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D2 prework Flashcards

1
Q

What is the class of Penicillin?

A

B-lactam

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2
Q

What is the cellular target of B-Lactam?

A

Penicillin-binding proteins (PBPS) - transpeptidase.

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3
Q

What cell structure is affected by B-Lactam?

A

Cell wall synthesis

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4
Q

What are some of the toxicities of B-Lactam?

A

Hypersensitivity, anaphylaxis (Except Aztreonam), seizure, CDAD

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5
Q

What are all the medications in Penicillin?

A

Penicillin G/VK,
(Anti-staphylococcal) Oxacillin/nafcillin/dicloxacillin,
ampicillin/amoxicillin and Ampicillin+sulbactam/amoxicillin+clavunate,
Ticarcillin+clavunate, PIP+TAZ

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6
Q

What bacterias are covered by PenG?

A

Staph (Except SA), Strep/Pneumonia, Oral anaerobes, syphilis.

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7
Q

What bacterias are covered by Pen VK?

A

Staph (Except SA), Strep/Pneumonia, oral anaerobes

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8
Q

What bacterias are covered by Group 3 B-Lactam?

A

Staph/MSSA, Step/pneumo

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9
Q

What bacterias are covered by Ampicillin/amoxicillin?

A

Strep/Pneumo, +VRE, PEK, Some PIDDLY, Oral anaerobes.

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10
Q

What bacterias are covered by PIP+TAZ?

A

Staph/MSSA, Strep/Pneumonia, Enterococcus/VRE, PEK, PIDDLY, SPACE, Anaerobes

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11
Q

What is the MOA of Penicillins?

A

Inhibition of cross linked peptidoglycan formation

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12
Q

What are the 4 Stages of NAG-NAM polymer formation?

A

Stage 1: NAG-NAM
Stage 2: Monomer Export
Stage 3: Transglycosylation
Stage 4: Transpeptidase

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13
Q

Explain the Stage 1 of NAM polymer.

A

NAG-NAM synthesis: NAG-NAM monomers are assembled and NAG is converted into pentapeptide

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14
Q

Explain the Stage 2 of NAM polymer.

A

Monomer Export: Bactoprenol (BP) carrier transports and release the NAG-NAM monomer outside the cell

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15
Q

Explain the Stage 3 of NAM polymer.

A

Transglycosylation: Transglycosylase catalyzes the transfer of the NAG-NAM monomer to the end of the growing peptidoglycan strand

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16
Q

Explain the Stage 4 of NAM polymer.

A

Transpeptidation is cross linking step between petidoglycan strands. Enzymes that form peptide bonds between the a side chains of NAM are called Transpeptidase (PBPs).

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17
Q

What is the purpose of B-Lactam ring?

A

The hydrolytic site in the PBP makes it more prone to by hydrolyzed

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18
Q

How is Penicillin G pen formulated?

A

Na+ and K+ (Pfirzerpen)
Benzathine, or procain salts

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19
Q

What are the type of bacteria that Penicillin G is effective against?

A

Non B-lactamase producing cocci, syphilis. most oral anaerobes.

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20
Q

What makes Penicillin unstable to stomach acid?

A

IV (Na+/K+ salt) or IM (Procain/benzathine salt) injection

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21
Q

How do you formulate Penicillin G to last longer and decrease the local pain?

A

IM injections of low H2O salt forms of PEN are used with Procain and benzathine Base

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22
Q

(T/F) You can take long acting PEN by IV

A

False (can be fatal)

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23
Q

How do penicillin cause anemia

A

The medication may react with proteins on the surface of RBC which can be read by immune system and it starts to destroy cells.

24
Q

What are some of the adv rx of Penicillins?

A

Immediate IgE-mediated anaphylaxis (type 1 hypersensitivity), Later allergic reaction (type IV) and CDAD

25
Q

What are some drug interactions of Penicillin?

A

No CYP450 interactions, can be placed form serum proteins by other drugs (Warfarin)

Probenecid (for gout) could increase the time B-Lactam drugs stay in the system.

