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PHRM 865 > Beta Lactams > Flashcards

Beta Lactams Flashcards

1
Q

MOA of beta lactams

A

inhibit cell wall synthesis by binding to and inhibiting PBPs

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2
Q

resistance mechanisms of beta lactams

A

beta lactamase production
alteration in PBPs
decreased permeability of outer cell membrane

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3
Q

are beta lactams time dependent or concentration dependent?

A

time dependent
T>MIC

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4
Q

are beta lactams bactericidal or bacterostatic

A

bactericidal
(Except against enterococcus)

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5
Q

half life of beta lactams

A

<2 hours
(except: ceftriaxone, cefotitan, cefixime, ertapenem)

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6
Q

elimination of beta lactams

A

renal
(except: nafcillin, oxacillin, ceftriaxone, cefoperazone)

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7
Q

is there cross allergenicity with beta lactams?

A

yes except aztreonam

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8
Q

mechanisms of resistance penicillins

A

beta lactamases
altered PBPs
decreased penetration through outer cell membrane (gram negatives)

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9
Q

which bacteria make beta lactamase enzymes?

A

Gram +: staph aureus
Gram -: most, haemophilus, moraxella, neisseria, E. coli, Klebsiella, Enterobacter
Gram neg anaerobes: bacteroides

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10
Q

natural penicillins

A

penicillin G
benzathine penicillin
procaine penicillin
penicillin VK

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11
Q

penicillinase resistant penicillins

A

methicillin
nafcillin
dicloxacillin

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12
Q

aminopenicillins

A

ampicillin
amoxicillin

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13
Q

carboxypenicillins

A

ticaricillin

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14
Q

ureidopenicillins

A

pipericillin

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15
Q

beta lactamase inhibitor combo penicillins

A

amoxicillin-clavulaunate (Augmentin)
piperacillin-tazobactam (Zosyn)
ampicillin-sulbactam (Unasyn)

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16
Q

natural penicillins (Pen G, Pen V)
general spectrum

A

gram pos
gram neg cocci
anaerobes

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17
Q

penicillinase resistant (nafcillin, methicillin,dicloxacillin) general spectrum

A

gram pos
MSSA

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18
Q

aminopenicillins (amox and amp) general spectrum

A

gram pos
gram neg
anaerobes

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19
Q

carboxypenicillin (ticarcillin) general spectrum

A

gram neg aerobes only
pseudomonas aeruginosa

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20
Q

uriedopenicillin (piperacillin) general spectrum

A

gram pos
gram neg
anaerobes
pseudomonas aeruginosa
BDA (with Zosyn)

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21
Q

beta lactamase inhibitors general spectrum

A

gram pos
gram neg
anaerobes
below diaphragm anaerobes
MSSA (not used)

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22
Q

CSF penetration with penicillins

A

all penicillins will get in if max IV dose and inflamed meninges

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23
Q

which penicillins do not need renal dose adjustment

A

nafcillin
oxacillin

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24
Q

what dosage form for mild to moderate infections

A

oral

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25
Q

which penicillins are IM

A

procaine pen G
benzathine

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26
Q

best oral anti staph penicillin

A

dicloxacillin

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27
Q

which drug for syphilis

A

penicillin G

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28
Q

which penicillin for MSSA

A

nafcillin, dicloxacillin, oxacillin

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29
Q

which drug of choice for enterococcus

A

ampicillin, amoxicillin

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30
Q

which penicillin of choice for pseudomonas aeruginosa

A

piperacillin

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31
Q

augmentin uses

A

otitis media, sinusitis, bronchitis, lower respiratory tract infections, animal bites, human bites

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32
Q

Zosyn use

A

empiric therapy for hospital acquired pneumonia

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33
Q

adverse effects of penicillins

A

hypersensitivity
seizures (renal insufficiency if no dose adjus
leukopenia, neutropenia
diarrhea w clauv
interstitial nephritis
phlebitits
hypokalemia
sodium overload

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34
Q

drugs to use in caution for pts with CHF or renal insufficiency due to high sodium content

A

aqueous sodium penicillin G
nafcillin
ticarcillin
piperacillin (and Zosyn)

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35
Q

what is interstitial nephritis

A

abrupt increase in serum creatinine
(sometime with eosinophilia)

