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Infectious Disease > Beta-Lactams > Flashcards

Beta-Lactams Flashcards

1
Q

How do penicillins get excreted from the body?

a. tubular reabsorption
b. tubular secretion
c. gastrointestinal excretion
d. bilary excretion

A

B. Tubular Secretion

90% tubular secretion

Use with caution on patients with renal insufficiency or you will cause seizures

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2
Q

Natural penicillins are efficient against what type of bacteria?

A. gram positive

B. gram negative

C. Both

A

A. gram positive

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3
Q

Aminopenicillins are efficient against with type of bacteria?

A. gram positive

B. gram negative

C. both

A

C. Both

a. all penicillins are effective against gram positive
b. aminopenicillins have an electron withdrawing group, which means the drug can go throug the porins of the gram negative

c.

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4
Q

Which of the following are not effective against beta-lactamase? (select all that apply)

a. amoxicillin
b. naficillin
c. ampicillin
d. oxacillin

A

A, C

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5
Q

Which of the following are broad spectrum? (select all that apply)

A. piperacillin

B. Amoxicillin

C. Penicillin

D. Oxacillin

A

A, B

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6
Q

Mike Jones is a medical resident and asks you if he can give probenecid and penicillin together. What do you respond?

A. Nah! Probenecid can decrease penicillin through CYP3A4 enzymes

B. Nah! Probenecid can increase penicillin by interfereing with renal excretion

C. Yass!! Penicillin has no metabolism

D. Yass!!

A

B.

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7
Q

Which of the following a first generation cephalosporin?

a. ceftaroline
b. cefepime
c. cefazolin
d. cefdinir

A

C. Cefazolin

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8
Q

Which of the following is not a 2nd generation cephalosporin?

a. cefuroxime
b. cefotetan
c. ceftriaxone
d. cefoxitin

A

C. Ceftriaxone

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9
Q

What generation is cefprozil?

a. 1st
b. 2nd
c. 3rd
d. 4th
e. 5th

A

B. 2nd

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10
Q

Which of following are 3rd generation cephalosporins? (select all that apply)

a. cefazolin
b. ceftriaxone
c. ceftazidime
d. cefotaxime

A

B,C,D

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11
Q

Which of the following is a4th generation cephalosporin?

a. ceftaroline
b. cefazolin
c. cefotaxime
d. cefepime

A

D. Cefepime

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12
Q

True or False. Cefepime is given PO

A

False

Cefepime is Parenteral

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13
Q

Which of the following is a 5th generation cephalosporin?

a. cefepime
b. ceftriaxone
c. ceftaroline
d. cefuroxime

A

C. Ceftaroline

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14
Q

Cephalexin is a _________cephalosporin given______.j

a. 2nd generation; PO
b. 1st generation; parenteral
c. 1st generation; PO
d. 2nd generation: parenteral

A

C

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15
Q

Cefuroxime is a _____cephalosporin administed______.

a. 3rd generation; po
b. 3rd generation; parenteral
c. 2nd generation; po
d. 2nd generation; parenteral

A

D

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16
Q

Which of the following medications is not given PO?

a. ceftaroline
b. cefdinir
c. cefuroxime axetil
d. cephalexin

A

A.

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17
Q

True or False

Joel is taking warfarin. He will develop hypotrhombinemia for taking cefazolin.

A

False

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18
Q

The red structure is an oxime, what is its function on the beta-lactam?

a. Increases absorption
b. Electron withdrawing group
c. resistance to beta-lactamase
d. Activate the drug

A

C. Resistance to beta-lactamase

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19
Q

Which of the following is incorrect based on the cefprozil structure?

a. Medication is administered PO
b. susceptible to beta-lactamase
c. covers some gram positive and many other gram positive
d. medication cross the BBB

A

D. Medication crosses the BBB

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20
Q

Which of the following statements is true about cefuroxime axetil?

a. penetrates the CNS
b. administered parenterally
c. administered PO
d. broad spectrum antibiotic

A

C. Administered PO

b/c of the ester groups in the red, they icrease absorption

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21
Q

Which of the following is true about cefepime?

A. active against streptococcus, staphylococcus (MSSA)

B. active against gram-positive bacteria

C. Administered PO

D. beta-lactamase susceptible

A

a. active against streptococcus Staphylococcus MSSA

b is wrong bc its effective against gram negative

c is wrong bc its adminstered PO

d is wrong it contains a methyoxyimine group

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22
Q

Which of the following cephalosporins is a prodrug?

a. cefazolin
b. ceftriaxone
c. ceftaroline
d. cefempime

A

C. Ceftaroline

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23
Q

Which of the following structures will make penicillin resistant to beta-lactamase? (select all that apply)

A.

