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Therapeutics 3 > Beta Lactam Antibiotics > Flashcards

Beta Lactam Antibiotics Flashcards

1
Q

What is the MOA of beta lactam antibiotics?

A

interferes with bacterial cell wall synthesis, time dependent killing (high concentration of drug not needed)

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2
Q

What are the main uses of Natural Penicillins?

A

overall activity: gram (+)&raquo_space;> gram (-)
-streptococci infections (groups a, b, c, f, g)
-mouth anaerobes (dental procedures)
-DRUG OF CHOICE for syphilis (treponema pallidum)
-streptococcus pneumoniae (not the best empiric choice, but could be used in targeted therapy if found susceptible)

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3
Q

Describe the Distribution of Natural Penicillins:

A

widely distributed throughout the body

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4
Q

What are the adverse effects of Natural Penicillins?

A

-rash
-anaphylaxis
-FEVER
-seizures
-GI upset (N/V)

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5
Q

What drugs are Natural Penicillins?

A

penicillin G (IV), penicillin VK (oral), penicillin benzathine/procaine (IM)

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6
Q

What drugs are Aminopenicillins?

A

ampicillin (IV/PO), amoxicillin (PO)

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7
Q

What are the main uses of Aminopenicillins?

A

-similar to natural penicillins= strep activity, mouth anaerobes
- ADDS enterococcus (not used for empiric therapy, but is first line for directed therapy)
-streptococcus pneumoniae
-ADDS gram (-): H. influenzae, E. coli, Proteus, Salmonella, Shingella
-drug of choice for listeria (ampicillin)

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8
Q

How are aminopenicillins eliminated?

A

renally eliminated, dose adjustments may need warranted

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9
Q

What drugs are aminopenicillin + beta lactamase inhibitor combinations?

A

ampicillin + sulbactam (IV), amoxicillin + clavulanate (PO)

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10
Q

What are the main uses of aminopenicillin + beta lactamase inhibitor?

A

-gram positive: adds MSSA
-gram negative: more reliable PEK (proteus, E. coli, klebsiella spp. not klebsiella aerogenes), sulbactam has activity against Acinetobacter spp.
-gut anaerobes (due to beta lactamase inhibitors
-often used to treat infection caused by animal bites

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11
Q

What are the adverse drug effects of aminopenicillins?

A

-rash/allergic reactions
-fever
-seizures (secondary to drug accumulation due to renal insufficiency)

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12
Q

What are the adverse drug reactions of aminopenicillins + beta lactamase inhibitors?

A

same SE as aminopenicillins (rash/allergic reaction, fever, seizures)
the addition of the beta lactamase inhibitor adds extended spectrum leading to increased GI side effects

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13
Q

What drugs are anti-pseudomonal penicillins?

A

piperacillin + tazobactam (IV)

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14
Q

What are the main uses of anti-pseudomonal penicillins?

A

-gram positive: streptococcus, enterococcus
-gram negative: more stable against “SPACE” bugs (serratia spp, pseudomonas spp, acinetobacter spp, citrobacter spp, enterobacter spp. including klebsiella aerogenes)
-gut anaerobes
-often used as empiric therapy for hospital/health system associated infections where multi-drug resistant gram negative organisms (especially pseudomonas spp) are suspected: febrile neutropenia, SIRS/sepsis, pneumonia, urinary tract infection/kidney infection, intra-abdominal infection

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15
Q

What are the adverse drug reactions of anti-pseudomonal penicillins?

A

-rash (steven-johnson syndrome)/allergic reaction
-C. diff
-fluid adjustment due to large amount of sodium
-fever
-interstitial nephritis (AKI)

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16
Q

What drugs are anti-staphylococcal penicillins?

A

nafcillin (IV, IM), oxacillin (IV), dicloxacillin (oral), pivmecillinam (PO)

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17
Q

What are the main uses of anti-staphylococcal penicillins?

A

-MSSA
-group A streptococcus
-dicloxacillin= skin infection
-nafcillin/oxacillin= systemic infections (bacteremia/endocarditis/osteomyelitis), nafcillin may be specifically used for CNS infections

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18
Q

What are the adverse drug reactions of anti-staphylococcal penicillin?

A

-rash/allergic reaction
-fever
-interstitial nephritis (nafcillin, oxacillin, dicloxacillin)

19
Q

What is the main use of Pivmecillinam?

