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Respiratory 2 > Beta Lactams 1 (Penicillins) - Fitzpatrick > Flashcards

Beta Lactams 1 (Penicillins) - Fitzpatrick Flashcards

1
Q

Natural Penicillin + Oral

A

Penicillin V

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2
Q

Natural Penicillin + IV/IM

A

Penicillin G

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3
Q

Anti-Staph. Penicillin no longer in use

A

Methicillin

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4
Q

Anti-Staph. Penicillin + Oral (2)

A

Oxacillin, Dicloxacillin

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5
Q

Anti-Staph. Penicillin + IV

A

Nafcillin

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6
Q

Extended Spectrum Penicillin + IV

A

Ampicillin

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7
Q

Extended Spectrum Penicillin + Oral

A

Amoxicillin

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8
Q

Anti-pseudomonas Penicillins + IV (2)

A

Ticarcillin, Piperacillin

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9
Q

Function of Beta-lactam drugs

A

Inhibit cross-linking transpeptidase (PBPs) in GRAM (+) cell wall synthesis via resembling the D-ala-D-ala cross link AA sequence

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10
Q

D-ala-D-ala

A

Cross link AA sequence in Gram (+) cell wall

- Inhibited by Beta Lactams

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11
Q

**Organisms (& diseases) that indicate PENICILLIN G (6)

A
  • Strep. pneumoniae (pneumococcal pneumonia)
  • Strep. pyogenes (pharyngitis, scarlet fever)
  • Strep. viridans (L-side endocarditis)
  • Treponema (syphilis)
  • Neisseria meningitides (meningitis)
  • Clostridium perfringens (gas gangrene)
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12
Q

Penicillin G/V will distribute to CNS IF…

A

Meninges are deranged from meningitis

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13
Q

**Complication of Penicillin G/V

A

HYPERSENSITIVITY (esp. type 1 anaphylaxis on 2nd exposure)

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14
Q

Organisms resistant to many Penicillins do so by _____

A

Producing Beta-Lactamase (Penicillinase)

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15
Q

Penicillins that are INEFFICIENT against beta-lactamase-producing bacteria (6)

A 
Naturals (G/V)
Extended Spectrum (Ampi, Amox)
Anti-pseudomonal (Ticarcillin, Piperacillin)
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16
Q

Penicillins that are GOOD against beta-lactamase-producing bacteria (Staph. aureus) (4)

A

Anti-staph. (Methi, Naf, Oxa, Dicloxa)

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17
Q

Organism that is resistant to Penicillin G/V but sensitive to Anti-staph. (Methicillin, Naf, Oxa, Dicloxa) drugs = _______

A

Methicillin-sensitive Staph. aureus (MSSA)

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18
Q

CLINICALLY, for MSSA infection (or beta-lactamase), use what drugs? (3)

A

Nafcillin, Oxacillin, Dicloxacillin (NOT methicillin)

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19
Q

Why is methicillin not used clinically?

A

Toxicity = interstitial nephritis

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20
Q

Major toxicity of Naf, Oxa, Dicloxa?

A

Hypersensitivity

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21
Q

MSSA infection + need IV drug = _____

A

Nafcillin

22
Q

MSSA infection + need P.O. drug = _____

A

Oxacillin or Dicloxacillin

23
Q

Additional toxicity (potential) of Nafcillin

A

INDUCTION of P450 (decreased action of other drugs)

24
Q

MRSA - resistant to what?

Mechanism of resistance?

A
  • Resistant to anti-staph. penicillins ALSO

- Mec A gene mutation –> Penicillin Binding Protein 2 alteration

25
Q

MRSA - treatment?

A

Vancomycin

26
Q

Organism uses of Vancomycin (4)

A
  • MRSA
  • MRSE (methicillin resistant staph. epidermidis)
  • Enterococci (faecalis, faecium)
  • C. difficile colitis (if metronidazole fails)
27
Q

Patient is hypersensitive to Penicillin or Anti-staph drugs…

Alternative?

A

Vancomycin

28
Q

Vancomycin is NOT used for what?

A

Gram (-) – has NO effect

29
Q

A patient has an MSSA infection. No known Penicillin allergy. Should you use Anti-Staph. drug (3 options) or Vancomycin?

Why?

A

Anti-Staph. drugs – greater efficiency against MSSA

30
Q

Vancomycin - drug class

A

Glycopeptide cell wall synthesis inhibitor

31
Q

Vancomycin - MoA

A

Binds D-ala-D-ala and inhibits TRANSGLYCOSYLATION in cell wall synthesis

32
Q

Why is Vancomycin effective against C. diff. colitis?