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36
Q

which drugs more likely to cause interstitial nephritis

A

nafcillin, methicillin

37
Q

1st generation cephalosporins

A

cefazolin
cephalexin

38
Q

2nd generation cephalosporins

A

cefuroxime
cefoxitan
cefotetan
cefprozil

39
Q

3rd generation cephalopsporins

A

ceftriaxone
ceftazidime
cefpodoxime
cefoperazone

40
Q

4th generation cephalosporins

41
Q

anti MRSA cephalosporin

A

ceftraroline

42
Q

new miscellaneous cephalosporin

A

cefiderocol

43
Q

beta lactamse inhibitor combo cephalosporins

A

cetolozane-tazobactam
ceftazidime-avibactam

44
Q

general spectrum of activity for generations of cephalosporins

A

1st gen - highest gram pos, lowest neg
4th gen - highest gram neg, lowest neg

45
Q

which cephalosporins have the best activity out of all the cephalos

A

cefazolin
cephalexin

46
Q

which cephalosporins cover BDA

A

cephamycins
2nd gens
(cefotetan, cefoxitan, cefmetazole)

47
Q

which cephalosporin covers only gram negative

A

cefiderocol

48
Q

which cephalosporins cover enterococcus

A

none, its a hole in the spectrum of these

49
Q

cefazolin, cephalexin target organisms

50
Q

cefuroxime,
cefprozil target organisms

A

MSSA (not used)

51
Q

cefotetan, cefoxitin, cefmetazole target organisms

52
Q

ceftraixone target organisms

A

MSSA (not used)
PRSP

53
Q

ceftazidime target organisms

A

pseudomonas aeruginosa

54
Q

cefepime target organsism

A

pseudomonas aeruginosa
MSSA (not used)

55
Q

ceftaroline target organisms

A

MRSA
PRSP
MSSA

56
Q

cefiderocol target organisms

A

pseudomonas aeruginosa

57
Q

ceftolozane-tazobactam and ceftazidime-avibactam target organisms

A

pseudomonas aeruginosa

58
Q

which cephalosporins cover PRSP?

A

ceftriaxone (primary)
ceftaroline
cefepime

59
Q

which cephalosporins cover MSSA

A

cephalexin, cefazolin
2nd, 3rd, 4th, ceftaroline (Not used)

60
Q

which cephalosporins cover MRSA

A

ceftaroline

61
Q

which cephalosporins cover pseudomonas

A

ceftazidime (primary)
cefepime
cefiderocol
combos

62
Q

which cephalosporins cover BDAs

A

cefoxitin
cefotetan
cefmetazole

63
Q

which cephalosporins cover legionella

A

none, hole in spectrum

64
Q

which cephalosporins penetrate the CSF?

A

cefuroxime

65
Q

which cephalosporins do not require dose adjustment in renal insufficiency

A

ceftraixone
cefoperazone

66
Q

which cephalosporin is the only once daily dosing

A

ceftraixone

67
Q

adverse effects of cephalosporins

A

hypersensitivity
leukopenia, thrombocytopenia, neutropenia
biliary sludging: ceftriaxone
c. diff colitis
nonconvulsive status epilepticus
disulfuram, hypoprothombinemia

68
Q

which drugs cause disulfuram reaction and hypoprothrombinemia

A

cefamandole
cefotetan
cefmetazole
cefoperazone
moxalactam
(due to MTT side chain)

69
Q

which cephalosporins can cause nonconvulsive status epilepticus in nephrotoxicity

A

cefepime
ceftazidime
cefiderocol

70
Q

which cephalosporin should you avoid with calcium

A

ceftriaxone

71
Q

can we use cephalosporins in PCN allergy>

A

if anaphylaxis - no
if delated reaction - avoid first gens (side chain r1)

72
Q

carbapenems

A

imipenem
doripenem
meropenem
ertapenem
meropenem-vabobactam
imipenem-relebactam

73
Q

monobactams

74
Q

spectrum of activity of carbapenems general

A

most broad spectrum antibiotics

75
Q

carbapenems with best gram positive activity

A

imipenem
doripenem

76
Q

carbapenems with best gram negative activity

A

meropenem
doripenem

77
Q

target organisms carbapenems

A

BDA
MSSA (not used)
pseudomonas aeruginosa (not erta)
ESBL and Amp C producing
KPC (combos)

78
Q

which carbapenem does not cover pseudomonas

79
Q

which drugs cover ESBL and Amp C

A

carbapenems

80
Q

which drugs cover KPC

A

carbapenem combos

81
Q

CSF penetration of carbapenems

A

meropenem only one

82
Q

which carbapenems require dose adjustment in renal insuf

A

all of them

83
Q

adverse effect of carbapenems

84
Q

which drug is used with cilastatin

A

imipenem
prevent breakdown of imipenem by DHP in kidney

85
Q

what is cilastatin

A

DHP inhibitor used with imipenem

86
Q

risks for CNS toxicity with carbapenems

A

CNS disorder (recent stroke, seizure, head trauma), high doses, renal insufficiency

87
Q

aztreonam spectrum

A

no gram positive
only gram negative
pseudomonas

88
Q

does aztreonam penetate the CNS?

PHRM 865 (11 decks)

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