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Pharmacology I Exam #2 > ICWS > Flashcards

ICWS Flashcards

1
Q

Name the 4 Penicillin groups

A
  1. Natural Penicillins
  2. Penicillinase Resistant Penicillins
  3. Extended spectrum penicillins
  4. Antipseudomonal penicillins
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2
Q

Name the Natural Penicillins

A

Pen G (IV, IM)
Pen V (oral)
Benzathine pen. (IM)
Procaine pen. G (IM)

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3
Q

Name the Penicillinase Resistant Penicillins

A

Nafcillin (IV/IM)
Dicoloxacillin (oral)
Oxacillin (IV/IM, oral)
Methicillin (testing only)

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4
Q

Name the extended spectrum penicillins

A

Ampicllin (oral)

Amoxicillin (oral)

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5
Q

Name the antipseudomonal penicillins

A

Piperacillin (IV/IM)

Ticarcillin (IV/IM)

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6
Q

What are the general rules regarding ICWS?

A
  • All ICWS (lyse cells)
  • All have B-lactam rings
  • All are bacterioCIDAL
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7
Q

What is the spectrum of the penicillins?

A

Progress from very G+++ w/ some G- to very G— w/ some G+

  • Extended spectrum: More extended G- coverage (more broad spectrum)
  • Antipsuedomonals are the only ones with coverage for psuedomonas
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8
Q

What is the MOA for penicillins?

A

Target penicillin binding proteins (PBPs) which form the trans-pep and trans-glyco bonds

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9
Q

What is the MOR for penicillins?

A

Penicillinase: Inactivates abx by hydrolyzing B-lactam ring

*Excludes penicillinase resistant class

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10
Q

Why do Penicillinase Resistant Penicillins not work against MRSA?

A
  • MRSA has nothing to do with B-lactamase

- MRSA produces an alternate PBP which decreases the binding affinty of B-Lactam abx to PBPs

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11
Q

What is the only B-Lactam that can be used against MRSA?

A

Ceftaroline

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12
Q

Which penicillin is metabolized by the liver?

A

Penicillinase Resistant (Hepatic metabolism w/ kidney excretion)

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13
Q

What is the purpose of the B-Lactamase inhibitors

A

When used in conjunction w/ the antipsuedomonal penicillins or extended spectrum penicillins, they help to extend the spectrum of the abx to include many organisms that are resistant due to B-lactamase production

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14
Q

Name the 3 B-Lactamase inhibitors

A

Clavulnaic acid, Sulbactam, and Tazobactam

+extended spectrum/antipsuedomonal

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15
Q

Toxicities of Penicillins

A
  • Allergy (all forms)
  • Electrolyte imbalances
  • GI distubrances
  • Superinfections
  • Relatively safe though
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16
Q

While very similar, what is the advantage cephelosporins have over penicillins?

A

7-methyl group increases their resistance to B-lactamase

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17
Q

Name the 1st gen. cephalosporins

A

1st gen: Narrow spectrum

  • Cephazolin IV/IM
  • Cephalexin (Keflex) ORAL
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18
Q

Name the 2nd gen. cephalosporins

A

2nd gen: Intermediate spectrum

  • Cefaclor ORAL
  • Cefuroxime IV/IM
  • Cefprozil ORALe
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19
Q

Name the 3rd gen cephalosporins

A

3rd gen: Broad spectrum (but remember, this does not mean the most broad of all abx)

  • Cetrioxone IV/IM
  • Cefotaxime IV/IM
  • Ceftazidime IV/IM
  • Cefixime ORAL
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20
Q

Name the 4th gen cephalosporins

A

4th gen:

-Cefepime IV (100% bioavailability)

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21
Q

Name the 5th gen cephalosporins

A

“Unnamed”

-Cetaroline fosamil IV

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22
Q

Which class has the broadest spectrum coverage of all B-lactams?

A

4th gen cephalosporins (Cefepime)

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23
Q

MOA for cephalosporins

A

Bind to PBP’s to interfere with bacterial cell wall synthesis (same as penicillins)

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24
Q

What is the spectrum of the 1st gen cephalosporins

A 
Good G+
Moderate G-
Increased B-lactamase resistance
No antipseduomonal
(similar to natural penicillins)
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25
Q

What is the spectrum of the 2nd gen cephalosporins

A

Lower G+ activity
Somewhat increased G- activity
Increased B-lactamase resistance
No antipseduomonal

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26
Q

What is the spectrum of the 3rd gen cephalosporins

A

Less active against G+

Much more active against Enterobacteriaceae

27
Q

What is the spectrum of the 4th gen cephalosporins

A

More resistant to some B-lactamases (compared to 3rd gen)
Antipsuedomonal!
Better G+ coverage
Very good broad spectrum coverage

28
Q

Penicillinase Resistant penicllins are the DOC for:

A

MSSA

29
Q

Extended spectrum penicillins are the DOC for:

A

Lysteria

H. pylori

30
Q

Antipseudomonal penicillins are the DOC for:

A

P. aeruginosa and acinetobacter

31
Q

Ceftazolin is the DOC for:

A

Surgical prophylaxis

32
Q

When would be an appropriate time to use 4th gen cephalosporins?

