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Beta-Lactams Flashcards

1
Q

What is the Beta-Lactam’s primary PD effect?

A

Time Dependent

T > MIC

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2
Q

What is the MOA of Beta-Lactams/penicillin?

A

B-lactams are bactericidal cell wall inhibitors. They inhibit cell wall synthesis by binding to penicillin binding proteins (PBP) which inhibits the transpeptidase reaction step.

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3
Q

What does it mean for an antibiotic to be time dependent?

A

Once the concentration of the drug is a certain level above the MIC, there is no further benefit, however, after the concentration is above the MIC for a specific period of time, it achieves optimal effect.

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4
Q

How do bacteria become resistant to B-lactam abx?

A

Bacteria produce beta lactamase enzymes, which hydrolyze the B-lactam ring, rendering it inactive.

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5
Q

How do B-lactamase inhibitors work?

Do in vitro tests always translate to in vivo and why?

A

The MOA of B-lactamase inhibitors is that it binds IRREVERSIBLY to B-lactamase to prevent the destruction of the B-lactam ring in the abx. This allows intact penicillin to bind to PBP and inhibit cell wall synthesis.

No. In vitro, it may seem to work but in vivo it may not. This is because the type and amount of B-lactamase present can affect how well the inhibitors can work.

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6
Q

Natural Penicillins

…and their route of administration

A

Pen G (IV, IM)

IM form of Pen G = procaine and benzathine

Pen VK (PO) - potassium salt resists breakdown in stomach.

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7
Q

Aminopenicillins

…and their route of administration

A

Ampicillin (IV, PO)

Amoxicillin (PO)

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8
Q

Carboxypenicillin & Ureidopenicillin

A

Ticarcillin (w/d in US)

Piperacillin (+ B-lactamase inhibitor)

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9
Q

Beta-Lactamase Inhibitors (4)

A
  1. Clavulanic Acid
  2. Sulbactam
  3. Tazobactam
  4. Durlobactam
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10
Q

Augmentin

A

Clavulanic Acid + Amoxicillin

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11
Q

Unasyn

A

Sulbactam + Ampicillin

(Acinetobacter activity)

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11
Q

Zerbaxa

A

Tazobactam + Ceftolozane

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11
Q

Zosyn

A

Tazobactam + Piperacillin

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11
Q

Xacduro

A

Durlobactam + Sulbactam

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11
Q

Name all classes of B-Lactams (3)

A
  1. Natural Penicillins
  2. Aminopenicillins
  3. Carboxy - and - Ureido -Penicillins
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12
Q

Name the Natural Penicillins

A

Pen G
Pen VK

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13
Q

Name the Aminopenicillins

A

Ampicillin
Amoxicillin

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14
Q

Name the Ureidopenecillin

A

Piperacillin + Tazobactam = Zosyn

aka Pip/Tazo

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15
Q

Which B-lactam covers:

Staphylococcus spp.

A

Anti Staph Penicillinase-Resistant PCN.
1. Oxacillin (IV)
2. Nafcillin (IV)
3. Dicloxacillin (PO)

Pen G *
Pen VK *
Ampicillin *
Amoxicillin *
Pip/Tazo *

  • Combination with beta lactam inhibitors might restore activity
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16
Q

Which B-lactam covers:

Streptococcus spp.

A

Pen G
Pen VK
Ampicillin
Amoxicillin
Pip/Tazo

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17
Q

Which B-lactam covers:

Enterococcus spp.

A

Pen G
Pen VK
Ampicillin
Amoxicillin
Pip/Tazo

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18
Q

Which B-lactam covers:

Peptostreptococcus

A

Pen G
Pen VK
Ampicillin
Amoxicillin
Pip/Tazo

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19
Q

Which B-lactam covers:

Clostridium spp.

