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Cology 2 Exam 2 > Beta lactams > Flashcards

Beta lactams Flashcards

1
Q

Name the beta lactam agents

A 
Penicillins
Cephalosporins
Monobactams
Carbapenems
B-lactamase innhibitors
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2
Q

Are beta lactams bacteriostatic or bacteriocidal?

A

Bacteriostatic

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3
Q

What organisms do beta lactams target?

A

Gam + and gram -

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4
Q

Name the natural penicillins

A

Penicillin V

Penicillin G

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5
Q

Are the natural penicillins oral or IV?

A

Penicillin V is oral

Penicillin G is parenteral

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6
Q

What do the natural penicillins target?

A

Streptococcal and sensitive pneumococcal infections

Pen G drug of choice for syphillis

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7
Q

What are the penicillinase resistant penicillins?

A

Dicloxacillin
Nafcillin
Oxacillin

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8
Q

What do the penicillinase resistant penicillins target?

A

They target penicillinase producing staphylococcal infections, MSSA

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9
Q

What are the broad spectrum penicillins?

A

Ampicillin
Amoxicillin
Amoxicillin + Clavulanate
Ampicillin + Sulbactam

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10
Q

What do the broad spectrum penicillins target?

A 
S pyrogens
H influenzae
S pneumoniae
N meningitidis induced meningitis
Uncomplicated UTI
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11
Q

Which agents increase gram negative activity? Why is this helpful?

A

Antipseudomonal penicillins increase gram negative activity, allows them to target pseudomonas (P. aeruginosa, proteus, Enterobacter)

Piperacillin
Ticarcillin + Clavulanate
Piperacillin + Tazobactam

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12
Q

What is the broadest spectrum penicillin available?

A

Piperacillin + Tazobactam

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13
Q

How are penicillins absorbed?

A

They have good acid stability (except pen G) so they are absorbed orally

Absorption is DECREASED by food

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14
Q

How is penicillins solubility?

A

Poor lipid solubility (limited)

But they distribute well into the tissues

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15
Q

How are penicillins excreted?

A

Elimination is by active tubular secretion in the kidneys (90% unchanged in urine)

Anti-staph PCN’s are also in the bile

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16
Q

True or false: Penicillins are safe in nursing mothers

A

False - they cross the breast milk

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17
Q

How can you increase blood conc of penicillins?

A

Give probenecid to block active transport in kidneys to keep them in the body longer

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18
Q

What are adverse effects of penicillins?

A 
Allergy/sensitivity (environmental exposure)
CNS irritation/seizures (if an infection decreases permeability of BBB; doesn't normally cross BBB)
GI irritation (diarrhea)
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19
Q

What causes penicillin resistance?

A

Production of B-lactamases (and transfer via plasmids)

Addition of (S aureus) or lack of PBP’s

Cell membrane not lysing after penicillin binds

Penicillins are inactive against organisms without cell walls

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20
Q

True or false: Penicillins are active against mycoplasma

A

False; they do not have cell walls

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21
Q

What super infections can occur if penicillins are misused?

A

Fungal; c diff

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22
Q

What are cephalosporins?

A

Beta lactams that are structurally similar to penicillins; they are semi-synthetic

Usually NOT first line agents

23
Q

Describe the generations of cephalosporins

A

They have increasing gram negative activity with each generation

24
Q

True or false: Pts with penicillin allergy can use cephalosporins

A

Meh

2-5% cross-sensitivity

If a pt has a severe penicillin allergy, cephalosporins are absolutely contraindicated

25
Q

How are cephalosporins administered?

A

Cephalosporins have poor oral bioavailability; most are given pareneteral

26
Q

What are 1st generation cephalosporins effective against?

A

Streptococci
S Aureus

Used in surgical prophylaxis

27
Q

What are 2nd generation cephalosporins effective against?

A

E coli
Klebsiella proteus
H influenzae
Moraxella catarrhalis

28
Q

What are 3rd generation cephalosporins effective against?

