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Pharmacology > B lactams and monobactam > Flashcards

B lactams and monobactam Flashcards

1
Q

What is the hallmark sign of infection?

A

fever, above 38C

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2
Q

What are noninfectious causes of fever?

A

malignancy, drug fever, blood transfusions

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3
Q

What is the level of leukocytosis?

A

4000-10,000 cells/mm

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4
Q

What does a low WBC in the setting of confirmed infection indicate?

A

poor prognosis

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5
Q

What are bacterial infections associated with?

A

elevated neutrophils and bands

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6
Q

What is associated with lymphocytosis?

A

viral infections, TB or fungal infection

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7
Q

What is empiric therapy?

A

directed against suspected organism before identification of the pathogen, outcomes will always be better if initial therapy was later found to provide adequate coverage

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8
Q

What is important in determining the right antimicrobial?

A

the PK, causative organism for site of infxn, host factors, drug factors, resistance

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9
Q

What is concentration dependent abx?

A

efficacy and extent of killing is directly related to the [drug] compared to the MIC, give higher doses less frequently

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10
Q

What is time dependent abx?

A

efficacy and extent of killing is directly to time the [drug] is greater than MIC, give lower doses more frequently

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11
Q

When using combo abx, what are the effects?

A

synergy, additive, antagonist

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12
Q

What does date support for treatment of pseudomonas?

A

double empiric coverage- always use different classes, 1 time dependent 1 concentration dependent

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13
Q

Natural PCNs options

A

penicillin G, penicillin benzathine, penicillin VK

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14
Q

Aminopenicillin options

A

ampicillin, amoxicillin (amoxil)

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15
Q

penicillinase resistant PCNs (anti-staphylococcal)

A

nafcillin, dicloxacillin, oxacillin

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16
Q

Carboxypenicillins

A

ticarcillin

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17
Q

Ureidopenicillins

A

piperacillin

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18
Q

B lactamase inhibtors

A

taxobactam, sulbactam, clavulanate

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19
Q

B lactam/B lactamase inhibitor combos

A

piperacillin/tazobactam (Zosyn), ampicillin/sulbactam (Unasyn), amoxicillin/clavulanate (augmentin)

20
Q

What is MOA of penicillins

A

inhibition of bacterial cell wall synthesis by binding to and inactivating binding proteins

21
Q

What account for penicillin antimicrobial activity

A

the B lactam ring

22
Q

What are the pk of penicillin

A

time dependent, rapid bactericidal, short T1/2, onlly penetrates CNS in inflamed meninges, renally eliminated

23
Q

Spectrum of natural penicillins

A

viridans strep, Group A strep, S. pneu, neisseria meningitidis, oral anaerobes, trepnema pallidum, clostridium

24
Q

What do natural penicillins not cover?

A

staphlococcus since most staph produce A beta lactamase

25
Q

Clinical uses of natural penicillins?

A

s. pneu, syphilius, prophylactic dental procedures, oral anaerobes, labor and delivery, strep pharyngitis

26
Q

Anti-staphlococcal penicillin spectrum of activity

A

penicillinase resistant, MSSA

27
Q

What do anti-staphlococcal penicillins not cover?

A

MRSA, not as good for strep, no gram -

28
Q

Clinical use of anti-staphlococcal penicillins

A

any infection with confirmed MSSA, skin, bacteremia, pneu, osteoarthritis, septic arthritis

29
Q

Spectrum of aminopenicillins

A

gram +, DOC for enterococci and listeria, adds gram - coverage not seen with naturals, H. influenzae, E. coli, proteus mirabilis, salmonella, shigella

30
Q

Clinical use aminopenicillins

A

upper RTI, dental prophylaxis, enteroccal UTI, endocarditis, Meningitis

31
Q

What do aminopenicillins not cover?

A

alone, they do not cover S. Aureus

32
Q

Aminopenicillins PK

A

decreases effectiveness of birth control pills, amoxicillin better absorbed than ampicillin so higher doses of ampicillin required, ampicillin penetrates inflamed meninges

33
Q

Beta lactamase inhibitors antimicrobial activity

A

alone do not have antimicrobial activity, gives stability to other penicillins, provides additional activity against anaerobes

34
Q

What SE is high in beta lactamase inhibtors

A

abx associated diarrhea

35
Q

Aminopenicillins+ B lactamase inhibitor spectrum

A

improves activity against H influ, e coli, proteus mirabilis, s aureus (MSSA), moraxella catarrhalis, anaerobes

36
Q

Clinical use of aminopenicillins + B lactamase inhibitor

A

abd infxn (anaerobes, gram -, enterococcus)

37
Q

Clinical use of augmentin

A

otitis media, sinusitis, chronic bronchitis, skin and soft tissue, lower resp tract infxn, human or animal bite

38
Q

Clinical use of Ampicillin/sulbactam (Unasyn)

A

otitis media sinusitis, chronic bronchitis, skin and soft tissue, lower RTI, human or animal bite, better for enterococci

39
Q

Spectrum of carboxypenicillins

A

pseudomonas, drug resistant proteus, morganella, enterobacter, MSSA, anaerobes, enterobacteriasceae

40
Q

Clinical use of carboxypenicillins

A

multi-drug resistant gram -, many conditions, IV only

41
Q

Dose of Zosyn

A

IV 3.375 gm Q 6hrs

42
Q

Spectrum of ureidopenicillins

A

even more broad spectrum than carboxypenicillins, better reliability against klebsiella, serratia, enterobacter, enterobacteriaeceae, enterococcus faecalis, pseudomonas, MSSA

43
Q

What is the DOC against pseudomonas

A

piperacillin/tazobactam (Zosyn)

44
Q

Clinical use of ureidopenicillins

A

Multi-drug resistant gram -, many conditions

45
Q

What is the drug of choice for empiric therapy for any severe infection?

A

Ureidopenicillins, Zosyn

46
Q

ADRs of penicillins

A

N/V/D, rash, allergic rxns, hematologic effects, seizures

Pharmacology (61 decks)

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