A

Important for serious infections (pseudomonas, enterobacteriaciae, etc.)

33
Q

What is the spectrum of the 5th gen cephalosporins

A
  • Effective against MRSA and VRSA! Binds to mutated PBP (PBP2A) with very good affinity (unlike the other B-lactams)
  • Also good for CABP (complicated skin infections)
  • No antipseudomonal activity
34
Q

What are the contraindications for 3rd gen. cephalosporins?

A

Neonates (bilirubin displacement)

35
Q

What are the toxicities of the cephalosporins?

A
  • Fairly safe
  • Superinfection
  • Disulfiram-like rxn after alcohol consumption
  • Allergy (10% cross sensitivity w/ penicillins)
  • Dose dependent renal tubular necrosis (synergistic nephrotoxicty w/ amingoglycosides!) so avoid in pts with poor renal function
  • Diarrhea
36
Q

What is the MOR for the cephalosporins?

A

Same as penicillins

37
Q

Name the Monobactams (1)

A

Aztreonam IV/IM/ inhalation

38
Q

What is the spectrum of Aztreonam (Monobactam class)

A

Aerobic G-

39
Q

What is an appropriate use of Aztreonam?

A

Good alternative for G- rxns in penicillin allergic pts

40
Q

Is there cross sensitivity with Aztreonam and other B-Lactam abx?

A

No! Good alternative for people with pen. allergies

41
Q

What is the toxicity of Aztreonam?

A

Very minimal

  • Phlebitis
  • Skin rash
  • Abnormal liver function
42
Q

Name the Carbapenems (3)

A
  • Imipenem + Cilastin IV
  • Meropenem IV
  • Ertapenem IV/IM

CarbaPENEMS end in PENEM

43
Q

What is the spectrum of the Carbapenems

A
  • Mixed aerobic/anaerobic infections
  • One of the best classes for broad spectrum coverage (empirical therapy!)
  • Indicated for organisms resistant to other antimicrobials
44
Q

What is the purpose of cilastin being paired with Imipenem?

A
  • Imipenem is rapidly inactivated by renal tubule dihydropeptidases
  • Cilastin is a dihydropeptidase inhibitor
45
Q

Which bacteria rapidly develops resistance against imipenem and meropenem?

A

Pseudomonas (recommend giving in combo w/ aminoglycoside)

46
Q

Which carbapenem should you never use for a psuedomonas infection?

A

Ertapenem (not effective enough)

47
Q

What is a major toxicity concern for imipenem?

A 
Imipenem can cause SEIZURES at high levels!
Use cautiously in pts with:
-Brain lesions
-Head trauma
-Hx of CNS disorders such as seizures

**Meropenem less likely to cause seizures

48
Q

Name the 3 drugs that are ICWS but are NOT B-Lactams

A

Vancomycin
Fosfomycin
Bacitracin

49
Q

What is the MOA for Vancomycin?

A

Prevents elongation of the polypeptide chain by binding to terminal D-Ala-D-Ala (= no tethering)

50
Q

Imipenem/cilastin and Meropenem are the DOC for:

A

Serratia

Enterobacter

51
Q

What is the MOR to Vancomycin?

A

Modification of the D-ala-D-ala binding site, inhibiting Vanco from binding
(Vancomycin-resistant enterococci - VRE)

52
Q

What is the spectrum coverage of Vanco?

A

G+ only

53
Q

Vancomycin is the DOC for:

A

MRSA
C. diff*
Staph superinfection

HOWEVER, due to emergence of Vanco-resistant enterocci (VRE), Vanco is the drug of last resort (*exception is C. Diff)

54
Q

When would you give Vanco via an IV? When would you give Vanco orally?

A

IV- systemic infections

Oral- GI infections caused by c. diff and staph

55
Q

What are the adverse affects of Vanco?

A
  • Ototoxicity
  • Nephrotoxicity
  • “Red man” syndrome: flushing from histamine release
56
Q

What is the MOA for Fosfomycin?

A

f by preventing NAG to NAM reduction

57
Q

What is the spectrum coverage of Fosfomycin?

A

G+ and G-

58
Q

What is the use of fosfomycin?

A

Uncomplicated lower UTIs in women (but not necessarily drug first choice)

59
Q

Fosfomycin plus what other drugs cause a synergistic rxns? (3)

A

B-lactam
Aminoglycosides
Fluorquinolones

60
Q

What is the spectrum of Bacitracin?

A

Mainly G+ bacteria

61
Q

What is the MOA of Bacitracin?

A

Interferes with the final dephosphorylation step in the phospholipid transmembrane carrier cycle

62
Q

What is Bacitracin commonly use in combo with?

A

Neomycin and Polymyxins (think Neosporin)

63
Q

What is the most common use of Bacitracin

A

Superficial skin and eye infections following minor injuries

Pharmacology I Exam #2 (3 decks)

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