A 
Enterobacteriacae
P aeruginosa
Serratia
Nisseria gonorrhea
Pseudomonas

Lack gram + activity!

29
Q

What are 4th generation cephalosporins effective against?

A 
Enterobacteriacae
P aeruginosa
Serratia
Nisseria gonorrhea
Pseudomonas

Lack gram + activity!

30
Q

What are 5th generation cephalosporins effective against?

A

MRSA
Enterobacter
Streptococci
Enterococcus

Not yet approved in US

31
Q

Name the oral cephalosporins

A

1st generation Cephalexin, Cephradine, Cefadroxil
(Lex is Rad, he Rox)

2nd generation Cefuroxime, Cefprozil
(He rox bc he’s a pro)

3rd generation Cefpodoxime, Cefibuten, Cefditoren, Cefixime
(He lives in a pod but he had to fib about what was toren)

4th generation: None
5th: None

32
Q

What are adverse effects of cephalosporins?

A

cross-reactivity with penicillins (allergic/sensitivity)

Nephrotoxicity!

Bleeding disorders (Ring interferes with vitamin K, can cause bleeding)

Disulfuram reactions - no alcohol

33
Q

Which cephalosporins have highest bleeding risk?

A

Cefmetazole
Cefoperazone

Went to the Met in Paris and started bleeding

34
Q

What are carbapenems?

A

Broadest spectrum beta lactams

They are beta-lactamase resistant!

35
Q

What do carbapenems work against?

A

Gram +, Gram -, anaerobes, and pseudomonas aeruginosa (Dorapenem, not Ertapenem)

36
Q

Do carbapenems work against pseudomonas aeruginosa?

A

Yes

Dorapenem does
Ertapenem does not

37
Q

Which carbapenem is dangerous for the kidneys?

A

Imipenem; it is metabolized into nephrotoxic compound in the renal tubule by dehydropeptidase

Compounded with cilastatin to inhibit the enzyme

38
Q

What is imipenem compounded with? Why?

A

Cilastatin; it inhibits dehydropeptidase to prevent metabolism into nephrotoxic compound

39
Q

How are carbapenems administered?

A

IV

40
Q

What are the carbapenems? Name them

A

Imipenem
Meropenem
Ertapenem
Dorapenem

41
Q

What are the indications for carbapenems?

A

Mixed aerobic and anaerobic intra-abdominal infections (people of Panem are hungry! get infections in their tummies)

Multi-drug resistant organisms; nosocomial infections (imipenem and meropenem)

Community acquired infections (ertapenem)

Abdominal and complicated UTI’s (Dorapenem)

42
Q

Which carbapenem is useful in nosocomial infections?

A

Imipenem and Meropenem

43
Q

Which carbapenem is useful in community acquired infections?

A

Ertapenem

Effie goes out into the community

44
Q

Which carbapenem is useful in abdominal infections and complicated UTI’s?

A

Dorapenem

UTI’s are not aDORable

45
Q

What adverse effects occur with carbapenems?

A

Sensitivity with other B-lactams (low-5%)

Seizures (Imipenem)

Anemia, thrombocytopenia, altered bleeding time (tests ONLY, doesn’t actually cause bleeding)

46
Q

Which carbapenem is associated with seizures?

A

Imipenem

IMI - Intracranial muscle itchiness (seizures idk)

47
Q

What are monobactams?

A

Aztreonam

48
Q

What are monobactams effective against?

A

Aztreoname is effective against gram -, p aeruginosa, H influenzae, and gonococci

NOT GRAM +!

49
Q

What are monobactams used for?

A

Multi-drug resistant strains

50
Q

How are monobactams administered?

A

Aztreonam is given IV or IM

51
Q

What are side effects of monobactams?

A 
Nausea
Vomiting
Diarrhea
Seizures
Bone marrow suppression
52
Q

Which agent has bone marrow suppression?

A

Aztreonam (monobactam)

53
Q

Can monobactams be used in penicillin allergy?

A

Yes - no cross sensitivity with Aztreonam and penicillins

Cology 2 Exam 2 (18 decks)

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