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AI > Beta Lactams > Flashcards

Beta Lactams Flashcards

1
Q

Beta-lactams MOA

A

Bind to penicillin binding proteins (PBPs)

Inhibit cross-linking of peptidoglycan in the cell wall -> autolysis -> cell death

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2
Q

Natural Penicillin Examples

A 
Pen G (IV) 
Benzathine Pen (IM) 
Pen V K (PO)
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3
Q

Natural penicillin: NO ACTIVITY

A

Staph

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4
Q

Natural Penicillin: TOC

A

Strepto

Clostridium perfringens

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5
Q

Natural Penicillin: Good for

A

Gram positive: (P/AP)

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6
Q

Natural penicillin: GN coverage

A

Minimal (resistance)

Maybe N. meningitidis (doesn’t pass BBB well but MIC90)

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7
Q

Natural Penicillin ADE

A

Seizures
Neutropenia
Hypersensitivity
AIN/renal tubular disease

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8
Q

Natural penicillin: DDI

A

OAT 1/3 (pretomanid, teriflunomide, fexinidazole)

Probenecid

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9
Q

Natural penicillin: Renal dosing adj?

A

Yes

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10
Q

PRP: Examples

A

Nafcillin (IV)
Oxacillin (IV)
Dicloxacillin (PO)

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11
Q

PRP: TOC

A

MSSA

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12
Q

PRP: NO ACTIVITY

A

MRSA
entero
GN

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13
Q

PRP: Good activity

A

strepto

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14
Q

PRP: GI ADE

A

Dicloxacillin

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15
Q

PRP: ADEs

A

Hepatotoxicity, increase serum transminases, neutropenia, AIN, renal tubular disease

Naf/Ox: local – inj site reactions, phlebitis
Diclo: GI upset

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16
Q

PRP: Nafcillin DDI

A

3A4 (azole, anti-epileptics, statins, transplant meds, etc.)

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17
Q

PRP: Dicloxacillin DDI

A

3A4: transplant meds, carbamazepine
2C19: fosphyenytoin/phyenytoin, omeprazole

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18
Q

PRP: Renal dosing adj?

A

NO

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19
Q

PRP: Nafcillin excretion

A

Feces

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20
Q

PRP: Oxacillin excretion

A

Bile/urine

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21
Q

PRP: Dicloxacillin excretion

A

Feces/urine

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22
Q

Amino P: NO ACTIVITY

A

Staph aureus

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23
Q

Amino P: TOC

A

Entero

Listeria

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24
Q

Amino P: same as penicillin against ___ but broader

A

Strepto

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25
Q

Amino P: Good

A

P/AP

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26
Q

Amino P: GN

A

Limited E.coli and P. mirabilis (younger pt w/o abx exposure)
H. influenzae if beta-lactamse neg (otitis media or sinusitis)

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27
Q

Amino P: ADE

A

Derm - erythema multiforme, exfoliative dermatitis, skin rash, urticaria
Neutropenia, leukopenia, anemia, eosinophilia
AIN (rare)

Amox: GI Upset

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28
Q

Amino P: DDI

A

NONE

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29
Q

Amino P: Renal adj dosing?

A

YES

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30
Q

Pen+B: Examples

A

Ampicillin/sulbactam (IV)
Amoxicillin/clavulanate (PO) – Augmentin!
Piperacillin/tazobactam (IV)

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31
Q

Pen+B: Added activity against ___

A

MSSA

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32
Q

Pen+B: NO ACTIVITY

A

MRSA

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33
Q

Pen+B: Same as ampicillin or penicillin for ___ and ___

A

Entero

Strepto

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34
Q

Pen+B: TOC

A 
Oropharyngeal infections (GPA: P/AP) 
GNA: BPF

Amp/sulb + amox/clav: CAP (H. influenza, M. catarrhalis) // Animal bites (Pasteurella multocida, capnocytophaga spp.)

