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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
Q

What is the SOA of aminopenicillins combined w/ beta-lactamase inhibitors?

A
  • Streptococci
  • Enterococci
  • Gram-positive anaerobes (mouth flora)
  • more resistant strains of HPNEK
  • MSSA
  • Gram-negative Anaerobes (B. fragilis)
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26
Q

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

A
  • Same as aminopenicillin/beta-lactamase inhibitor
  • Citrobacter, Acinetobacter, Providencia, Enterobacter, Serratia (CAPES)
  • Pseudomonas
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27
Q

What are the side effects of penicillins?

A
  • 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
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28
Q

What are the monitoring parameters of penicillins?

A
  • Renal function
  • Symptoms of anaphylaxis w/ 1st dose
  • CBC and LFTs w/ prolonged course
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29
Q

What are the contraindications of penicillins?

A
  • 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
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30
Q

What is the boxed warning for Penicillin G Benzathine?

A

Not for IV use
* Can cause cardio-respiratory arrest or death

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31
Q

What are the 1st generation cephalosporin?

A
  • Cefazolin
  • Cephalexin (Keflex)
  • Cefadroxil
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32
Q

What is the dose of Cefazolin?

A

IV/IM: 1-2 g q8h

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33
Q

What is the dose of Cephalexin (Keflex)?

A

PO: 250-500 mg q6-12h

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34
Q

What is the dose of Cefadroxil?

A

PO: 500-2,000 mg q12-24h

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35
Q

What is the indication of Cefazolin?

A

Surgical prophylaxis

36
Q

What is the indication of Cephalexin?

A
  • Skin infections (MSSA)
  • Strep throat
37
Q

What is the SOA of 1st generation?

A
  • Streptococcus and staphylococci
  • Preferred for MSSA infections
  • Have some activity against the gram-negative rods Proteus, E.coli, and Klebsiella
38
Q

What are 2nd generation cephalosporins?

A
  • Cefuroxime (Ceftin)
  • Cefotetan
  • Cefoxitin
  • Cefaclor
  • Cefprozil
39
Q

What is the dose of Cefuroxime (Ceftin)?

A

PO/IV/IM: 250-1,500 mg q8-12h

40
Q

What is the dose of Cefotetan?

A

IV/IM: 1-2 g q12h

41
Q

What is the dose of Cefoxitin?

A

IV/IM: 1-2 g q6-8h

42
Q

What is the dose of Cefaclor?

A

PO: 250-500 mg q8h

43
Q

What is the dose of Cefprozil?

A

PO: 250-500 mg q12-24h

44
Q

What is the indiction of Cefuroxime?

A
  • Acute otitis media
  • Community-acquired pneumonia (CAP)
45
Q

What is the indication of Cefotetan and Cefoxitin?

A

Surgical prophylaxis (gastrointestinal procedures)

46
Q

What are the 3rd generation group 1 cephalosporins?

A
  • Cefdinir
  • Ceftriaxone
  • Cefotaxime
  • Cefixime (Suprax)
  • Cefpodixime
47
Q

What is the dose of Cefdinir?

A

PO: 300 mg q12h or 600 mg daily

48
Q

What is the dose of Ceftriaxone?

A

IV/IM: 1-2 g q12-24h

49
Q

What is the dose of Cefotaxime?

A

IV/IM: 1-2 g q4-12h

50
Q

What is the dose of Cefixime (Suprax)?

A

PO: 400 mg divided q12-24h

51
Q

What is the dose of Cefpodixime?

A

PO: 100-400 mg q12h

52
Q

What is the indication of Cefdinir?

A

Acute otitis media

53
Q

What is the indication of Ceftriaxone?

A
  • CAP, meningitidis, SBP, pyelonephritis
54
Q

What is the SOA of 3rd generation group 1?

A

Covers
* Resistant streptococci
* Staphylococci (MSSA)
* Gram-positive anaerobes
* Resistant strains of HPNEK

55
Q

What is the 3rd generation cephalosporin group 2?

A

Ceftazidime (Tazicef)

56
Q

What is the SOA of 3rd geneartion group 2 cephalosporin?

A

Covers Pseudomonas

57
Q

What is the 4th generation cephalosporin?

58
Q

What is the dose of Cefepime?