B.

C.

D.

A

A, D

R groups have to be in the ortho position to cause beta-lactamase resistance

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24
Q

Which of the following antibiotics has excellent activity against normal and mutated PBPs like PBP2A and PBP2X?

a. cefepime
b. ceftriaxone
c. cefuroxime
d. ceftaroline

A

d. ceftaroline

25
Q

Gordon is a 2 week old neonate with hyperbilirubin. He unfortunately got meningitis. Which of the following medications should the neonate not receive because it is contraindicated with hyperbilirubin.

a. cefepime
b. ceftriaxone
c. cefotaxime
d. cefotetan

A

B. Ceftriaxone

26
Q

Andy is reading a passage on micromedex, Woody is being a metiche and wants to know which antibiotic he is researching. The passage reads “Do not co-administer with calcium containing solutions”

a. ceftriaxone
b. cefotaxine
c. ceftaroline
d. cefepime

A

a. ceftriaxone

27
Q

In the structure below, the alpha is NH2. What is the purpose of the NH2 in the structure?

a. improved antibacterial activity
b. improved beta-lactamase resistance
c. improved stability under acidic conditions therefore orally active
d. improved stability under acidic conditions therefore parenterally active

A

c

28
Q

In the structure below, the X is an OR (OCH3), what is the purpose of the X structure?

a. improved stability under acidic conditions therefore orally active
b. improved antibacterial activity
c. increased beta-lactamase resistance
d. a and b
e. b and c

A

E.

29
Q

What beta-lactam antibiotics is a drug of choice for ESBL-producing bacteria?

a. penicillins
b. monobactams
c. cephalosporins
d. cabapenems

A

d. carbapenems

30
Q

Which carbapenem is metabolized in the kidney by dehydropeptidase I?

a. doripenem
b. ertapenem
c. meropenem
d. imipenem

A

d. imipenem

31
Q

What is the purpose of cilastatin?

a. resistance to renal dehydropeptidase
b. renal dehydropeptidase inhibitor
c. extend half-life so it could be once daily dosing
d. prevent seizures

A

b. renal dehydropeptidase inhibitor

Resistance to renal dehydropeptidase is done by a methyl group at the C4 on meropenem and ertapenem.

32
Q

There are four patients each takin a carbapenem. Which of the following is at risk for getting seizures?

a. Patient one taking ertapenem
b. patient 2 taking meropenem
c. patient 3 taking imipenem
d. patient 4 taking Primaxin (imipenem with cilastin)

A

D. patient 4

33
Q

A medical resident asks you the pharmacist what will happen is imipenem/cilastin is administered to a patient taking cyclosporin?

a. seizures
b. CNS adverse effects of cyclosporin may be increased
c. loss of seizures
d. CNS adverse effects of cyclosporin may be decreased

A

B.

34
Q

What bacteria has decreased permeability and enhaned efflux?

a. E. Coli
b. pseudomonas aeruginosa
c. N. gonorrhoeae
d. MRSA

A

b. pseudomonas aeruginosa

35
Q

Which of the following can extended spectrum beta-lactamases inactivate? (select all that apply)

a. PCN
b. cephalosporins
c. monobactams
d. carbapenems

A

A, B, C

Carbapenems are currently effective against ESBL

36
Q

Which of the following statements is incorrect?

a. ampicillin is formulated with sulbactam
b. piperacillin is formulated with tazobactum
c. amoxicillin is formulated with clauvante
d. the inhibition of beta-lactamse by the the beta-lactamse inhibitors is reversible

A

D.

37
Q

Based on the structure of penicillin, what is the best route of administration? (select all that apply)

A. PO

B. IV

C. IM

D. Sublingual

A

B, C

In the presence of acid, the negatively charged oxygen makes a nucleophillic attack on the beta-lactam ring which then opens the ring and becomes inactive. This is what makes penicillin G have poor oral bioavailability

38
Q

What is the purpose of the electron withdrawing groups on the antibiotics?

A. Makes antibiotics stable in acid

B. Makes antibiotics unstable in acid

C. Makes antibiotics stable toward beta-lactamases

D. Makes antibiotics unstable toward beta-lactamases

A

A.

39
Q

Marcos had his blood drawn because he had an infection. when the results came back, it said marcos had methicillin susceptible staphylocococus aureus (MSSA). The doctor calls to ask you what he should prescribe, what do you respond? (select all that apply)

a. cefepime
b. oxacillin
c. cloxacillin
d. ceftriaxone

A

B, C

40
Q

Which of the following antistaphylococcal penicillins are acid resistant? (select all that apply)

a. nafcillin
b. oxacillin
c. cloxacillin
d. dicloxacillin

A

C, D

those 2 are acid resistant because they have chloro as an electron withdrawing group

41
Q

Based on the following structrus provided which are not resistant to acid?

