decrease Permeability via efflux pump in Gram -
3. Modification of Target PBPs (MRSA + resistant pneumococci)

Question 13

Pencilling administration

Answer 13

IV/IM: PenG, Naf, Oxa

PO: PenV, Diclox, Amox, + Augmentin

Either: Ampicillin
G
Depot: Benzathine PenG

Question 14

Pen Excretion

Answer 14

Renal Tubular excretion

Probenecid -> Inhibits tubular excretion + Prolongs

Nafcillin: Eliminated via biliary routes

Question 15

AE penicillins

Answer 15

• Hypersensitivity
• Diahhrea
• Nephritis
• Neurotoxicity
• Platelet dysfunction
• Superinfections

Question 16

Cephalosporin Generations affects

Answer 16

1: Gram Positive organisms
2-4: Improved activity against gram negative
5: Multidrug resistant Gram + Cocci

Question 17

First Generation Cephalosporins

Answer 17

• Cephalexin, Cefazolin, Cefadrozil
• Gram + Cocci (Strep, Stap, pneum)
• Others: Proteus, E. Col, and Klebsiella
• NOT: MRSA, Enterococcus, Pseudomonas, aeuginosa, enters a term Serratus, citrobacter, bacteroides
• Oral: UTI, Pneum, Otitis Media, minor infections
• Parenteral: Surgical pretreatment, Bone + endocarditis

Question 18

2nd Gen Cephalosorins

Answer 18

• Cefprozil, Cefuroxime, Cefaclor, Cefoxitin, Cefotetan
• Noncephmycins(NCM): Extended activity against Hem Inf, Moraxella Cat; NOT Serratia + Bacteroides
• Cephmycins(CM) (-Oxitin/-Otetan): Active against Bacteroides, C.Perf, Neis. Gon., and Serratia
• Clinical NCM: Oral for U/LRI; Skin infections; UTIs
• Clinical CM: Parenteral for Neis Gon.; Peritonitis/ diverticulitis

Question 19

3rd Gen Cephalosporins names

Answer 19

Ceftriaxone
Cefotaxime
Ceftazidime
Cefdinir
Cefixime
Ceftibuten
Cefpodoxime
Cefditoren

Question 20

BBB 3rd Gen Ceph

Answer 20

Cephtriaxone
Cephotaxime
Ceftazidime

Question 21

Cephtriaxone

Answer 21

• Gonorrhea, Chancroid, typhoid fever, Haemophilus meningitis, Pen-res Strep Pneum, Bacteremia, UTIs, RTIs, Bone infections, skin/ST infections

Question 22

Cepftazidime

Answer 22

• Pseudomonas
• UTIs, Meningitis, Bacteremiam pneumonia

*W/ Avibactam for complicated UTIs, pyelonephritis, Intrabdominal for PTs Under 18 YO

Question 23

Cefixime

Answer 23

1st line gonorrhea

Question 24

Cefdinir

Answer 24

• Most common 3rd gen prescribed
• RTIs, Skin infections
• Pediatrics (Taste)

Question 25

4th Generation (Cefepime)

Answer 25

• IV or IM
• INC resistance to chromosomal B-Lactamase (Enterobacter)
• Strep, Staph, Enterobacter, pseudomonas, Proteus, E. Coli, Klebsiella; HIGHLY against Haem., Mora, Neis, and PRPneumo/staph

Question 26

5th Gen Ceph

Answer 26

Ceftaroline

• IV Prodrug
• Multidrug resistant Staph (MRSA, VRSA, VISA)
• Enterococcis, Pneumococci, Strep, PEcK, Haem, Mora, Enterobacter

Question 27

CSF Ceph

Answer 27

4th: Ceftriaxone, Cefotaxime, Ceftazidime
5th: Cefepime

Question 28

Bone Ceph

Answer 28

Cefazolin

Question 29

Probenecid + Ceph

Answer 29

Inhibits tubular secretion of Cephs + Prolongs activity

Question 30

Bile excreted Cephs

Answer 30

Ceftriaxone

Question 31

AE Cephs

Answer 31

• Cross-allergenic w/ penicillins

- Cefotetan: Hypoprothrombopenia + Bleeding disorders; Disulfiram Rxn

Question 32

Carbapenems/Monopenem names

Answer 32

Imipenem
Meropenem
Doripenem
Ertapenem

Monopenem: Aztreonam

Question 33

Cabapenem General

Answer 33

• Imipeneem, Meropenem, + Doripenem: Broad spectrum for Gram +, Gream - rods and anaerobes; Resitant to most B-lactamases
• Ertapenem: NOT pseudomonas
• Empiric therapy; Enterobacter UTIs, RTIs, Pseudomonas,

Question 34

Imipenem use

Answer 34

• Inactivated by renal dehydropeptidase

- Combined with cilastatin for use

Question 35

Carbapenem AE

Answer 35

• Nausea, Vom, Diarrhea
• Seizures
• Pen Allergy

Question 36

Aztreonam

Answer 36

• Gram - Rods: PSeudomonal UTIs, Serratia, Enterobacter, E.Coli, Klebsiella Pneum
• Other clinical: Respiraoty symptoms in CF
• NOT activa against Gram + bcacteria or Anaerobes
• NO PEN cross-allergy
• IV/IM/Inhalation