A

Pen G
Pen VK
Ampicillin
Amoxicillin
Pip/Tazo

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20
Q

Which B-lactam covers:

Listeria

A

Pen G
Pen VK
Ampicillin
Amoxicillin
Pip/Tazo

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21
Which B-lactam covers: Actinomyces
Pen G Pen VK Ampicillin Amoxicillin Pip/Tazo
22
Which B-lactam covers: Neisseria meningitidis
Pen G >> Pen VK Ampicillin Amoxicillin Pip/Tazo
23
Which B-lactam covers: Moraxella catarrhalis
*Aminopenicillins *Aminopenicillins + BLI Augmentin Unasyn
24
Which B-lactam covers: Proteus mirabilis
Pip/Tazo = Zosyn *Aminopenicillins *Aminopenicillins + BLI Augmentin Unasyn
25
Which B-lactam covers: E. coli
Pip/Tazo = Zosyn *Aminopenicillins *Aminopenicillins + BLI Augmentin Unasyn
26
Which B-lactam covers: H. Flu
Pip/Tazo = Zosyn *Aminopenicillins *Aminopenicillins + BLI Augmentin Unasyn
27
Which B-lactam covers: H. Pylori
Aminopenicillins Aminopenicillins + BLI
28
Which B-lactam covers: Acinetobacter
Pip/Tazo = Zosyn Sulbactam/Ampicillin = Unasyn
29
Which B-lactam covers: Shigella
Ampicillin > Amox
30
Which B-lactam covers: Salmonella
Amoxicillin Ampicillin
31
Which B-lactam covers: B. frag
Pip/Tazo = Zosyn *aminopenicillins + BLI
32
Which B-lactam covers: Klebsiella pneumoniae
Pip/Tazo = Zosyn
33
Which B-lactam covers: Citrobacter spp.
Pip/Tazo = Zosyn
34
Which B-lactam covers: Enterobacter spp.
Pip/Tazo = Zosyn
35
Which B-lactam covers: Serratia spp.
Pip/Tazo = Zosyn
36
Which B-lactam covers: Providencia
Pip/Tazo = Zosyn
37
Which B-lactam covers: Pseudomonas
Pip/Tazo = Zosyn
38
What are the G - bacteria Zosyn is effective against?
Proteus mirabilis E. coli H. flu Acinetobacter Pseudomonas B. frag Klebsiella Citrobacter Serratia Providencia Pseudomonas B. frag
39
No renal adjustment needed
Ox/Naf
40
PO only
Pen VK Dicloxacillin Amoxicillin
41
PO, IV, IM (All)
Pen G Ox Amp
42
Which B-lactam's absorption is not affected by food intake?
PCN VK Amoxicillin (unless ER, then take within 1h of meal)
43
Which route of administration is needed for CSF or CNS infx?
IV only
44
True or false: Penicillin is the drug of choice for many infections
True
45
True or False: there is a higher rate of clinical failure observed with non-B-lactam antibiotics for GNB blood infections?
True
46
Cutaneous clinical manifestation of drug allergy: 1. Pruritis 2. Erythematous 3. Maculopapular rash 4. Morbilliform eruption 5. Urticaria 6. Purpura/Petechiae
1. itchy skin 2. red skin 3. flat/raised 4. red and flat or raised 5. hives/edema 6. purple spots (blood filled)
47
Antibody IgE mediated penicillin rxn 1. symptoms 2. onset 3. drug challenge
1. Type 1 urticaria/hives angioedema bronchospasms cardiovascular collapse/low BP anaphylaxis 2. Appears quick, disappears quick 3. Never do a drug challenge
48
Antibody T-cell mediated penicillin rxn
1. Serum sickness, hemolytic anemia, DRESS, SJS-TEN, AGEP 2. onset is days to weeks after 3. never do a drug challenge
49
What is the difference between an allergic rxn and an adverse rxn?
Allergy: unanticipated, immune related, dose INDEPENDANT Adverse: anticipated, drug related, dose DEPENDENT
50
Contraindications to penicillin skin testing (PST):
Contraindicated with non-IgE mediated severe hypersensitivity rxn: SJS, TEN, DRESS, AIN, hemolytic anemia
51
Contraindications to Drug Challenge:
SJS, TEN, DRESS, AIN, hemolytic anemia
52
Induction of drug tolerance
this is for IgE rxns to desensitize the patient through exposure and must be done consistently and with every restarting of the medication. However, it only lessens the risk.
53
AE's of B-lactams:
1. GI: N,V,D 2. C. diff 3. Seizures with high dose PCN G and others
54
Rare AE's
1. Blood dyscrasias 2. LFT's 3. interstitial nephritis 4. electrolyte imbalance in high dose PCN VK 5. Jarisch-Herxheimer rxn in PCN tx for syphilis
55
DDI's
1.Piperacillin/Aminoglycosides 2. Doubling up on B-lactam combos. 3. ABX/oral contraception
56
Points to council on:
1. Can they take the medication with food? 2. Are they on oral contraception? 3. AE to be aware of?

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