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Beta Lactams Flashcards

1
Q

What class do PCNs fall under?

A

Bactericidals, Cell Wall Synthesis Inhibitors, Beta Lactams

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2
Q

Beta Lactams inhibit what enzyme?

A

Transpeptidase or PCN Binding Proteint

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3
Q

What is the MOA of Beta Lactams, like PCNs?

A

Inhibits cell wall synthesis by inhibiting transpeptidase, causing lysis

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4
Q

Are Beta Lactams and PCNs time dependent or concentration dependent?

A

Time dependent -> can require frequent dosing to keep drug concentration therapeutic

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5
Q

What are the mechanisms of resistance to beta Lactams, like PCNs?

A
  1. Increase # of transpeptidase enzymes
  2. Change binding characteristics of those enzymes (ex. MRSA)
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6
Q

Why to PCNs have less ability to fight MRSA?

A

All MRSA have a methicillin resistant gene that encodes for a transpeptidase with low affinity to bind to antistaph PCNs

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7
Q

PCN provides good coverage for which bugs?

A

Gram +: strep pyogenes (GABHS), viridans strep, some S. Pneumoniae
Gram - aerobes: N.meningitis, pasteurella multocida
Anaerobes: Clostridium
SYPHILIS***

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8
Q

Are PCNs used for staph a?

A

No. Staph aureus produce penicillinases

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9
Q

What two drugs are combined for GBS coverage for pregnant culture+ women?

A

PCN and ampicillin

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10
Q

What are the indications for PCNs?

A

Erysipelas, pharyngitis (GABHS or Strep pyogenes), prevention of rheumatic HD, syphilis, chemo-diphtheria prophylaxis

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11
Q

Which PCN can you give IV and for what indication?

A

Aqueous PCN G, for neurosyphilis

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12
Q

Which PCN is long acting (LA) and for what indication?

A

Benzathine PCN G (Bicillin L-A), syphilis

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13
Q

Which PCN can you give orally?

A

PCN V Potassium, give on empty stomach

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14
Q

How are PCNs, and most beta Lactams, cleared?

A

Renally

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15
Q

Are beta Lactams, and PCNs, safe or unsafe for pregnancy?

A

Safe, catagory B

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16
Q

Why is probenecid added to PCNs?

A

Prolongs PCN serum levels
- blocks renal tubular secretion of PCN
- alternative to standard therapy for neurosyph, which requires high frequ of dosing (500mg q6h)
- SE: N/V

17
Q

What are the SE of PCNs?

A
  • Anaphylaxis (IgE, type 1)
  • rash
  • nausea
  • seizure, usually if taking with other drugs that lower threshold
  • hyperK with aqueous PCN G (caution with CKD)
  • Jarisch-Herxheimer reaction (fever, muscle aches, HA, tachycardia) with 2’ syphilis and IM PCN G
18
Q

Why don’t we give PCNs for Staph A?

A

Staph A produces penicillinase
- but we can give Penicillinase-Resistant PCNs
- (Dicloxacillin, Nafcillin, Oxacillin)

19
Q

What are the indications for Penicillinase-Resistant Penicillins?

A

***Staph aureus, Staph epidermis
- no gram - , no MRSA/ORSA, no enterococcus
- Skin and soft tissue infections 2’ to MSSA, endocarditis 2’ MSSA

20
Q

Which Penicillinase-REsistant PCN can be given orally and for what reason?

A

Dicloxacillin, and like the other PR PCNs, MSSA
-give on empty stomach, excreted bile, no renal dosage

21
Q

What SE does Nafcillin cause?

A

Neutropenia and phlebitis
-excreted bile

22
Q

What are the aminopenicillins and what do they cover?

A

Amoxicillin and ampicillin
-gram+: strep
-gr- coverage H influenza, E.coli, proteus, lis.
- PCN-resistant pneumococci
- enterococcus
-MSSA when combined with BLI like clavunalic acid and sulbactam

23
Q

General uses for aminopenicillins

A

-otitis media, bacterial sinusitis, cystitis, salmonella (amoxicillin), shigella (ampicillin), H. pylori, endocarditis/dental prophylaxis
- GBS (PCNs and ampicillin)
- **Listeria (meningitis) -> ampicillin, for new borns and over 60y, and meningococcal meningitis

24
Q

What are the side effects for ampicillin?

A

GI, diffuse rash if given with EBV (mono)

25
Q

SE for amoxicillin?

A

Diffuse rash if given with EBV (mono)

26
Q

Beta Lactams/Beta Lactamase Inhibitors extend coverage to which bugs?

A

Pseudomonas and enterobacter
TCP= Takes Care of Pseudomonas

27
Q

How do Beta Lactam/Beta-Lactamase Inhibitors work?

A

They are added to abx to irreversibly bond to bacterial enzymes, inactive them, and allow abx to go on for the kill

28
Q

What drugs are Beta-Lactam/Beta-Lactamase Inhibitors?

A

Avibactam
Clavulanic acid
Sulbactam
Tazobactam

29
Q

Which BLI can you take orally, what does it not cover, and what are the SE?

A

Amoxicillin/CA, no pseudomonas, diarrhea

30
Q

Which BLI is best for pseudomonas coverage?

A

Piperacillin/TZ

31
Q

Which BLI drugs cover pseudomonas?

A

Ticarcillin/CA, Pip/TZ (best), Ceftazidime/AV (also ESBLs), Ceftolozane/TZ (also ESBLs)

Test (13 decks)

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