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Clinical Pharmacology > PCN/CPH > Flashcards

PCN/CPH Flashcards

1
Q

PO PCN

A
  • Natural PCN (PCN VK)
  • Anti-staph PCN (Dicloxacillin)
  • AminoPCN (Amoxicillin)
  • Augmented AminoPCN (amox/clav)
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2
Q

IV PCN

A
  • Natural PCN (PCN G)
  • Anti-staph PCN (Nafcillin)
  • AminoPCN (ampicillin)
  • Augmented AminoPCN (amp/sulbactam)
  • Extended-spectrum PCN (piptaz)
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3
Q

PCN and Cephalosporin MOA

A

Arrest cell wall synthesis by binding to PBPs

**bacteria need to be actively dividing for B-lactams to work

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4
Q

PCN and Cephalosporin Mechanism of Resistance

A
  1. destruction of abx by b-lactamases
  2. failure of abx to penetrate to PBP targets
  3. low-affinity binding of abx to PBP
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5
Q

PCN Pharmacology

A
  • minimal drug interactions
  • most renal excretion (except Nafcillin)
  • time-dependent killing
  • bactericidal

coverage:
- natural PCNs & anti-staph PCNs have good G+ activity
- as generations increase you lose G+ and gain G-

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6
Q

PCN ADRs

A

Class Effect:

  • hypersensitivity rxn
  • drug fever (rare)

Unique:

  • **nafcillin: phlebitis, AIN, hypokalemia
  • **clavulanate: diarrhea, hepatotoxicity (subclinical LFT elevations)
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7
Q

Natural PCNs

A
  • PCN G (IV) or PCN VK
  • