EXAM 2 Penicillins

Question 1

B-lactams are primarily unchanged in the kidneys except for..

Answer 1

nafcillin, oxacillin, ceftriaxone, cefoperazone

Question 2

B-lactams have cross allergenicity except for

Answer 2

aztreonam
can be used in penicillin allergy

Question 3

penicillin MOA

Answer 3

Bactericidal
interfere w/ cell wall synthesis by binding PBPs

Question 4

Penicillin mechanism of resistance

Answer 4

production of b-lactamase enzymes
Alteration in structure of PBPs
alteration of outer membrane porin

Question 5

production of b-lactamase enzymes

Answer 5

produced by
gram (+): penicillin-resistant staph aureus
gram (-):
gram(-) anaerobes: bacteroides

Question 6

alteration in structure of PBPs

Answer 6

leads to decrease binding affinity
MRSA, PRSP

Question 7

alteration of outer membrane porin proteins

Answer 7

lead to decreased penetration

Question 8

natural penicillins

Answer 8

Aqueous penicillin G
benzthine penicillin G
procaine penicllin G
Phenoxymethyl penicillin (pen VK)

Question 9

natural penicillins spectrum

Answer 9

do not target any blue bugs

Question 10

penicillinase resistant penicillins

Answer 10

Nafcillin and dicloxacillin

Question 11

nafcillin spectrum

Answer 11

MSSA

Question 12

aminopenicillins

Answer 12

ampicillin and amoxicillin

Question 13

ampicillin spectrum

Answer 13

no blue bugs

Question 14

carboxypenicillins

Answer 14

ticarcillin

Question 15

ticarcillin spectrum

Answer 15

pseudomonas aeruginosa

Question 16

ureidopenicillins

Answer 16

Piperacillin

Question 17

piperacillin spectrum

Answer 17

pseudomonas aeruginosa
penicillin of choice

Question 18

b-lactamase-inhibitor combos

Answer 18

parental: ampicillin-sulbactam(unasyn), piperacillin-tazobactam (zosyn)
oral: amoxicillin-clavulanate (augmentin)

Question 19

Ampicillin/sulbactam (unasyn) and Amoxicillin/clavulanate (augmentin) spectrum

Answer 19

MSSA

Question 20

Piperacillin/tazobactam (zosyn) spectrum

Answer 20

MSSA
Psuedomonas
BDA (bacteroides)

Question 21

Which penicillin is consdidred a potential drug of choice for infections due to MSSA?
A. Pen G
B. Ticarcillin
C. Ampicillin
D. Nafcillin
E. Piperacillin

Answer 21

D. Nafcillin

Question 22

Which penicillin is considered drug of choice for infections due to Pseudomonas aeruginosa?
A. Pen G
B. Ampicillin/sulbactam
C. Amoxicillin
D. Nafcillin
E. Piperacillin

Answer 22

E. Piperacillin

Question 23

Penicillin distribution

Answer 23

widely distributed into tissues and fluids
Adequate CSF concentrations of pens (but NOT b-lactamase inhbitors) are ONLY achieved in the presence of inflamed meninges w/ high-dose parenteral administration

Question 24

penicillins elimination

Answer 24

most are eliminated unchanged in the kidneys –> dosage adjustment required in renal insufficiency
NAFCILLIN and OXACILLIN are eliminated primarily by the liver –> no dose adjustments in renal insuffiiciency

Question 25

sodium load

Answer 25

must be used in cuation in patients with CHF or renal insufficiency Ticarcillin - 5.2mEq Nafcillin - 2.9mEq Sodium PenG - 2.0mEq Piperacillin - 1.85mEq

Question 26

Which one of the following is not a general characteristic of b-lactam antibiotics? A. inhibition of cell wall synthesis B. long elimination half-lives C. Primarily eliminated by the kidney D. Bactericidal E. Degradation by b-lactamase enzymes

Answer 26

B. long elimination half-lives

Question 27

penicillin adverse effects

Answer 27

hypersensitivity neurologic - seizures hematologoic - neutropenia, thrombocytopenia Interstitial nephritis (especially in nafcillin)

Question 28

T/F: A patient who developed a rash to penicillin can safely take augmentin

Answer 28

FALSE