A

only approved for the use of uncomplicated UTI caused by susceptible isolates of E.coli, Proteus, Staph saprophyticus
has activity against ESBL producing organisms

20
Q

What are the 5 general rules of cephalosporin generations?

A

-streptococcus activity increases with generation
-staph (MSSA) activity decreases with generation
-staph (MRSA) activity only exists in 5th generation
-cephalosporins have NO ACTIVITY against enterococcus
-gram negative activity increases with generation

21
Q

What is the drug of choice for syphilis (Treponema pallidum)?

A

natural penicillin (penicillin benzathine)

22
Q

What is the drug of choice for Listeria?

A

aminopenicillins (ampicillin/amoxicillin)

23
Q

What is that main uses of 1st generation cephalosporins?

A

-streptococcus spp (unreliable for strep pneumoniae)
- MSSA
-PEK (proteus, e.coli, klebsiella)

24
Q

What drug is used prior to GI surgeries to prevent infection?

A

cefazolin (1st generation cephalosporin)

25
Q

What drugs are 1st generation cephalosporins?

A

cephalexin (oral), cefazolin (IV), cefadroxil (oral)

26
Q

What is the main uses of 2nd generation cephalosporins?

A

-streptococcus, including strep pneumoniae
-gram negative: H. influenzae, Moraxella catarrhalis, Neisseria + PEK (HNPEKM)

27
Q

What drug can cause decreased Vitamin K dependent clotting factor?

A

cefoxitin, use caution in combination with warfarin

28
Q

What drugs are 2nd generation cephalosporins?

A

cefaclor (oral), cefuroxime (IV, oral), cefprozil (oral), cefoxitin (IV)

29
Q

What 3rd generation cephalosporin has pseudomonas activity?

A

ceftazidime

30
Q

What drugs are 3rd generation cephaosporins?

A

ceftriaxone, cefotaxime, ceftazidime (IV)

31
Q

What are the main uses of 3rd generation cephalosporins?

A

-streptococcus spp, including strep pneumoniae
-HNPEKM
-increased gram negative to add Serratia, Shingella, Salmonella, Morganella, Providencia
-ceftazidime adds pseudomonas activity

32
Q

What 3rd generation cephalosporin is excreted via biliary excretion?

A

ceftriaxone, avoid use in neonate patients

33
Q

Why should Ceftriaxone not be infused at the same time as IV calcium?

A

precipitation

34
Q

Describe the distribution of 3rd generation cephalosporins?

A

widely distributed

35
Q

What beta lactamase drugs can treat Extended Spectrum Beta Lactamase bugs?

A

-cephalosporins + beta lactam inhibitors
-carbapenems

36
Q

What drugs are 4th generation cephalosporin?

A

cefepime

37
Q

What are the main uses of 4th generation cephalosporins?

A

-streptococcus spp, including strep pneumoniae
-MSSA
-HNPEKM
-gram negative: Serratia, Acinetobacter, Citrobacter, Enterobacter (also klebsiella aerogenes), Shingella, Salmonella, Morganella, Providencia
-Pseudomonas

38
Q

What are the significant adverse drug effects of 4th generation cephalosporin, cefepime?

A

neurotoxicity, possible seizures

39
Q

What drugs are 5th generation cephalosporins?

A

ceftaroline, ceftobiprole

40
Q

What are the main uses of 5th generation cephalosporins?

A

-streptococcus spp, including strep pneumoniae
-MSSA +MRSA
-HNPEKM
-loses some gram negative activity from previous generation, but retains: enterobacter, morganella

41
Q

What is the use of Cefiderocol?

A

-PEK
-acinetobacter baumannii and pseudomonas aeruginosa
-carbapenemase producing organisms

42
Q

What drug should not be taken with valproic acid or its derivatives?

A

carbapenems

43
Q

What Carbapenems have activity against Pseudomonas?

A

-imipenem + cilastatin
-meropenem
NOT ertapenem

44
Q

What is the main uses of Carbapenems?

A

-streptococcus spp, including strep pneumoniae
-MSSA
-mouth anaerobes
-excellent gram negative: HNPEKM, Serratia, Citrobacter, Enterobacter, imipenem & meropenem have pseudomonas activity
-gut anaerobes

Therapeutics 3 (14 decks)

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