A.

B.

C.

D.

A

C,D

The ones that have a chloro group are acid resistant and remember they will be able to be given orally. C and D are not acid resistant and can only be given parenterally

42
Q

What is the purpose of antistaphylococcal penicillins? (select all that apply)

A. MRSA

B. Penicillinase-Producing Staph. Infections

C. gram negative bacteria

D. MSSA

A

B,D

43
Q

Which of the following antistaphylococcals is a veiscant?

a. dicloxacillin
b. oxacillin
c. nafcillin
d. cloxacillin

A

C. Nafcillin

A vesicant causes tissue necrosis in surrounding area this is if is injected and comes out of the blood and comes in contact with the skin.

44
Q

Which of the following statements is true about aminopenicillins?

a. ampicillin and amoxicillin have an amino group in the side chain that allows them to be given orally
b. aminopenicillins are broad spectrum
c. aminopenicillins have a bulky R group that is resistant to penicillinase
d. Polar R group in aminopenicillins allows the drug to go through the bacteria’s porins

A

C

45
Q

Which of the following statements is true regarding antispseudomonal PCNs?

A. Acid Unstable therefore PO administration

B. Resistant to Beta-lactamase

C. Effective against gram positive and gram negative bacteria

D. Ureido group in the piperacillin provides better or additional point of interaction with the beta-lactamase

A

C. Effective against gram positive and gram negative

a. false: acid unstable therefore parenteral administration
b. false: sensitive to beta-lactamsase therefore they are formulated with beta-lactamase inhibitors.
c. TRUE
d. false: ureido group in the piperacillin provides better or additional point of interaction with PBPs

46
Q

True or False

Penicillins are known as Haptens

A

True

Haptens are not allergenic themselves but when they combine with proteins they produce products that are anti-genic

47
Q

What is the function of the group highlighed in red in Cephalexin?

a. MTT, that causes hypothromboneima
b. amino group that causes acid unstability
c. amino group that causes acid stability
d. bulky ortho group that causes beta-lactamase resistance

A

C. Amino group that causes acid stability

This drug can be given orally

48
Q

True or False: The following structure causes hypoprothrombonemia

A

False

49
Q

What does the structure in red do in cefuroxime?

a. Increases Acid Stability
b. increases beta-lactamase resistance
c. increases beta-lactamase susceptibility
d. increases anti-bacterial properties

A

c. increass beta-lactamase susceptibility

bc its an oxime

50
Q

What does the structure in red do in cefrprozil?

A. Increase acid stability

b. Increase Beta-lactamse resistance
c. increase bacterial properties
d. increases the risk of hypoprothrombonemia

A

A.

51
Q

What does the red structure in cefuroxime axetil do?

a. improve stability under acidic conditions
b. improve antibacterial activity
c. increase beta-lactamase resistance
d. drug is a prodrug therefore it cleves at the ester to become active

A

A. improve stability under acidic conditions

52
Q

What does the structure in red do?

a. provide increase stability towards beta-lactamase
b. improved antibacteial activity
c. improved stability under acidic conditions
d. administered PO

A

A. Provide increase stability towards beta-lactamase

53
Q

Which of the following is not true regarding Cefoxitin?

a. its a second generation cephalosporin
b. it increases beta-lactamase resistance
c. It doesn no increase stability towards acid conditions
d. rout of admnistration is PO

A

D. Route of administration is PO

54
Q

Which of the following statements is false regarding cefotetan?

a. it provides increased stability towards beta-lactamases
b. useful activity against anaerobes
c. Causes hypoprothrombonmia
d. Increased stability under acidic conditions

A

D. Increased stability under acidic conditions

55
Q

What does the red structure in cefotaxime do?

a. improves stability under acidic conditions
b. causes hypoprothrombonemia
c. causes the drug to be lipophilic therefore increasing absorption
d. becomes hydrolyzed to form a lactone and become inactive

A

D.

56
Q

What is not true regarding cefdinir?

a. the highlighted portion is called a vinyl bond
b. the Vinyl bond causes increase lipophilicity
c. contains an MTT
d. vinyl bond promoates oral absorpiton

A

C

57
Q

Which of the following statements is false?

a. It is a prodrug
b. contains a paroxetil group
c. methyl group makes it more lipophilic therefore helping with oral absorption
d. increased beta-lactamase resistance

A

A.

58
Q

Which of the following is correct regarding ceftriaxone?

a. contains and MTT group
b. its a 3nd generation cephalosporin
c. decreased beta-lactamse resistance
d. route of administration is PO

A

B

Infectious Disease (8 decks)

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