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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
Amino P: Good
P/AP
26
Amino P: GN
Limited E.coli and P. mirabilis (younger pt w/o abx exposure) H. influenzae if beta-lactamse neg (otitis media or sinusitis)
27
Amino P: ADE
Derm - erythema multiforme, exfoliative dermatitis, skin rash, urticaria Neutropenia, leukopenia, anemia, eosinophilia AIN (rare) Amox: GI Upset
28
Amino P: DDI
NONE
29
Amino P: Renal adj dosing?
YES
30
Pen+B: Examples
Ampicillin/sulbactam (IV) Amoxicillin/clavulanate (PO) – Augmentin! Piperacillin/tazobactam (IV)
31
Pen+B: Added activity against ___
MSSA
32
Pen+B: NO ACTIVITY
MRSA
33
Pen+B: Same as ampicillin or penicillin for ___ and ___
Entero | Strepto
34
Pen+B: TOC
``` 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
35
Pen+B: DDI
Derm: Skin rash, urticaria, pruritus Pancytopenia, thrombocytopenia Increased LFTs, hepatitis AIN Amox/clav: GI upset
36
Pen+B: DDI
Piper/tazo + vanco increases nephrotoxicity risk
37
1st Gen Cephalosporin: Examples
Cefazolin (IV) Cephalexin (PO) Cefadroxil (PO)
38
1st Gen Cepha: Cefazolin TOC for
MSSA
39
1st Gen Cephalo: NO ACTIVITY
MRSA | Entero
40
1st Gen Cephalo: Good coverage
All Strepto Most cover peptostrepto GN: KEP GNA: limited BPF
41
1st Gen Cephalo: ADE
Diarrhea LFT elevation Hypersensitivity (< penicillin)
42
1st Gen Cephalo: DDI
Warfarin | Probenecid
43
2nd Gen Cephalosporin: Examples
``` Cefuroxime (IV/PO) Cefprozil (PO) Cefaclor (PO) Cefotetan (IV) * Cefoxitin (IV) * ``` *cephamycins
44
Cephamycin examples
Cefotetan | Cefoxitin
45
2nd Gen Cephalo: NO ACTIVITY
MRSA Entero GN: Non fermenters (PAS)
46
2nd Gen Cephalo: Good coverage
All strepto GPA: Peptrostrepto Increased KEP CAP bacteria: H influenza, M. catarrhalis Best anaerobe activity: cephamycins
47
Of the 2nd gen cephalosporins, which drugs had best anaerobe activity
cephamycins: cefotetan and cefoxitine
48
3rd Gen Cephalosporins: Examples
``` Ceftriaxone (IV) Cefotaxime (IV) Ceftazidime (IV) Cefdinir (PO) Cefditoren (PO) Cefixime (PO) Cefpodoxime (PO) Ceftibuten (PO) ```
49
3rd and 4th gen cephalo are ___ active than 1st and 2nd gen for GP
LESS
50
3rd and 4th gen cephalo are ___ active than 1st and 2nd gen for GN
MORE
51
3rd Gen Cephalo: _____ is TOC against invasive strep
Ceftriazone
52
3rd Gen: Limited and NO ACTIVITY
Limited MSSA NO MRSA NO entero (except ceftriaxone + ampicillin for E. faecalis endocarditis) ``` GN: non-fermenters (PAS) (except ceftazidime) Limited GNA (BPF) ```
53
3rd Gen: ____ is TOC for KEP
Ceftriaxone
54
3rd Gen: ADE
Diarrhea OBSTRUCTIVE BILIARY TOXICITY LFT elevations Hypersensitivity (less than penicillins)
55
3rd Gen: DDI
Warfarin | Probenecid
56
3rd Gen: Ceftriazone elimination
Bile
57
3rd Gen: Ceftriaxone dosing freq
QD or BID
58
3rd Gen: ___ undergoes deacetylation in liver
Cefotaxime
59
4th gen: Examples
Cefepime
60
4th gen is ___ active than 1st and 2nd gen
LESS
61
4th gen: Limited and NO ACTIVITY
Limited MSSA NO MRSA NO entero Limited GNA (BPF)
62
T/F: Cefepime has broader activity against all GN
True
63
4th gen: TOC
P. aeruginosa
64
4th Gen: Good for
All strep
65
4th gen: ADE:
Diarrhea LFT elevation ENCEPHALOPATHY, SEIZURES Hypersensitivity (
66
4th gen: DDI
Warfarin | Probenecid
67
Which generation has greatest GP coverage?
