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respiratory med > Beta lactam drugs > Flashcards

Beta lactam drugs Flashcards

1
Q

penicillin G

A

IV, IM

natural and has a narrow spectrum but potent and effective

Effective against
Gram + cocci : Strep. pneumoniae, Strep. pyogenes, strep. viridian’s group

Spirochetes : treponema pallidum (syphilis)

Gram - Cocci : Neisseria meningitides

certain gram + anaerobic species: Clostridum perfringens

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2
Q

Penicillin V

A

P.O., stable at gastic, acidic pH

natural and has a narrow spectrum but potent and effective

Effective against
Gram + cocci : Strep. pneumoniae, Strep. pyogenes, strep. viridian’s group

Spirochetes : treponema pallidum (syphilis)

Gram - Cocci : Neisseria meningitides

certain gram + anaerobic species: Clostridum perfringens

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3
Q

Methicillin

A

Discontinued for clinical use but is one of the strongest Beta lactase so its used for laboratory testing of bacterial sensitivity

was clear renaly and causes interstitial nephritis

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4
Q

Oxacillin

A

Anti-staphlococcal drug that is given PO.

cleared via the renal and biliary method. can cause hypersensitivity

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5
Q

Dicloxacillin

A

anti-staphylococcal drug that is given PO.

Excreted via renal and biliary pathway

can cause hypersensitivity

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6
Q

Nafcillin

A

Anti-Staphylococcal drug that is given IV or PO

Given in inpatient settings, cleared through hepatic and biliary pathway.

Causes P450 induction and can lead to hypersensitivity.

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7
Q

Ampicillin + sulbactam

A

An extended spectrum drug that has a beta lactam inhibitor ( sulbactam).

Given IV

clinical indications
(gram +)
Strep. pneumoniae, strep. pyogenes, strep viridans, enterococci, Listeria monocytogenes (gram + bacilli).

(Gram - )
H. Influenza,
E. coli
Proteus mirabilis.

Brand name: Unasyn

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8
Q

Amoxicillin + clavulanic acid

A

called augmentin.

A extend spectrum drug that uses clavulanic acid to inhibit beta lactase.

absorption approached 100% and therefore can’t be used for gut bugs like nigella and salmonella.

clinical indications
(gram +)
Strep. pneumoniae, strep. pyogenes, strep viridans, enterococci, Listeria monocytogenes (gram + bacilli).

(Gram - )
H. Influenza,
E. coli
Proteus mirabilis.

this drug is given PO

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9
Q

Ticarcillin + clavulanic acid

A

Given IV and is a Anti-Pseudomonal drug

Pseudomonus aeruginosa (gram - rod) -> opportunistic pathogen that is hard to treat. it happens in burn patients, cystic fibrosis, drug users, immunosuppressed patients.

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10
Q

Pipericillin + tazobactam

A

A Anti-pseudomonal drug that is given IV That is most potent. Has a beta lactam inhibitor in it called Tazobactam.

Pseudomonus aeruginosa (gram - rod) -> opportunistic pathogen that is hard to treat. it happens in burn patients, cystic fibrosis, drug users, immunosuppressed patients.

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11
Q

penicillin elimination

A

renal and tubular secretion

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12
Q

Penicillin adverse effects

A

Hapten of drug reacts with protein to make a Hapten-protein antigen. can cause allergy/ ANAPHYLAXIS in sensitized host.

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13
Q

penicillin resistance

A

this is because of bacteria that have a beta lactamase that cleaves the lactam ring making them useless to stop cross linking.

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14
Q

penicillin resistant Staph Aureus drugs

A

Methicillin, Nafcillin, Oxacillin, Dicloxacillin.

Have chemical appendages that make beta lactamase hard to cleave.

used in penicillin resistant staph aureus but Methicillin sensitive. (MSSA)

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15
Q

MRSA.

A

the methacilin resistance is caused by alteration of the mec A gene and PBP2 (not caused by Beta-lactamase enzymes)

Treatment is Vancomycin

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16
Q

Vancomycin

A

inhibit glycopeptide cell wall systhesis by binding D-ala-D-ala and hindering transglycosylation and transpeptidation.

this drug is used for MRSA and MRSE (methicillin resistant S. Epidermis).

there has also been use for enterococci; E. faecalis and E. faecium

Important to know that you can use Vanco for C. difficile infections via oral administration.

