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Respiratory Medicine > beta Lactams > Flashcards

beta Lactams Flashcards

1
Q

What anti-staphylococcal drug should you never choose on a clinical stem because it is not used?

A

Methicillin

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2
Q

What beta lactamase inhibitor is used with the extended spectrum drug, AMPICILLIN?

Route?

A

sulbactam

IV

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3
Q

What beta lactamase inhibitor is used with the extended spectrum drug, AMOXICILLIN?

route?

A

Clavulanic acid

Oral

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4
Q

Anti-Psudomanal Drugs + their combo with a beta lactamase inhibito

A
  • Ticarcillin + clavulanic acid

- Pipericillin + Tazobactam

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5
Q

What enzyme do penicillins block?

A

transpeptidases

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6
Q

complication of penecillins

A

hypersensitivity type 4/anaphylaxis

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7
Q

Drugs of choice for penicillin resistant but methicillin-sensitive organisms like S. aureus (MSSA)?

A
  • Nafcillin
  • Oxacillin
  • Dicloxacillin
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8
Q

If Methicillin is given to a human what is the result

A

interstitial nephritis

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9
Q

Route of administration for Nafcillin?

A

IV so hospital setting

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10
Q

Route of administration for oxacillin and Dicloxacillin

A

oral so outpatient

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11
Q

What do Methicillin adn related anti-staphylococcal penicillins bind to

A

PBPs (penicillin binding proteins)

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12
Q

What gets altered in S. aureus to confer high level resistance to Methicillin . .. MRSA

A

MecA gene and PBP2

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13
Q

What is given to treat MRSA?

A

vancomycin

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14
Q

What is given to someone who has severe allergic reaction to anti-staph drugs?

A

vancomycin

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15
Q

What type of bacteria do you use Vancymycin for?

A

Gram +

  • MRSA
  • MRSE
  • enterococci
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16
Q

What can be used to treat C. Difficile if metronidazole fails

A

Vancomycin

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17
Q

Is vancomycin a substitute to treat MSSA if no known allergies to penicillin?

A

NO. antistaphylococcal drugs are superior

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18
Q

How does vancomycin and teicoplanin inhibit cell wall synthesis?

A

binding the D-ala-D-ala and sterically hindering TRANSGLYCOSYLATION and transpeptidation

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19
Q

Rate of Vancomycin and route?

A

parenteral and slow (60-90) min

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20
Q

Side effects that is exacerbated with other drugs that have same effects?

A

Nephro and oto toxicities

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21
Q

Adverse effects of Vancomycin?

A
  • erythroderma/shock
  • nephro/oto toxicity
  • rash
  • phlebitis at injection site
22
Q

what drugs act by entering porins and binding to PBPs in the PERIPLASM to disrupt cell wall integrity

A

Extended spectrum penicillins

  • Ampicillin
  • Amoxicillin
23
Q

What drugs are more soluble and can cover gram negatives

A

Extended spectrum penicillins

  • Ampicillin
  • Amoxicillin
24
Q

What are the clinical indications for extended spectrum penicillins

A
  • Respiratory infections (CAP, sinusitis, bronchitis, pharyngitis)
  • Bronchitis from COPD
  • Otitis media
25
Q

What is often used for pharyngitis in children because of taste

A

Amoxicillin

26
Q

Amoxicillin Absortption in gut approaches 100% which negates its use for what?

A

enteritis (shigella, salmonellla)

27
Q

is Ampicillin and Amoxicillin active against MRSA and MRSE?

A

No

28
Q

What situations are people at risk for pneuomonas infection?

A
  • Burn
  • CYSTIC FIBROSIS
  • Injection drug users
  • Immunosuppressed
29
Q

Ticarcillin and piperacillin cover what?

A
  • psuedomonas

- Gram negative rods (enterobacter spp., E. coli, Proteus mirabilis, Hemophilus influenza)

30
Q

What is more potent between piperacillin and Ticarcillin

A

Piperacillin

31
Q

Why do you pair and anti-pseudomonal drug with a Beta lactamase inhibitor?

A

For EMPIRICAL therapy

  • Severe pneumonia in hospitalized patient with a structural disease (COPD)
  • Aspiration pneumonia in hospitalized patients
  • NEUTROPENIC FEVER
32
Q

Stems that lead towards neutropenic fever and use of anti-pseudomonal drugs

A
  • transplants
  • lots of steroid
  • cancer patient got chemo
33
Q

Generations 1-3 cephalosporins lack activity against what organisms?

A
  • Listeria monocytogenes
  • Legionella
  • Atypical mycoplasma
  • MRSA
  • Enterococci
34
Q

1st gen cephalosporins

A
  • Cefazolin
  • CEPHALEXIN
  • cephradrine
35
Q

What 1st generation cephalosporin is oral only

A

cephalexin

36
Q

What can 1st gen cephalosporin can be taken twice daily to treat pharyngitis

A

Cephalexin

37
Q

What generation of cephalosporins is used for surgical prophylaxis if skin flora are likely pathogens; soft tissue and skin infections due to S. aureus and S. pyogenes

A

1st generation

38
Q

What generation cephalopsporins are used for intra-abdominal and gynecological sepsis, surgical prophylaxis for intra-abdominal and colorectal surgery

A

2nd generation

39
Q

2nd gen cephs

A
  • cefoxitin
  • cefotetan
  • cefaclor
  • cefuroxime axetil
40
Q

3rd gen cephs

A
  • ceftriaxone
  • cefotaxime
  • cetazidime
  • cefaperazone
41
Q

What 3RD gen ceph is particularly active against P. aeruginosa

A

Ceftazidime

42
Q

What is the 4th gen ceph drug called that is pretty much equal to ceftazidime in treating P. aeruginosa?

A

Cefepime

43
Q

Adverse effects of cephalosporins?

A
  • Hypersensitivity

- Disulfiram-like reaction

44
Q

if a patient has had a recent, severe hypersensitivity reaction to a penecillin, do you give a ceph?

A

no

45
Q

What two cephs reduce vitamin K-producing bacteria in GI and cause hypoprothrombinemia and bleeding so should be used with caution in patients taking warfarin or with coagulation abnormalities

A

Cefotetan and cefaperazone

46
Q

What is the one Monobactam?

A

Aztreonam

47
Q

What do Monobactams treat?

A

Gram (-) rods

48
Q

When do you used Aztreonam

A

substitute for extended spectrum penicillin or gen 3,4 cephs if these are contra-indicated because of hypersensitivity

49
Q

What is the carbapenems, Imipenem always administered with and why?

A

Cilastatin because it causes nephrotoxicity

50
Q

Adverse effects of Carbapenems?

A
  • hypersensitivity and rash
  • CNS toxicity: seizures and confusion
  • Nephrotoxicity
51
Q

what enzyme does cilastatin inhibit to prevent the nephrotoxicity caused by imipenem?

A

dipeptidase

Respiratory Medicine (37 decks)

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