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Beta-Lactam/Monobactam Antibiotics Flashcards

1
Q

MOA of Beta-Lactam antibiotics?

A

Inhibit the cell wall synthesis by binding to the penicillin binding proteins and preventing the cross linking of the peptidoglycan and the cell wall

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2
Q

What are the natural penicillins?

A
  • Penicillin V Potassium
  • Penicillin G Aqueous (Pfizerpen)
  • Penicillin G Benzathine (Bicillin L-A)
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3
Q

What is the dose of Penicillin V Potassium?

A

PO: 125-500 mg q6-12h on an empty stomach

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4
Q

What is the dose of Penicillin G Aqueous (Pfizerpen)?

A

IV: 2-4 million units q4-6h

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5
Q

What is the dose of Penicillin G Benzathine (Bicillin L-A)?

A

IM: 1.2-2.4 million units x 1 (frequency varies)

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6
Q

What is the indication for Penicillin V Potassium?

A

First line treatment for pharyngitis (“strep throat”)

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7
Q

What is the indicaton of Penicillin G Benzathine (Bicillin L-A)?

A
  • Drug of choice for syphilis (2.4 million units IM x 1)
  • Can use w/ beta-lactam allergy for syphillis during pregnancy or in patients w/ poor compliance/follow up (desensitive first)
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8
Q

What is the SOA of natural penicillins?

A
  • Gram-positive cocci (streptococci and enterococci)
  • Gram positive anaerobe mouth flora (peptostreptococci)
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9
Q

What are the antistaphylococcal penicillins?

A
  • Dicloxacillin
  • Naficillin
  • Oxacillin
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10
Q

What is the dose of dicloxacillin?

A

PO: 125-500 mg q6h

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11
Q

What is the dose of Naficillin?

A

IV/IM: 1-2 g q4-6h

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12
Q

What is the dose of Oxacillin?

A

IV: 250-2,000 mg q4-6h

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13
Q

What is the indication for antistaphylococcal penicillins?

A

Preferred for MSSA soft tissue, bone and joint, endocarditis, and blood stream infections

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14
Q

What is the SOA of antistaphylococcal penicillins?

A
  • Streptococci and MSSA
  • Have a large R group that can block beta-lactamases which can hydrolyze the beta-lactam ring (lack gram-neg coverage due to large R group)
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15
Q

What are some key notes of antistaphylococcal penicillins?

A
  • No renal dose adjustments necessary
  • Nafcillin is a vesicant (administration through a central line)
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16
Q

What are the aminopenicillins?

A
  • Amoxicillin (Moxatag)
  • Amoxicillin/Clavulanate (Augmentin, Augmentin ES-600)
  • Ampicillin
  • Ampicillin/Sulbactam (Unasyn)
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17
Q

What is the formulation of Amoxicillin?

A

PO

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18
Q

What is the dose of Ampicillin?

A

PO: 250-500 mg q6h on an empty stomach 30 min before or 2hrs after meals
IV/IM: 1-2 g q4-6h

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19
Q

What is the dose of Ampicillin/Sulbactam (Unasyn)?

A

IV: 1.5-3 g q6h

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20
Q

What is the indication of Amoxicillin?

A
  • First line treatment of acute otitis media (pediatric dose 80-90 mg/kg/day)
  • Drug of choice for infective endocarditis prophylaxis before dental procedures (2 g PO x 1, 30-60 min before procedure)
  • Used in H. pylori treatments
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21
Q

What is the indication of Amoxicillin/Clavulanate (Augmentin)?

A
  • First line treatment for acute otitis media (pediatric 90 mg/kg/day) and bacterial sinusitis
  • Use the lowest dose of clavulanate to decrease diarrhea
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22
Q

What is the SOA of aminopenicillins?

A
  • Streptococci
  • Enterococci
  • Gram-positive anaerobes (mouth flora-peptostreptococci)
  • Gram-negative: Haemophilus, Proteus, Neisseria, E.coli, Klebsiella
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23
Q

What is the Extended-Spectrum Penicillin?

A

Piperacillin/Tazobactam (Zosyn)

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24
Q

What is the dose of Piperacillin/Tazobactam (Zosyn)?