5th gen
68
5th Gen: Examples
Ceftaroline
69
5th Gen: Limited NO ACTIVITY
NO Entero NO GN: Non-fermenters (PAS) Limited GNA (BPF)
70
5th gen: Great for
MSSA MRSA All strepto Most cover peptostrepto KEP CAP germs: H. influ, M. catarrhalis
71
All gens EXCEPT which gen has NO activity for MRSA and entero // Good activity for strepto
5th Gen (ceftaroline)
72
Which gens have limited activity for GNA (BPF)
All gens
73
Which gens have NO activity for GN non-fermenters (PAS)
2nd, 3rd, 5th
74
Which gens have KEP coverage
1st, 2nd, 3rd, 5th
75
Which gen can cause encephalopathy and seizures
Gen 4
76
Which gen can cause obstructive biliary toxicity?
Gen 3
77
What are common ADEs for cephalosporins?
Diarrhea LFT elevation Hypersensitivity (
78
What are common DDIs for all cephalosporins
Warfarin | Probenecid
79
Adv. gen GP activity is similar to __ and__ gen
3rd and 4th
80
Carbapenem Examples
Ertepenem Imipenem Meropenem Doripenem (D/C**)
81
Carbapenems: Seizure risk order (increase > decrease)
Imi > Mero > erta
82
Carbapenem NO ACTIVITY
MRSA | GN: Non-fermenters (PAS) -- except imi and mero active against P. aeruginosa
83
Carbapenems: Good activity
MSSA Strepto KEP (including ESBL-producing strains) Anerobes
84
Carbapenem: ADE
N/V/D Headache Seizure (imi>mero>erta) Hypersensitivity - maculopapular rash
85
Carbapenem: DDI
Valproic acid | Probenecid
86
Carbapenems: Renal adj dosing?
YES
87
Carba+B: Examples
Meropenem-vaborbactam | Imipenem-relebactam
88
Carba+B: NO Activity
MRSA Limited entero stenotrophomonas maltophilia (from PAS)
89
Carba+B: ADE
N/V/D Headache Hypersensitivity - maculopapular rash
90
Carba+B: DDI
Valproic acid | Probenecid
91
Carba + P: Renal adj dosing?
YES
92
Monobactam example
Aztreonam
93
Aztreonam MOA
Same as beta-lactam but specifically high affinity for PBP3
94
Aztreonam ONLY ___ activity
GN
95
Aztreonam Coverage
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
Aztreonam ADE
N/V/D | Rash
97
Aztreonam: DDI
NONE
98
Cell function: Macrophage/monocyte
Antigen presenting cell | Surveillance of antigens
99
Cell function: Neutrophils
Defense against BACTERIA and FUNGUS
100
Cell function: Eosinophils
Defense against PARASITES | Response against allergic rxn
101
Cell function: Basophils
Allergic response
102
Cell function: B-lymphocytes
Antibody production | Antigen presenting cell
103
Cell function: T-lymphocyte
Cellular immunity against VIRUS and TUMORS | Regulation of immune system
104
Differential: WBC breaks down into (2)
Granulocytes | Agranulocytes
105
Differential: Granulocytes break down into (1) (3)
Polymorphonuclear granulocytes (PMNs) break down into 1. neutrophils 2. basophils 3. eosinophils
106
Differential: Agranulocytes break down into (2)
Lymphocytes (B-lymph, T-lymph) | Monocytes (macrophages)

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