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Pharmacology > L22: Penicillins > Flashcards

L22: Penicillins Flashcards

1
Q

True or False: Penicillin G and Penicillin V/K are natural penicillins

A

True

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2
Q

Which four drugs are anti-staphylococcals?

A

1) Nafcillin
2) Oxacillin

3) Cloxacillin
4) Dicloxacillin

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3
Q

Ampicillin and Amoxicillin belong to which class?
A. Natural Penicillins
B. Anti-Staphylococcals
C. Anti-pseudomonals
D. Aminopenicillins

A

D. Aminopenicillins

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4
Q

Clavulanate, Tazobactam, and Avibactam belong to which group?
A. Natural Penicillins
B. Anti-Staphylococcals
C. Anti-pseudomonals
D. Aminopenicillins
E. Beta-lactamase Inhibitors

A

E. Beta-lactamase Inhibitors

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5
Q

True or False: Amoxicillin-clavulanate and Piperacillin-tazobactam are combination drugs

A

True

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6
Q

β-lactams antibiotics include which 4 major subgroups?

A
  1. Penicillins
  2. Cephalosporins
  3. Monobactams
  4. Carbapenems
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7
Q

Features shared by: 1) Penicillins, 2) Cephalosporins, 3) Monobactams, and 4) Carbapenems??

A

1) four membered lactam ring
2) can cause SJS
3) commonly used during pregnancy

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8
Q

What are two reasons for major resistance of β-lactams antibiotics?

A

1) Resistance to bacterial lactamase enzymes
2) Altered penicillin binding proteins

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9
Q

True or False: Lactamase inhibitors are co-formulated with penicillinsand other beta-lactams, to protect against degradation by lactamase enzymes

A

True

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10
Q

β-lactams inhibit _____ peptidoglycan cross-linking

A

transpeptidase-mediated

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11
Q

True or False: Transpeptidase reaction
site centers are found on D-alanyl-D-alanine, which β-lactam resembles

A

True

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12
Q

With β-lactam, transpeptidase mistakenly uses ___ as substrate, results in
irreversible inhibition

A

lactam

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13
Q

β-lactams inhibit transpeptidase-mediated peptidoglycan crosslinking.

Inhibition of peptidoglycan synthesis weakens ___, making it vulnerable to osmotic stress and rupture

A

cell well

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14
Q

β-lactams inhibit transpeptidase-mediated peptidoglycan crosslinking.

In this case, only ___ cells die – mechanism of cell death not completely understood

A

replicating

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15
Q

____: bacterial proteins that bind to penicillins & cephalosporins

A

penicillin binding proteins (PBP’s)

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16
Q

True or False: Only some bacteria with cell walls contain PBPs (penicillin binding proteins)

A

False - ALL bacteria with cell walls
contain PBPs (penicillin binding proteins)

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17
Q

True or False: Gram (-) strains contain B-lactamase while Gram (+) strains contain PBP

A

False –

Both Gram (+)/(-) contain PBP and B-lactamase

  • However, B-lactamase is more externally located in Gram (+) while it is in more internal in Gram (-)
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18
Q

Structural differences & mutations in PBPs mean…?

A

They do not bind β-lactam drugs

  • 4 of 5 PBPs in highly resistant Strep
    pneumoniae have lower affinity for
    penicillins
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19
Q

Alterations of PBP’s result in resistance typical of ___

A

MRSA

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20
Q

_____ commonly describes
organisms resistant to many beta-lactams

A

“Methicillin-resistant”

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21
Q

MRSA/ORSA refers to resistance to virtually all β-
lactams, including nearly all cephalosporins except 5th
gen agent ____

A

ceftaroline

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22
Q

___ is the leading cause of surgical site infection in
both tertiary and community hospitals
A. MRSA
B. ORSA

A

B. ORSA

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23
Q

____ is a β-lactamase with spectrum limited to
penicillins

A

Penicillinase

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24
Q

____ can hydrolyze a wide
variety of β-lactams; exclusive to gram(-) nosocomials

A

Extended Spectrum β-lactamases (ESBLs)

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25
Q

____: A few lactamase-producing individuals can protect an
entire community; this effect is commonly seen in Gram (+) microbes

A

Inoculum Effect

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26
Q

Which test uses substrate that changes color when degraded by lactamase?

A

Nitrocefin

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27
Q

Penicillins are more effective in ___ vs.
stationary growth phase

A

Logarithmic

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28
Q

Which four factors influence antibiotic efficacy?