A

NOT ABSORBED in gut –> good for acting in gut

33
Q

Length of onset of Vancomycin

A

SLOW - 60-90 minutes

34
Q

Adverse effects of Vancomycin (4)

A
  • Erythroderma or shock
  • Nephrotoxicity or Ototoxicity (IF used w/ aminoglycoside)
  • Rash
  • Phlebitis at injection site
35
Q

Pt. on Vancomycin develops widespread redness and shedding of skin. Treat with what?

A

Anti-histamine and steroids

36
Q

Pt. on Vancomycin needs Aminoglycoside drug for gram (-) infection (later lecture). Must be careful of what?

A

Nephrotoxicity and/or Ototoxicity

37
Q

“Extended Spectrum” Penicillins - drugs? (2)

What does this mean?

A

Ampicillin, Amoxicillin

Has additional NH2 group attached, which gives additional polarity to the drug and allows for passage through PORINS w/in GRAM (-) outer cell membrane IN ORDER TO ACCESS PBPs in the PERIPLASM

38
Q

Clinical (and organism) indications for Ampicillin/Amoxicillin in the respiratory system (4)

A
  • Staph. aureus
  • Community-acquired pneumonia, sinusitis, bronchitis, or pharyngitis caused by STREP. PNEUMONIAE/PYOGENES
  • Bronchitis in COPD patient via H. INFLUENZA
  • E. coli
39
Q

Patient has COPD and develops bronchitis. Likely organism?

Treatment?

A

H. influenza

Amoxicillin/Ampicillin

40
Q

A CHILD has pharyngitis from penicillin-sensitive strep. pneumoniae. 2 potential treatments? Which is preferred? Why?

A
  • Penicillin V or Amoxicillin
  • Amoxicillin is preferred
  • Amoxicillin has better TASTE than Penicillin V
41
Q

A patient has a strep or H. influenza infection with a strain that produces beta-lactamase. Treatment options? (2)

A

ADD A BETA-LACTAMASE INHIBITOR…

  • Ampicillin + Sulbactam
  • Amoxicillin + Clavulanic acid (Augmentin)
42
Q

Sulbactam - function

A

Irreversibly inactivate and deplete beta-lactamase enzyme

43
Q

Strep. pneum./pyo. or H. influenza infection that also produces beta-lactamase. Need an IV drug. Treatment?

A

Ampicillin + Sulbactam

44
Q

Strep. pneum./pyo. or H. influenza infection that also produces beta-lactamase. Need an oral drug. Treatment?

A

Amoxicillin + Clavulanic acid

45
Q

Shigella or Salmonella GI infection (enteritis). Ampicillin or Amoxicillin? Why?

A

Ampicillin

- Amox. is almost 100% absorbed in gut, so won’t TREAT the gut

46
Q

Ampicillin-sulbactam and Amoxicillin-C.A. are best used for which organisms?

A

Penicillin-resistant, Methicillin-sensitive…

- Staph. aureus
- Strep. pneumoniae
- H. influenzae
- E. coli
47
Q

Populations at risk for Pseudomonas infection (4)

A
  • Burn victim
  • CF
  • IV drugs
  • Immunosuppressed
48
Q

Anti-Pseudomonal (Gram (-) rod) Penicillin drugs

Which is more potent?

A
  • Ticarcillin
  • Piperacillin

Piperacillin = more potent

49
Q

Pseudomonas - drug resistance mechanisms (2)

A
  • Altered PBPs

- Porin deficit - MULTI-DRUG RESISTANCE (MDR)

50
Q

Pseudomonas does NOT secrete beta-lactamase ever, BUT the Anti-Pseudomonal Penicillins are often combined with a beta-lactamase inhibitor. Why?

A

Empirical therapy in CRITICALLY-ILL patients

- In order to get coverage for Pseudomonas AND other GRAM (-) organisms that may secrete beta-lactamase

51
Q

Anti-Pseudomonal + Beta-lactamase inhibitor combos (2)

A
  • Ticarcillin + Clavulanic Acid

- Piperacillin + Tazobactam

52
Q

2 examples where an Anti-Pseudomonal + beta-lactamase inhibitor combo would be used in a critically ill patient

A
  • Severe pneumonia in COPD patient (Pseudomonas or H. influenza)
  • Aspiration pneumonia in hospitalized patient (Pseudomonas or Klebsiella)

Respiratory 2 (15 decks)

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