A
  • IV: 3.375 g q6h or 4.5 g q6-8h
  • Prolonged or extended infusions: 3.375 g q8h (each dose infused over 4hrs)
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25
What is the SOA of aminopenicillins combined w/ beta-lactamase inhibitors?
* Streptococci * Enterococci * Gram-positive anaerobes (mouth flora) * more resistant strains of HPNEK * MSSA * Gram-negative Anaerobes (B. fragilis)
26
What is the SOA of Piperacillin/Tazobactam (Zosyn)?
* Same as aminopenicillin/beta-lactamase inhibitor * Citrobacter, Acinetobacter, Providencia, Enterobacter, Serratia (CAPES) * Pseudomonas
27
What are the side effects of penicillins?
* Seizures (w/ accumulation when not correctly dose adjusted in renal adjustment) * GI upset, diarrhea, rash (including SJS/TEN) * Allergic reactions/anaphylaxis * Hemolytic anemia (identified w/ a positive Coombs test) * Renal failure, increase LFTs
28
What are the monitoring parameters of penicillins?
* Renal function * Symptoms of anaphylaxis w/ 1st dose * CBC and LFTs w/ prolonged course
29
What are the contraindications of penicillins?
* Type 1 sensitivity reactions * Augmentin and Unasyn: Hx of cholestatic jaundice or hepatic dysfunction associated w/ previous use * Severe renal impairment: do NOT use amoxicillin/clavulanate XR or the 875 mg strength
30
What is the boxed warning for Penicillin G Benzathine?
Not for IV use * Can cause cardio-respiratory arrest or death
31
What are the 1st generation cephalosporin?
* Cefazolin * Cephalexin (Keflex) * Cefadroxil
32
What is the dose of Cefazolin?
IV/IM: 1-2 g q8h
33
What is the dose of Cephalexin (Keflex)?
PO: 250-500 mg q6-12h
34
What is the dose of Cefadroxil?
PO: 500-2,000 mg q12-24h
35
What is the indication of Cefazolin?
Surgical prophylaxis
36
What is the indication of Cephalexin?
* Skin infections (MSSA) * Strep throat
37
What is the SOA of 1st generation?
* Streptococcus and staphylococci * Preferred for MSSA infections * Have some activity against the gram-negative rods Proteus, E.coli, and Klebsiella
38
What are 2nd generation cephalosporins?
* Cefuroxime (Ceftin) * Cefotetan * Cefoxitin * Cefaclor * Cefprozil
39
What is the dose of Cefuroxime (Ceftin)?
PO/IV/IM: 250-1,500 mg q8-12h
40
What is the dose of Cefotetan?
IV/IM: 1-2 g q12h
41
What is the dose of Cefoxitin?
IV/IM: 1-2 g q6-8h
42
What is the dose of Cefaclor?
PO: 250-500 mg q8h
43
What is the dose of Cefprozil?
PO: 250-500 mg q12-24h
44
What is the indiction of Cefuroxime?
* Acute otitis media * Community-acquired pneumonia (CAP)
45
What is the indication of Cefotetan and Cefoxitin?
Surgical prophylaxis (gastrointestinal procedures)
46
What are the 3rd generation group 1 cephalosporins?
* Cefdinir * Ceftriaxone * Cefotaxime * Cefixime (Suprax) * Cefpodixime
47
What is the dose of Cefdinir?
PO: 300 mg q12h or 600 mg daily
48
What is the dose of Ceftriaxone?
IV/IM: 1-2 g q12-24h
49
What is the dose of Cefotaxime?
IV/IM: 1-2 g q4-12h
50
What is the dose of Cefixime (Suprax)?
PO: 400 mg divided q12-24h
51
What is the dose of Cefpodixime?
PO: 100-400 mg q12h
52
What is the indication of Cefdinir?
Acute otitis media
53
What is the indication of Ceftriaxone?
* CAP, meningitidis, SBP, pyelonephritis
54
What is the SOA of 3rd generation group 1?
Covers * Resistant streptococci * Staphylococci (MSSA) * Gram-positive anaerobes * Resistant strains of HPNEK
55
What is the 3rd generation cephalosporin group 2?
Ceftazidime (Tazicef)
56
What is the SOA of 3rd geneartion group 2 cephalosporin?
Covers Pseudomonas
57
What is the 4th generation cephalosporin?
Cefepime
58
What is the dose of Cefepime?