A

IV/IM: 1-2 g q8-12h

59
Q

What is the SOA of 4th generation?

A
  • Broad gram-negative activity (HPNEK, CAPES, and Pseudomonas)
  • Gram-positive activity is similar to ceftriaxone
60
Q

What is the 5th generation cephalosprorin?

A

Ceftaroline fosamil (Teflaro)

61
Q

What is the dose of Ceftaroline?

A

IV: 600 mg q12h

62
Q

What is the indication of Ceftaroline?

A
  • CAP
  • Skin and soft tissue infections
63
Q

What is the SOA of 5th generation cephalosporin?

A
  • Gram-negative activity similar to ceftriaxone
  • Broad gram-positive activity
64
Q

What is the dose of Ceftazidime/Avibactam (Avycaz)?

A

IV: 2.5 g q8h

65
Q

What are the cephalosporin combinations?

A
  • Ceftazidime/Avibactam (Avycaz)
  • Ceftolazone/Tazobactam (Zerbaxa)
66
Q

What is the dose of ceftolazone/tazobactam?

A

IV: 2 g q8h

67
Q

What is the SOA of cephalosporin combinations?

A
  • Similar to ceftazidime
  • MDR gram-negative rods
68
Q

What is the dose of cefiderocol (Fetroja)?

A

IV: 2 g q8h

69
Q

What is the SOA of siderophore cephalosporins?

A
  • PEK
  • Enterobacter
  • Pseudomonas
70
Q

What are the side effects of cephalosporins?

A
  • 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
Q

What are the monitoring parameters of cephalosporins?

A
  • Renal function
  • Signs of anaphylaxis w/ 1st dose
  • CBC, LFTs
72
Q

What are some contraindications of Ceftriaxone?

A
  • Hyperbilirubinemic neonates (causes biliary sludging, kernicterus)
  • Concurrent use w/ calcium-containing IV products in neonates
73
Q

What are some warnings of cephalosporins?

A
  • Cross reactivity w/ penicillin
  • Cefotetan can cause disulifiram-like reaction w/ alcohol ingestion
74
Q

What are some drug interactions of cephalosporins?

A
  • 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
Q

What is the dose of meropenem?

A

IV: 500-1,000 mg q8h

75
Q

What is the dose of Meropenem/Vaborbactam (Vabomere)?

A

IV: 4 g q8h

76
Q

What is the dose of Imipenem/Cilstatin (Primaxin I.V.)?

A

IV: 500-1,000 mg q6-8h

77
Q

What is the dose of Imipenem/Cilastatin/Relebactam (Recarbio)?

A

IV: 1.25 g q6h

78
Q

What is the SOA of Ertapenem?

A
  • MSSA, penicillin-susceptible Streptococci
  • Enterobacterales (+ESBL, AmpC), H. influenzae, N. meningitidis
79
Q

What is the SOA of Imipenem/cilstatin (Primaxin)?

A
  • MSSA, Penicillin-susceptible Streptococci, some Enterococci
  • Enterobacterales (+ESBL, AmpC), Pseudomonas, Acinetobacter, H. influenzae, N. meningitidis
80
Q

What is the SOA of Imipenem/cilstatin/relebactam (Recarbio)?

A
  • Enterobacterales (+ESBL, AmpC, CRE)
  • Pseudomonas (+DTR)
  • Acinetobacter
81
Q

What is the SOA of Meropenem (Merrem)?

A
  • MSSA, penicillin-susceptible Streptococci, some Enterococci, Listeria
  • Enterobacterales (+ESBL, AmpC)
  • Pseudomonas
  • Acinetobacter
  • H. influenzae
  • N. meningitidis
82
Q

What are the side effects of Carbapenems?

A
  • Diarrhea
  • Rash/severe skin reactions (DRESS)
  • Bone marrow suppression w/ prolonged use
  • Increase LFTs
83
Q

What are the monitoring parameters of carbapenem?

A
  • Renal function
    Symptoms of anaphylaxis w/ 1st dose
  • CBC, LFTs
84
Q

What are the common uses of Carbapenems?

A
  • Polymicrobial infections
  • Empiric therapy when resistant organisms are suspected
  • ESBL-positive infections
  • Resistant Pseudomonas or Acinetobacter infections (except Ertapenem)?

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