A

1) Growth Phase
2) Population
3) Extracellular Biofilms
4) Location

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29
Q

True or False: Resistant minority microbes secrete lots of lactamase, which can protect neighbors

A

True

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30
Q

True or False: Bacteria persisting inside host cells are inaccessible to β-lactams + Adherent bacteria secrete polysaccharide
substrate

A

True

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31
Q

True or False: Penicillins are concentration-dependent, bacterialstatic agents

A

False - penicillins are TIME-DEPENDENT, BACTERICIDAL AGENTS

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32
Q

True or False: Penicillins kill power generally unaffected by low pH, low O2, or presence of proteins/constituents of pus

A

True

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33
Q

Where do penicillins distribute to? Where do they not distribute to?

A

Does: Joint, pleural, pericardial & bile fluids

Does NOT: Intraocular space, prostate, phagocytes, or CSF
when meninges are normal

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34
Q

When penicillins are used and meninges are inflamed, the drugs get into __

A

CNS

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35
Q

Penicillin dose is adjusted during renal failure. What is the exception?

A

Anti-staphylococcal penicillins are exceptions

  • Rely on significant biliary elimination
36
Q

____ organic acid transport
inhibitor; keeps drugs such as
penicillins in the circulation longer

A

Probenecid

37
Q

True or False: Originally, Penicillin G was useful against many
gram-positive organisms

A

True

38
Q

___ and ____ remain sensitive to Penicillin G

A

Gram (+) Cocci
Gram (-) Neisseria

39
Q

True or False: Many anaerobes are sensitive to Penicillin V and K, which makes them useful for abscesses, gangrene,
tetanus

A

False - many anaerobes are sensitive to Penicillin G!!!! which makes them useful for abscesses, gangrene, tetanus

40
Q

Treatment for syphilis?

A

Penicillin G

41
Q

Why is penicillin is used more rarely now?

A

Due to resistance

42
Q

True or False: Penicillin G can be administered via IM or IV. Penicillin G is acid instable while Penicillin V/K has greater acid stability

A

True

43
Q

True or False: Penicillin G was the first of the “oral penicillins”

A

False - Penicillin V/K were

44
Q

Anti-staphylococcal penicillins are stable toward Staph penicillinases. What type of infections do they treat?

A

Staph infections (skin, osteomyelitis, endocarditis)

45
Q

Anti-staphylococcal penicillins have bulky ____ group that inhibits Staph ___ ___ enzymes

A

R group; beta lactamase

46
Q

True or False: Anti-staphylococcal penicillins have significant biliary clearance, meaning NO need for dosing adjustments in
renal failure

A

True

47
Q

True or False: Anti-staphylococcal penicillins are superior to penicillin against penicillin-sensitive strains

A

False - Anti-staphylococcal penicillins are INFERIOR to penicillin against penicillin-sensitive strains

48
Q

True or False: Anti-staphylococcals have been
weakened by altered PBP resistance schemes: MRSA/ORSA
organism

A

True

49
Q

Aminopenicillins extend penicillin spectrum
to include ____ organisms

A

gram-negative

50
Q

True or False: Ampicillin & amoxicillin have nearly
identical spectrum

A

True

51
Q

Ampicillin & amoxicillin are effective against…. HELPS ME?

A

Haemophilus influenzae
E. coli
Listeria;
Proteus mirabilis
Salmonella

Moraxella
E. faecalis

52
Q

True or False: Aminopenicillins are not effective for gram(-)
nosocomials, which frequently possess β-lactamases that destroy aminopenicillins

A

True

Klebsiella, Enterobacter, P. aeruginosa

53
Q

The amino group of aminopenicillins carries a
___ charge that facilitates passage through porins of
gram negatives
A. neutral
B. positive
C. negative

A

B. positive

54
Q

Amoxicillin is better than ___ for oral therapy

A

Ampicillin

55
Q

True or False: Both Amoxicillin and Ampicillin are adjusted in renal failure + can be combined with β-lactamase
inhibitors to prevent β-lactamase breakdown

A

True

56
Q

True or False: There is a current shortage of amoxicillin suspension – using pills, penicillin, or cephalosporins

A

True

57
Q

β-lactamase inhibitors protect penicillins from ___

A

hydrolysis

58
Q

Some β-lactamase inhibitors mimetics lack antibacterial activity – instead, function as _____ _____ of bacterial β-lactamase