DOSENT COVER GRAM ( - ) ORGANISMS.

Will distribute into CNS if inflamed meninges.

slow onset (60-90 min)

Not absorbed in the GI (why we give IV; and oral if we want to treat a GI bug “c. diff”)

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17
Q

Teicoplanin

A

inhibit glycopeptide cell wall systhesis by binding D-ala-D-ala and hindering transglycosylation and transpeptidation.

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18
Q

Cause of Vacomyocin resistance

A

This is caused by the switching if D-ala to D-lactate. Because vanco inhibits cell wall synthesis by inhibiting transflycosylation and transpeptidaition.

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19
Q

Vanco adverse effects

A

vanco induced eruytroderma or shock

Nephrotoxicity and ototoxicity (now rare because of better drug production)

rash

phlebitis at injection site.

20
Q

Aminopenicilins

A

ampicillin and amoxicillin

extends the use of penicillin to gram ( - ) organisms. -> enter cell via porins and bind to PBP in periplasm

21
Q

Beta lactamase inhibitors

A

Sulbactam, clavulanic acid, and tazobactam

don’t have any antibiotic effect just prevent the drug from being degraded.

22
Q

treatment for neutropenic fever

A

Give both ticarcillin and pipericillin

23
Q

cephalosporins

A

have mechanisms related to beta lactams.

24
Q

Grade 1-3 cephalosporins are ineffective against

A 
Listeria monocytogenes
legionella spp. 
Atypical mycoplasma 
MRSA
Enterococci
25
Q

Cefazolin

A

Grade 1 cephalosporin

Given parenteral, IV and IM

Important that it penetrated well into bone. Used in diabetic people with amputation.

Works against Gram + cocci, streptococci and staph Aureus.

NOT ACTIVE AGAINST. MRSA, MRSE, Enterococci.

given for surgical prophylaxis against skin flora like S. aureus and S pyogenes.

26
Q

Cephalexin

A

Grade 1 cephalosporin

Given PO

Important that its given twice daily for pharyngitis.

Works against Gram + cocci, streptococci and staph Aureus.

NOT ACTIVE AGAINST. MRSA, MRSE, Enterococci.

given for surgical prophylaxis against skin flora like S. aureus and S pyogenes.

27
Q

Cephradrine

A

Grade 1 cephalosporin

Given PO or parenteral

Works against Gram + cocci, streptococci and staph Aureus.

NOT ACTIVE AGAINST. MRSA, MRSE, Enterococci.

given for surgical prophylaxis against skin flora like S. aureus and S pyogenes.

28
Q

Cefoxitin

A

A grade 2 cephalosporin

Given IV and IM

works against anaerobes like B. fragilis

less active than grade 1 but has ENHANCED gram ( - ) activity eg. E. coli, Klebsiella, H. Influenza, Moraxella cattharalis, Proteus spp.

Used if there are facultative gram - bacteria and anaerobes are likely pathogens.

29
Q

Cefotetan

A

A grade 2 cephalosporin

Given IV and IM

works against anaerobes like B. fragilis

less active than grade 1 but has ENHANCED gram ( - ) activity eg. E. coli, Klebsiella, H. Influenza, Moraxella cattharalis, Proteus spp.

Used if there are facultative gram - bacteria and anaerobes are likely pathogens.

reduces vitamin K bacteria leading to hypoprothrombinemia and bleeding. -> be careful with warfarin patients.

30
Q

Cefaclor

A

A grade 2 cephalosporin

Given PO

Used in SERUM SICKNESS

less active than grade 1 but has ENHANCED gram ( - ) activity eg. E. coli, Klebsiella, H. Influenza, Moraxella cattharalis, Proteus spp.

Used if there are facultative gram - bacteria and anaerobes are likely pathogens.