B-lactamase could interfere with enterohepatic circulation of oral estrogens causing low levels of estrogen.

26
Q

What penicillin do we use instead of PEN G for oral use?

A

Penicillin VK is more acid-stable

27
Q

What bacteria are covered by Penicillin VK?

A

it is a narrow spectrum drug that covers Staph/strep and oral anaerobes

28
Q

How are Penicillin group 3 more stable?

A

Due to the presence of C-6 side chains.

29
Q

What are some of the examples of Penicillin group 3?

A

Methicillin, Oxacillin, Dicloxacillin, Nafcillin

30
Q

How to increase the Short half-life of Oxacillin?

A

Blood levels may be prolonged by concurrent administration of probenecid which blocks the renal tubular secretion of penicillin

31
Q

How is Dicloxacilin excreted?

A

POO POO

32
Q

Which group 3 member of penicillin have erratic absorption?

A

Dicloxacillin (Dynapen) MOTHA FUKA

33
Q

What are some of the adverse reaction of Dicloxacillin?

A

Metallic taste and belching may cause poorly tolerated drug FOKA MOTHA

34
Q

How is Nafcillin excreted?

A

Through feces

35
Q

Why shouldn’t you give Group 4 penicillins by itself?

A

It is unstable to B-lactamase, (must be given with B-Lactamase inhibitor for MSSA and B. Fragilis

36
Q

What is a risk that is associated with Ampicillin?

A

higher risk of rash in patients with mononucleosis and diarrhea

37
Q

Which group IV have better Bioavailability than ampicillin?

A

Amoxicilin (Also causes less diarrhea)

38
Q

Adverse reaction of AMP?

A

Rashes occur more often with AMP and AMX than with other penicillins

39
Q

What are some of the examples of Group V penicillin?

A

Ticarcillin, Piperacillin

40
Q

Who should be cautious while taking Ticarcillin?

A

pts with restricted Na intake. Disodium formulated

41
Q

Is ticarcillin weak to B-lactamase?

A

Yes which is why it is dispensed with Clavulanic acid (Timentin)

42
Q

What is the administration requirement of Pipercillin?

A

admin with B-Lactamase inhibitor (tazobactam) Zosyn

43
Q

What is the MOA of B-lactamase inhibitor?

A

the inhibitors bind irreversibly to the B-lactation allowing B-al tam antibiotics to reach the PBPs unhindered

44
Q

Why are majority of of B-lactamase inhibitors require another antibiotic to go along with it?

A

Most B-lactamases inhibitors do not bind PBPs and most have no antibiotic effects alone.

45
Q

Which Antibiotic would go with Clavulanic acid (CA)?

A

Amoxicillin (Augmentin)
Ticarcillin (Timentin)

46
Q

Which Antibiotic would go with Sulbactam (SUL)?

A

Ampicillin (Unasyn)

47
Q

Which Antibiotic would go with Tazobactam (TAZ)

A

Piperacillin (Zosyn)
Ceftolozane (Zerbaxa)

48
Q

Which Antibiotic would go with Avibactam (AVI)?

A

Ceftazidime (Avycaz)

49
Q

Which Antibiotic would go with Vaborbactam (VAB)?

A

Meropenem (Vabomere)

50
Q

Both Gram (+) and Gram (-) may produce _________.

A

Penicillinase

51
Q

only in Gram (-) bacteria can produce __________ and _________.

A

Cephalosporinases (TEM) and Carbapenemases (KPC)

52
Q

Which antibiotic is the only one that is not effected by Extended Spectrum B-Lactamases (ESBL) in PEK and SPACE?

A

Carbapenamase

53
Q

Cephalosporinases is the most common ESBL form in Gram (-) and can be inhibited by:

A

Clavulanic acid
Sulbactam
Tazobactam

54
Q

ALl ESBLs are inhibited by:

A

Avibactam
Vaborbactam

55
Q

Klebsiella pneumoniae carbapenemase is inhibited by

A

Avibactam
Vaborbactam

56
Q
A
56
Q
A

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