A

irreversible “suicide” inhibitors

59
Q

_____: A β-lactamase inhibitor that is useful for UTI’s and infections of respiratory tract, ear, skin (not affected by current shortage)

A. Clauvulanic Acid
B. Augmentin

A

B. Augmentin = amoxicillin + clavulanate

60
Q

True or False: β-lactamase inhibitors inhibit many plasmid encoded beta-lactamases, but usually do
not inhibit chromosomal beta lactamases

A

True

61
Q

_____ is an example of a non-beta lactam, beta-lactamase inhibitors

A

Avibactam

62
Q

Other new non-beta lactam, beta
lactamase inhibitors include
____ and _____ (also: Avibactam)

A

vaborbactam; relebactam

63
Q

____ is an antipseudomonal carboxypenicillin, works to treat Pseudomonas (known for drug resistance) – but also good for penicillin-resistant anaerobes (B. fragilis)

A

Ticarcillin

64
Q

Ticarcillin can lead to high sodium, which is bad for __ and cause ___ ___

A

heart; kidney failure

65
Q

True or False: Ticarcillin is good for penicillin-resistant
anaerobes, e.g. B. fragilis, and mixed aerobic/anaerobic infections

A

True

66
Q

Ticarcillin can interact with platelets, leading to increased __

A

bleeding

67
Q

True or False: Penicillin is a better anti-pseudomonal than Piperacillin

A

False - Piperacillin is a better anti-pseudomonal than Penicillin

68
Q

What advantage does piperacillin have over ticarcillin?

A

Greater activity against: Pseudomonas aeruginosa, Klebsiella

69
Q

Piperacillin is inactive against most ___, but it is vulnerable to
_____

A

Staph; Gram (+) β-lactamases

70
Q

____ + _____ (Zosyn®) has the
widest spectrum of the penicillins

A

Piperacillin + Tazobactam

71
Q

True or False: Piperacillin + Tazobactam can treat: bacteremia, pneumonias, burn infections

A

True

72
Q

True or False: Zosyn may not work on piperacillin-resistant P. aeruginosa

A

True

73
Q

For S. aureus strain without resistance
schemes….

A

Penicillin > oxacillin > vancomycin

74
Q

Incidence of penicillin are common cause of drug allergy and are influenced by route of administration.

What is the order?

A

topical > IM > IV > oral

75
Q

Penicillin allergies can manifest in ___, ____, ____, _____

A

skin (90%) ; respiratory (70%) ; GI (45%); cardiovascular (45%)

76
Q

When fatal, β-lactam allergies involve
___ or ____ failure

A

respiratory; cardiovascular

77
Q

Penicilloyl-polylysine (Pre-Pen) is ____ while several minor determinants include: ____, ____

A

major determinant; penicilloate, penilloate

78
Q

True or False: All beta lactams can cause
serum sickness-like reaction

A

True

  • May involve deposition of antigen or
    drug immune complexes, causing
    inflammation
79
Q

Amoxicillin and ampicillin may cause
non-allergic ___

A

rash

  • Also associated with viral infection; very common in
    those receiving amoxicillin who are also infected
    with cytomegalovirus
80
Q

True or False: Amoxicillin and ampicillin may cause
non-allergic rash - This phenomenon IS
antibody-mediated, and DOES increase risk of
true penicillin allergy

A

False - this phenomenon is NOT
antibody-mediated, and does NOT increase risk of
true penicillin allergy

81
Q

Why should you generally avoid avoid combination of penicillins with bacteriostatics (especially tetracyclines or chloramphenicol)???

A
82
Q

True or False: The transfer of plasmid DNA between different strains of bacteria can transfer resistance to different microbes

A

True

  • Example: resistant Strep sanguis + Strep viridans acquired PBP’s from S. pneumo
83
Q

True or False: In IV solution, penicillins can inactivate aminoglycosides

A

True
- sometimes combo still given though
- beta lactams can “help” aminoglycosides enter target bacteria

84
Q

____ and ___ are classes associated with C. Diff

A

Cephalosporins
Penicillins

85
Q

Why will failure rate for combination oral contraceptives go up after anti-biotic therapy?

A

Enterohepatic recirculation of OTC’s

86
Q

True or False: Failure rate for combination oral contraceptives will go up after antibiotic therapy

A

True

Pharmacology (53 decks)

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