IV/IM: 1-2 g q8-12h
59
What is the SOA of 4th generation?
* Broad gram-negative activity (HPNEK, CAPES, and Pseudomonas) * Gram-positive activity is similar to ceftriaxone
60
What is the 5th generation cephalosprorin?
Ceftaroline fosamil (Teflaro)
61
What is the dose of Ceftaroline?
IV: 600 mg q12h
62
What is the indication of Ceftaroline?
* CAP * Skin and soft tissue infections
63
What is the SOA of 5th generation cephalosporin?
* Gram-negative activity similar to ceftriaxone * Broad gram-positive activity
64
What is the dose of Ceftazidime/Avibactam (Avycaz)?
IV: 2.5 g q8h
65
What are the cephalosporin combinations?
* Ceftazidime/Avibactam (Avycaz) * Ceftolazone/Tazobactam (Zerbaxa)
66
What is the dose of ceftolazone/tazobactam?
IV: 2 g q8h
67
What is the SOA of cephalosporin combinations?
* Similar to ceftazidime * MDR gram-negative rods
68
What is the dose of cefiderocol (Fetroja)?
IV: 2 g q8h
69
What is the SOA of siderophore cephalosporins?
* PEK * Enterobacter * Pseudomonas
70
What are the side effects of cephalosporins?
* Seizures (w/ accumulation when not correctly dose adjusted renal dysfunction) * GI upset, diarrhea, rash (including SJS, TEN) * Allergic reactions, anaphylaxis * Acute interstitial nephritis * Hemolytic anemia * Myelosuppression w/ prolonged use * Increase LFTs * Drug fever
71
What are the monitoring parameters of cephalosporins?
* Renal function * Signs of anaphylaxis w/ 1st dose * CBC, LFTs
72
What are some contraindications of Ceftriaxone?
* Hyperbilirubinemic neonates (causes biliary sludging, kernicterus) * Concurrent use w/ calcium-containing IV products in neonates
73
What are some warnings of cephalosporins?
* Cross reactivity w/ penicillin * Cefotetan can cause disulifiram-like reaction w/ alcohol ingestion
74
What are some drug interactions of cephalosporins?
* Ceftriaxone and calcium-containing IV fluids * Drugs that can decrease stomach acid can DECREASE the bioavailability of some oral cephalosporins * Cefotetan and warfarin--> INCREASE risk of bleeding
75
What is the dose of meropenem?
IV: 500-1,000 mg q8h
75
What is the dose of Meropenem/Vaborbactam (Vabomere)?
IV: 4 g q8h
76
What is the dose of Imipenem/Cilstatin (Primaxin I.V.)?
IV: 500-1,000 mg q6-8h
77
What is the dose of Imipenem/Cilastatin/Relebactam (Recarbio)?
IV: 1.25 g q6h
78
What is the SOA of Ertapenem?
* MSSA, penicillin-susceptible Streptococci * Enterobacterales (+ESBL, AmpC), H. influenzae, N. meningitidis
79
What is the SOA of Imipenem/cilstatin (Primaxin)?
* MSSA, Penicillin-susceptible Streptococci, some Enterococci * Enterobacterales (+ESBL, AmpC), Pseudomonas, Acinetobacter, H. influenzae, N. meningitidis
80
What is the SOA of Imipenem/cilstatin/relebactam (Recarbio)?
* Enterobacterales (+ESBL, AmpC, CRE) * Pseudomonas (+DTR) * Acinetobacter
81
What is the SOA of Meropenem (Merrem)?
* MSSA, penicillin-susceptible Streptococci, some Enterococci, Listeria * Enterobacterales (+ESBL, AmpC) * Pseudomonas * Acinetobacter * H. influenzae * N. meningitidis
82
What are the side effects of Carbapenems?
* Diarrhea * Rash/severe skin reactions (DRESS) * Bone marrow suppression w/ prolonged use * Increase LFTs
83
What are the monitoring parameters of carbapenem?
* Renal function Symptoms of anaphylaxis w/ 1st dose * CBC, LFTs
84
What are the common uses of Carbapenems?
* Polymicrobial infections * Empiric therapy when resistant organisms are suspected * ESBL-positive infections * Resistant Pseudomonas or Acinetobacter infections (except Ertapenem)?

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