Piper/tazo: increased KEP coverage and P. aeruginosa

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35
Q

Pen+B: DDI

A

Derm: Skin rash, urticaria, pruritus
Pancytopenia, thrombocytopenia
Increased LFTs, hepatitis
AIN

Amox/clav: GI upset

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36
Q

Pen+B: DDI

A

Piper/tazo + vanco increases nephrotoxicity risk

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37
Q

1st Gen Cephalosporin: Examples

A

Cefazolin (IV)
Cephalexin (PO)
Cefadroxil (PO)

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38
Q

1st Gen Cepha: Cefazolin TOC for

A

MSSA

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39
Q

1st Gen Cephalo: NO ACTIVITY

A

MRSA

Entero

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40
Q

1st Gen Cephalo: Good coverage

A

All Strepto

Most cover peptostrepto

GN: KEP
GNA: limited BPF

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41
Q

1st Gen Cephalo: ADE

A

Diarrhea
LFT elevation
Hypersensitivity (< penicillin)

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42
Q

1st Gen Cephalo: DDI

A

Warfarin

Probenecid

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43
Q

2nd Gen Cephalosporin: Examples

A 
Cefuroxime (IV/PO) 
Cefprozil (PO) 
Cefaclor (PO) 
Cefotetan (IV) *
Cefoxitin (IV) *

*cephamycins

44
Q

Cephamycin examples

A

Cefotetan

Cefoxitin

45
Q

2nd Gen Cephalo: NO ACTIVITY

A

MRSA
Entero
GN: Non fermenters (PAS)

46
Q

2nd Gen Cephalo: Good coverage

A

All strepto
GPA: Peptrostrepto
Increased KEP
CAP bacteria: H influenza, M. catarrhalis

Best anaerobe activity: cephamycins

47
Q

Of the 2nd gen cephalosporins, which drugs had best anaerobe activity

A

cephamycins: cefotetan and cefoxitine

48
Q

3rd Gen Cephalosporins: Examples

A 
Ceftriaxone (IV)
Cefotaxime (IV)
Ceftazidime (IV)
Cefdinir (PO)
Cefditoren (PO)
Cefixime (PO)
Cefpodoxime (PO)
Ceftibuten (PO)
49
Q

3rd and 4th gen cephalo are ___ active than 1st and 2nd gen for GP

50
Q

3rd and 4th gen cephalo are ___ active than 1st and 2nd gen for GN

51
Q

3rd Gen Cephalo: _____ is TOC against invasive strep

A

Ceftriazone

52
Q

3rd Gen: Limited and NO ACTIVITY

A

Limited MSSA
NO MRSA
NO entero (except ceftriaxone + ampicillin for E. faecalis endocarditis)

GN: non-fermenters (PAS) (except ceftazidime) 
Limited GNA (BPF)
53
Q

3rd Gen: ____ is TOC for KEP

A

Ceftriaxone

54
Q

3rd Gen: ADE

A

Diarrhea
OBSTRUCTIVE BILIARY TOXICITY
LFT elevations
Hypersensitivity (less than penicillins)

55
Q

3rd Gen: DDI

A

Warfarin

Probenecid

56
Q

3rd Gen: Ceftriazone elimination

57
Q

3rd Gen: Ceftriaxone dosing freq

58
Q

3rd Gen: ___ undergoes deacetylation in liver

A

Cefotaxime

59
Q

4th gen: Examples

60
Q

4th gen is ___ active than 1st and 2nd gen

61
Q

4th gen: Limited and NO ACTIVITY

A

Limited MSSA
NO MRSA
NO entero

Limited GNA (BPF)

62
Q

T/F: Cefepime has broader activity against all GN

63
Q

4th gen: TOC

A

P. aeruginosa

64
Q

4th Gen: Good for

65
Q

4th gen: ADE:

A

Diarrhea
LFT elevation
ENCEPHALOPATHY, SEIZURES
Hypersensitivity (

66
Q

4th gen: DDI

A

Warfarin

Probenecid

67
Q

Which generation has greatest GP coverage?

