Beta Lactams Flashcards
Beta-lactams MOA
Bind to penicillin binding proteins (PBPs)
Inhibit cross-linking of peptidoglycan in the cell wall -> autolysis -> cell death
Natural Penicillin Examples
Pen G (IV) Benzathine Pen (IM) Pen V K (PO)
Natural penicillin: NO ACTIVITY
Staph
Natural Penicillin: TOC
Strepto
Clostridium perfringens
Natural Penicillin: Good for
Gram positive: (P/AP)
Natural penicillin: GN coverage
Minimal (resistance)
Maybe N. meningitidis (doesn’t pass BBB well but MIC90)
Natural Penicillin ADE
Seizures
Neutropenia
Hypersensitivity
AIN/renal tubular disease
Natural penicillin: DDI
OAT 1/3 (pretomanid, teriflunomide, fexinidazole)
Probenecid
Natural penicillin: Renal dosing adj?
Yes
PRP: Examples
Nafcillin (IV)
Oxacillin (IV)
Dicloxacillin (PO)
PRP: TOC
MSSA
PRP: NO ACTIVITY
MRSA
entero
GN
PRP: Good activity
strepto
PRP: GI ADE
Dicloxacillin
PRP: ADEs
Hepatotoxicity, increase serum transminases, neutropenia, AIN, renal tubular disease
Naf/Ox: local – inj site reactions, phlebitis
Diclo: GI upset
PRP: Nafcillin DDI
3A4 (azole, anti-epileptics, statins, transplant meds, etc.)
PRP: Dicloxacillin DDI
3A4: transplant meds, carbamazepine
2C19: fosphyenytoin/phyenytoin, omeprazole
PRP: Renal dosing adj?
NO
PRP: Nafcillin excretion
Feces
PRP: Oxacillin excretion
Bile/urine
PRP: Dicloxacillin excretion
Feces/urine
Amino P: NO ACTIVITY
Staph aureus
Amino P: TOC
Entero
Listeria
Amino P: same as penicillin against ___ but broader
Strepto
Amino P: Good
P/AP
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)
Amino P: ADE
Derm - erythema multiforme, exfoliative dermatitis, skin rash, urticaria
Neutropenia, leukopenia, anemia, eosinophilia
AIN (rare)
Amox: GI Upset
Amino P: DDI
NONE
Amino P: Renal adj dosing?
YES
Pen+B: Examples
Ampicillin/sulbactam (IV)
Amoxicillin/clavulanate (PO) – Augmentin!
Piperacillin/tazobactam (IV)
Pen+B: Added activity against ___
MSSA
Pen+B: NO ACTIVITY
MRSA
Pen+B: Same as ampicillin or penicillin for ___ and ___
Entero
Strepto
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
Pen+B: DDI
Derm: Skin rash, urticaria, pruritus
Pancytopenia, thrombocytopenia
Increased LFTs, hepatitis
AIN
Amox/clav: GI upset
Pen+B: DDI
Piper/tazo + vanco increases nephrotoxicity risk
1st Gen Cephalosporin: Examples
Cefazolin (IV)
Cephalexin (PO)
Cefadroxil (PO)
1st Gen Cepha: Cefazolin TOC for
MSSA
1st Gen Cephalo: NO ACTIVITY
MRSA
Entero
1st Gen Cephalo: Good coverage
All Strepto
Most cover peptostrepto
GN: KEP
GNA: limited BPF
1st Gen Cephalo: ADE
Diarrhea
LFT elevation
Hypersensitivity (< penicillin)
1st Gen Cephalo: DDI
Warfarin
Probenecid