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Therapy > Beta-Lactam > Flashcards

Beta-Lactam Flashcards

1
Q

Beta-Lactam Class

A
  1. Penicillins
  2. Cephlosporins
  3. Cephamycins
  4. Carbapenems
  5. Monobactam
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2
Q

Beta-Lactam Mechanism

A
  1. The β-lactam binds to a penicillin binding protein (PBP)
  2. PBP can no longer crosslink peptidoglycan chains
  3. The bacteria are unable to synthesize a stable cell wall
  4. The bacteria are lysed à bacteria died.
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3
Q

Beta-Lactam Pharmacokinetics/Dynamics

A
  1. Time-dependent” killers
  2. %T > MIC
  3. Bactericidal
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4
Q

What is Time-dependent” killers?

A

Effect is optimized based on the amount of time the antibiotic concentration (at infection site) is above the pathogen’s MIC (%T > MIC)

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5
Q

Penicillins Classes

A
  1. Natural
  2. Aminopenicillin
  3. Anti-Staphyllococcal
  4. Anti-Pseudomonal
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6
Q

Penicillin Characteristic

A
  1. Very short half-lives (<2 hours)
  2. Must dose frequently
  3. Cause hypersensitivity reactions
  4. Relatively poorly absorbed and can lead to diarrhea when oral therapy is needed
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7
Q

Streptococcus Hemolysis

Alpha

A

Partial hemolysis, reduction in Hb=green appearance (e.g. “Viridans”)

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8
Q

Streptococcus Hemolysis

Gamma

A

Non-hemolytic

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9
Q

Streptococcus Hemolysis

Beta

A

Complete lysis by hemolysin Toxins (e.g. “Lancefield”)

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10
Q

Natural Penicillins Classes

A
  1. PCN G
  2. PCN G benzathine
  3. PCN G procaine
  4. PCN VK
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11
Q

PCN V is the ____ form of PCN G.

A

Oral

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12
Q

What is the dosage form of PCN G benzathine and PCN G procaine?

A

IM

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13
Q

What is the dosage form of PCN G?

A

IV

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14
Q

Natural PCN Spectrum

A
  1. Beta-hemolytic Streptococci (e.g. pharyngitis)
  2. Alpha-hemolytic Streptococci (note next slide re: S. pneumoniae)
  3. Enterococcus sp.(note next slide)
  4. Oral anaerobes – Peptostreptococcus, Actinomyces sp. etc.
  5. Treponema pallidum (Syphillis)
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15
Q

Is Streptococci gram - or +?

A

gram +

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16
Q

Is Enterococcus gram - or +?

A

gram +

17
Q

Is Treponema pallidum gram - or +?

A

gram -

18
Q

What are the two oral anaerobes?

A
  1. Peptostreptococcus

2. Actinomyces

19
Q

Natural Penicillin Spectrum Cautions: What are the 3 bacteria?

A
  1. Pneumococcus (Streptococcus pneumoniae)
  2. Enterococcus
  3. Neisseria meningitidis & gonorrhoeae
20
Q

Natural Penicillin Spectrum Cautions: Pneumococcus (Streptococcus pneumoniae)

A

About 30% PCN resistant, 15% intermediately sensitive (PBP alteration). Not typically first line without susceptibility information in populations at-risk for resistance

21
Q

Natural Penicillin Spectrum Cautions: Enterococcus

A

Resistance increasing, but remains drug of choice if susceptible

22
Q

Natural Penicillin Spectrum Cautions: Neisseria meningitidis & gonorrhoeae

A

Increased prevalence of resistance due to beta-lactamase production. Do not use empirically for treatment in absence of susceptibility data.

23
Q

Natural Penicillin

Typical GI side effects

A

Diarrhea

most common, may use probiotic

24
Q

Natural Penicillin Notable Adverse Reactions

A
  1. Non-allergic rash
25
Q

Natural Penicillin

DDI

A

Methotrexate (MTX)

26
Q

Natural Penicillin increases or decreases methotrexate level of toxicity?

A

Increases
1. If using methotrexate as DMARD (rheumatoid arthritis, low dose) once weekly, likely safe, but should monitor for signs of MTX toxicity. Myelosuppression, increased N/V/D, increased LFTs

27
Q

Avoid penicillins (including piperacillin) if patient is on methotrexate for______ indication (______ dose).

A

Oncology/ High

28
Q

Penicillin G benzathine and Penicillin G procaine are 2 IM dosage forms. What is one clinical issue with these forms?

A

Medication error potential. Do not give IV.

29
Q

Aminopenicililn Classes

A
  1. Ampicillin

2. Amoxicillin

30
Q

Aminopencillin Spectrum

A
  1. Gram + bacteria
  2. Enteric gram - (if sensitive)
  3. Respiratory tract gram -
  4. Pasteurella multocida
  5. Listeria monocytogenes
31
Q

Aminopencillin Spectrum: name 2 gram (+) bacteria.

A
  1. Streptococci

2. Enterococci

32
Q

Aminopencillin Spectrum: name 4 enteric gram (-) bacteria.

A
  1. E. coli
  2. Proteus
  3. Salmonella
  4. Shigella
33
Q

Aminopencillin Spectrum: name 2 respiratory tract gram - bacteria.

A
  1. Haemophilus influenzae

2. Moraxella morganii

34
Q

Aminopencillin Spectrum Cautions: Haemophilus influenzae

A

Beta-lactamase production in about 30-40% of clinical isolates

35
Q

Is Haemophilus influenzae gram (-) or (+)?

A

gram (-)

36
Q

How can one overcome Beta-lactamase production of Haemophilus influenzae?

A

By combining with beta-lactamase inhibitor

37
Q

Aminopencillin Spectrum Cautions: Enteroccocus

A

Bacteriostatic if monotherapy

38
Q

How can one overcome Bacteriostatic of Enterococcus?

A

Add gentamicin for synergy to create bactericidal regimen

39
Q

Aminopenicillin clinical issue: Ampicillin

A

Very poor absorption

Therapy (1 decks)

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