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ID > Beta-Lactams > Flashcards

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
Q

Which B-lactam covers:

Actinomyces

A

Pen G
Pen VK
Ampicillin
Amoxicillin
Pip/Tazo

22
Q

Which B-lactam covers:

Neisseria meningitidis

A

Pen G&raquo_space; Pen VK
Ampicillin
Amoxicillin
Pip/Tazo

23
Q

Which B-lactam covers:

Moraxella catarrhalis

A

*Aminopenicillins
*Aminopenicillins + BLI
Augmentin
Unasyn

24
Q

Which B-lactam covers:

Proteus mirabilis

A

Pip/Tazo = Zosyn

*Aminopenicillins
*Aminopenicillins + BLI
Augmentin
Unasyn

25
Q

Which B-lactam covers:

E. coli

A

Pip/Tazo = Zosyn

*Aminopenicillins
*Aminopenicillins + BLI
Augmentin
Unasyn

26
Q

Which B-lactam covers:

H. Flu

A

Pip/Tazo = Zosyn

*Aminopenicillins
*Aminopenicillins + BLI
Augmentin
Unasyn

27
Q

Which B-lactam covers:

H. Pylori

A

Aminopenicillins
Aminopenicillins + BLI

28
Q

Which B-lactam covers:

Acinetobacter

A

Pip/Tazo = Zosyn
Sulbactam/Ampicillin = Unasyn

29
Q

Which B-lactam covers:

Shigella

A

Ampicillin > Amox

30
Q

Which B-lactam covers:

Salmonella

A

Amoxicillin
Ampicillin

31
Q

Which B-lactam covers:

B. frag

A

Pip/Tazo = Zosyn

*aminopenicillins + BLI

32
Q

Which B-lactam covers:

Klebsiella pneumoniae

A

Pip/Tazo = Zosyn

33
Q

Which B-lactam covers:

Citrobacter spp.

A

Pip/Tazo = Zosyn

34
Q

Which B-lactam covers:

Enterobacter spp.

A

Pip/Tazo = Zosyn

35
Q

Which B-lactam covers:

Serratia spp.

A

Pip/Tazo = Zosyn

36
Q

Which B-lactam covers:

Providencia

A

Pip/Tazo = Zosyn

37
Q

Which B-lactam covers:

Pseudomonas

A

Pip/Tazo = Zosyn

38
Q

What are the G - bacteria Zosyn is effective against?

A

Proteus mirabilis
E. coli
H. flu
Acinetobacter
Pseudomonas
B. frag
Klebsiella
Citrobacter
Serratia
Providencia
Pseudomonas
B. frag

39
Q

No renal adjustment needed

A

Ox/Naf

40
Q

PO only

A

Pen VK
Dicloxacillin
Amoxicillin

41
Q

PO, IV, IM
(All)

A

Pen G
Ox
Amp

42
Q

Which B-lactam’s absorption is not affected by food intake?

A

PCN VK
Amoxicillin (unless ER, then take within 1h of meal)

43
Q

Which route of administration is needed for CSF or CNS infx?

A

IV only

44
Q

True or false:

Penicillin is the drug of choice for many infections

A

True

45
Q

True or False:

there is a higher rate of clinical failure observed with non-B-lactam antibiotics for GNB blood infections?

A

True

46
Q

Cutaneous clinical manifestation of drug allergy:

  1. Pruritis
  2. Erythematous
  3. Maculopapular rash
  4. Morbilliform eruption
  5. Urticaria
  6. Purpura/Petechiae
A
  1. itchy skin
  2. red skin
  3. flat/raised
  4. red and flat or raised
  5. hives/edema
  6. purple spots (blood filled)
47
Q

Antibody IgE mediated penicillin rxn

  1. symptoms
  2. onset
  3. drug challenge
A
  1. Type 1
    urticaria/hives
    angioedema
    bronchospasms
    cardiovascular collapse/low BP
    anaphylaxis
  2. Appears quick, disappears quick
  3. Never do a drug challenge
48
Q

Antibody T-cell mediated penicillin rxn

A
  1. Serum sickness, hemolytic anemia, DRESS, SJS-TEN, AGEP
  2. onset is days to weeks after
  3. never do a drug challenge
49
Q

What is the difference between an allergic rxn and an adverse rxn?

A

Allergy: unanticipated, immune related, dose INDEPENDANT

Adverse: anticipated, drug related, dose DEPENDENT

50
Q

Contraindications to penicillin skin testing (PST):

A

Contraindicated with non-IgE mediated severe hypersensitivity rxn: SJS, TEN, DRESS, AIN, hemolytic anemia

51
Q

Contraindications to Drug Challenge:

A

SJS, TEN, DRESS, AIN, hemolytic anemia

52
Q

Induction of drug tolerance

A

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
Q

AE’s of B-lactams:

A
  1. GI: N,V,D
  2. C. diff
  3. Seizures with high dose PCN G and others
54
Q

Rare AE’s

A
  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
Q

DDI’s

A

1.Piperacillin/Aminoglycosides

  1. Doubling up on B-lactam combos.
  2. ABX/oral contraception
56
Q

Points to council on:

A
  1. Can they take the medication with food?
  2. Are they on oral contraception?
  3. AE to be aware of?

ID (2 decks)

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