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Infectious Disease > Beta Lactams > Flashcards

Beta Lactams Flashcards

1
Q

Mechanism of Action

A

Inhibition of cell wall synthesis via inhibition of cross-linking of peptidoglyan in the cell wall, leading to autolysis and cell death. Bactericidal

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2
Q

Mechanism of Resistance

A

Beta-lactamase - acquired by plasmid transfer

Alteration of PBPs - due to mutation

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3
Q

PBPs

A

Penicillin binding proteins

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4
Q

MRSA resistance

A

Has acquired both Beta-lactamase and altered PBPs

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5
Q

PCN 1/2 life

A

<2 hours

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6
Q

PCN oral bioavailability

A

Poorly absorbed. This can lead to diarrhea.

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7
Q

PCN Hypersensitivity

A

If a pt has a true hypersensitivity rxn to PCN, other PCNs should be avoided, even if they are from different classes of PCNs. If the rxn is not severe, cephalosporins and carbapenems may be useful

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8
Q

Natural PCNs

A 
PCN G (IV)
PCN VK (PO)
Procaine PCN (IM)
Benzathine PCN (IM)
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9
Q

Natural PCN Spectrum: Good

A 
Treponema pallidum (syphilis)
Some streptococci
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10
Q

Natural PCN Spectrum: Moderate

A

Enterococci

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11
Q

Natural PCN Spectrum: Poor

A

Atypicals

Almost everything else (narrow spectrum of activity)

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12
Q

Antistaphylococcal PCN Spectrum: Good

A

MSSA

Streptococci

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13
Q

Antistaphylococcal PCN Spectrum: Poor

A 
GNRs
Enterococci
Anaerobes
Atypicals
MRSA
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14
Q

Aminopenicillins Spectrum: Good

A

Streptococci

Enterococci

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15
Q

Aminopenicillins Spectrum: Moderate

A

Some GNRs

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16
Q

Aminopenicillins Spectrum: Poor

A

Staph
Anaerobes
Atypicals

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17
Q

Antistaphylococcal PCNs

A

Penicillinase-resistant
Nafcillin (IV)
Oxacillin (IV)
Dicloxacillin (PO)

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18
Q

Aminopenicillins

A

Extended-spectrum PCNs
Amoxicillin (PO)
Ampicillin (PO, IV)

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19
Q

Antipseudomonal PCNs

A

Broad-spectrum PCNs
Piperacillin (IV)
Ticarcillin (IV)

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20
Q

Antipseudomonal PCNs Spectrum: Good

A

Pseudomonas (And other GNRs)
Streptococci
Enterococci

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21
Q

Antipseudomonal PCNs Spectrum: Moderate

A

More resistant GNRs

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22
Q

Antipseudomonal PCNs Spectrum: Poor

A

Staph
Anaerobes
Atypicals

23
Q

Beta-Lactam/Beta-Lactamase Inhibitor Combinations

A

Amoxicillin/Calvulanate
Ampicillin/sulbactam (Unasyn IV)
Pipercillin/tazobactam (Zosyn IV)
Ticarcillin/calvulanate (Timentin IV)

24
Q

Beta-Lactam/Beta-Lactamase Inhibitor Combinations Spectrum: Good

A 
MSSA
Strep
Enterococci
Anaerobes
Enteric GNRs (including pseudomonas w/only Zosyn &amp; Timentin)
25
Q

Beta-Lactam/Beta-Lactamase Inhibitor Combinations Spectrum: Poor

A

MRSA
Atypicals
ESBL producing Beta-lactamase

26
Q

ESBL

A

Extended spectrum beta-lactamase

27
Q

AE w/aminopenicillins

A

Similar to other beta-lactams
Diarrhea w/PO administration
More diarrhea with ampicillin than amoxicillin

28
Q

AE w/antistaphylococcal PCNs

A

Similar to other beta-lactams

Interstitial nephritis, phlebitis

29
Q

DOC for syphilis

A

Natural PCNs

30
Q

Which PCN is eliminated via the liver

A

Antistaphylococcal PCNs

31
Q

Which aminopenicillin has better oral absorption?

A

Amoxicillin

32
Q

What is sulbactam good for?

A

Sulbactam has good activity against Acinetobacter

33
Q

What is Acinetobacter?

A

A highly drug-resistant GNR that causes nosocomial infxns

34
Q

Utility of natural PCNs

A

Syphilis

Susceptible strep infxn (pharyngitis, endocarditis)

35
Q

Utility of antistaphylococcal PCNs

A

MSSA infxns (endocarditis, skin/soft tissue infxns)

36
Q

Utility of aminopenicillins

A

Ampicillin DOC for susceptible enterococci
Susceptible GNRs
URTIs (pharyngitis, otitis media)

37
Q

Utility of beta-lactam/beta-lactamase inhibitor combinations

A

Zosyn/Timentin: empiric therapy for nosocomial infxns
Augmentin: URTIs, LRTIs, UTIs
Mixed infxns d/t anaerobic activity (intraabdominal, diabetic ulcers, aspiration pneumonia)

38
Q

How do aminopenicillins achieve bactericidal activity against enterococci?

A

Must be combined with an aminoglycoside

39
Q

What are the options for staph?

A

Beta-lactams kill staph quicker than vancomycin. Patients with MSSA infxns who lack serious beta-lactam allergies should be switched to anti-staph PCN or 1st generation cephalosporin when possible

40
Q

Cross-allergenicity of cephalosporins and PCNs

A

Reduced cross-allergenicity.
Most likely to cross with 1st generation
<10% cross-reactivity

41
Q

1st Generation cehalosporins

A

Cephalexin (PO)

Cefazolin (IV)

42
Q

2nd Generation Cephalosporins

A

Cefuroxime (PO,IV)
Cefoxitin (IV)
Cefotetan (IV)
Cefprozil (PO)

43
Q

1st Generation Cephalosporins Spectrum: Good

A

MSSA (if can’t tolerate PCN)

Streptococci

44
Q

1st Generation Cephalosporins Spectrum: Moderate

A

Some enteric GNRs

45
Q

1st Generation Cephalosporins Spectrum: Poor

A

Enterococci
MRSA
Anaerobes
Pseudomonas

46
Q

2nd Generation Cephalosporins Spectrum: Good

A

Some GNRs
Haemophilus influenzae
Neisseria

47
Q

2nd Generation Cephalosporins Spectrum: Moderate

A

Strep
Staph
Anaerobes (cefotetan, cefoxitin)

48
Q

2nd Generation Cephalosporins Spectrum: Poor

A

Enterococci
MRSA
Pseudomonas

49
Q

Which cephalosporins are used for surgical prophylaxis in abdominal surgery?

A

Cefoxitin and Cefotetan

50
Q

Which cephalosporins do not require renal adjustments?

A

Cefoxitin and Cefotetan

51
Q

Which generation of cephalosporins does not cross the CNS?

A

1st Generation

52
Q

Utility of 1st generation cephalosporins

A

Skin and soft tissue infxns, surgical prophylaxis, staph bloodstream infxns, endocarditis (MSSA)

53
Q

Utility of 2nd generation cephalosporins

A

URTI, CAP, gonorrhea, surgical prophylaxis (cefotetan, cefoxitin)

54
Q

CAP

A

Community acquired pneumonia

Infectious Disease (19 decks)

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