31
Q

Cefuroxime Axetil

A

A grade 2 cephalosporin

Given PO

this drug is a poor substrate for Beta Lactamase. (helps prevent resistance)

less active than grade 1 but has ENHANCED gram ( - ) activity eg. E. coli, Klebsiella, H. Influenza, Moraxella cattharalis, Proteus spp.

Used if there are facultative gram - bacteria and anaerobes are likely pathogens.

32
Q

Ceftriaxone

A

Grade 3 Cephalosporin

Has good Gram + and - coverage and penetrates into privileged areas of the body.

Used in Neisseria gonorrhea infections thats penicillin resistant.
penetrates CSF and bone.

Recommend in lyme disease involving the central nervous system or joints.

Biliary clearance.

33
Q

Cefotaxime

A

Grade 3 cephalosporin

has good gram + and - coverage.

enters the CSF and is USEFUL FOR MENINGITIS due to H. influenza, S. pneumonia, N. Meningitidis.

34
Q

Cetazidime

A

Grade 3 cephalosporin

ACTIVE against PSEUDOMONAS AERUGINOSA. good for serious infections when the organism is resistant to the anti-pseudomnal penicillins or is allergic to penicillin.

often given in combination with amino glycoside (tobramycin) in serious pseudomonus infections.

has good gram + and - coverage.

35
Q

Cefaperazone

A

Grade 3 cephalosporin

Good gram - and + coverage

causes disulfiram like alcohol intolerance.

ACTIVE against PSEUDOMONAS AERUGINOSA.

reduces vitamin K bacteria leading to hypoprothrombinemia and bleeding. -> be careful with warfarin patients.

36
Q

Cefepime

A

Grade 4 cephalosporin

Given both IV and IM

Has gram + activity like grade 1 and extended gram - activity like grade 3

insensitive to many Beta lactamase organisms.

Excellent penetration int o the CSF

can be used for H. influenza, N. gonorrhea and meningitidis. Also good for pseudomonas aerudinosa.

37
Q

Adverse effects of cephalosporins

A

Hypersensitivity

  • Immediate with bronchospasm, anaphylaxis, urticaria.
  • Delayed -> rash

there is a correlation in 1-2% of penicillin allergy patients. for this reason we want to avoid a cephalosporin in a patient that just had a hypersensitive traction of penicillin

38
Q

Monobactam drug

A

Aztreonam

39
Q

Aztreonam

A

a Monobactam drug

used to substitute for extended spectrum penicillin or gen 3,4 cephalosporins (if contraindicated because of hypersensitivity)

SAFE ALTERITIVE FOR PENICILLIN ALLERGY PATIENTS.

safe alternative for aminoglycocides in patents with renal problems.

given parenteral IV, IM

synergistic with aminoglycosides.

40
Q

Carbapenem class drugs

A

Imipenem/ cilastatian
Meropenem
ertapenem

have the BROADEST spectrum available.

have important role in empiric therapy

not commonly degraded by Beta lactamase.

administered IV with excellent penetration into tissues and fluid, including CNS with inflamed meninges. cleared by kidneys.

41
Q

Carbapenems adverse effects

A

Hypersensitivity and rash.

CNS toxicity -> seizures, confusion

Nephrotoxicity in imipenem. Always use with Cilastatin.

42
Q

imipenem/ cilastatian

A

a Carbapenem drug

Great coverage for both great gram - and + coverage.

Can cause nephrotoxicity

always used with cilastatin because it is a renal dipeptidate inhibitor that will prevent nephrotoxicity

43
Q

Clindamycin

A

used with penicillin to decrease toxin synthesis in life treating streptococcal toxic shock and necrotizing fasciitis

44
Q

Erythromycin

A

Used in peniclic hypersensitivity.

narrow spectrum Gram + cocci and bectal lactamase recreating staph but not MRSA or PRSP (penicillin resistant strep pneumonia)

45
Q

Tigecycline

A

broad spectrum drug that is used in MRSA and VRE (vancomycin resistant enterococcus)

46
Q

Linezolid

A

Used in VRSA (vancomycin resistant staph aureus) and

VRE (vancomycin resistant enterococcus)

respiratory med (3 decks)

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