68
Q

5th Gen: Examples

A

Ceftaroline

69
Q

5th Gen: Limited NO ACTIVITY

A

NO Entero

NO GN: Non-fermenters (PAS)

Limited GNA (BPF)

70
Q

5th gen: Great for

A

MSSA
MRSA
All strepto

Most cover peptostrepto

KEP
CAP germs: H. influ, M. catarrhalis

71
Q

All gens EXCEPT which gen has NO activity for MRSA and entero // Good activity for strepto

A

5th Gen (ceftaroline)

72
Q

Which gens have limited activity for GNA (BPF)

73
Q

Which gens have NO activity for GN non-fermenters (PAS)

A

2nd, 3rd, 5th

74
Q

Which gens have KEP coverage

A

1st, 2nd, 3rd, 5th

75
Q

Which gen can cause encephalopathy and seizures

76
Q

Which gen can cause obstructive biliary toxicity?

77
Q

What are common ADEs for cephalosporins?

A

Diarrhea
LFT elevation
Hypersensitivity (

78
Q

What are common DDIs for all cephalosporins

A

Warfarin

Probenecid

79
Q

Adv. gen GP activity is similar to __ and__ gen

A

3rd and 4th

80
Q

Carbapenem Examples

A

Ertepenem
Imipenem
Meropenem
Doripenem (D/C**)

81
Q

Carbapenems: Seizure risk order (increase > decrease)

A

Imi > Mero > erta

82
Q

Carbapenem NO ACTIVITY

A

MRSA

GN: Non-fermenters (PAS) – except imi and mero active against P. aeruginosa

83
Q

Carbapenems: Good activity

A

MSSA
Strepto
KEP (including ESBL-producing strains)
Anerobes

84
Q

Carbapenem: ADE

A

N/V/D
Headache
Seizure (imi>mero>erta)
Hypersensitivity - maculopapular rash

85
Q

Carbapenem: DDI

A

Valproic acid

Probenecid

86
Q

Carbapenems: Renal adj dosing?

87
Q

Carba+B: Examples

A

Meropenem-vaborbactam

Imipenem-relebactam

88
Q

Carba+B: NO Activity

A

MRSA
Limited entero
stenotrophomonas maltophilia (from PAS)

89
Q

Carba+B: ADE

A

N/V/D
Headache
Hypersensitivity - maculopapular rash

90
Q

Carba+B: DDI

A

Valproic acid

Probenecid

91
Q

Carba + P: Renal adj dosing?

92
Q

Monobactam example

93
Q

Aztreonam MOA

A

Same as beta-lactam but specifically high affinity for PBP3

94
Q

Aztreonam ONLY ___ activity

95
Q

Aztreonam Coverage

A

ONLY GN

KEP (not for ESBL or KPC but active against MBLs)
TOC: P. aeruginosa (if B-L intolerant or allergic)
No activity other non-fermenters

96
Q

Aztreonam ADE

A

N/V/D

Rash

97
Q

Aztreonam: DDI

98
Q

Cell function: Macrophage/monocyte

A

Antigen presenting cell

Surveillance of antigens

99
Q

Cell function: Neutrophils

A

Defense against BACTERIA and FUNGUS

100
Q

Cell function: Eosinophils

A

Defense against PARASITES

Response against allergic rxn

101
Q

Cell function: Basophils

A

Allergic response

102
Q

Cell function: B-lymphocytes

A

Antibody production

Antigen presenting cell

103
Q

Cell function: T-lymphocyte

A

Cellular immunity against VIRUS and TUMORS

Regulation of immune system

104
Q

Differential: WBC breaks down into (2)

A

Granulocytes

Agranulocytes

105
Q

Differential: Granulocytes break down into (1) (3)

A

Polymorphonuclear granulocytes (PMNs) break down into

  1. neutrophils
  2. basophils
  3. eosinophils
106
Q

Differential: Agranulocytes break down into (2)

A

Lymphocytes (B-lymph, T-lymph)

Monocytes (macrophages)

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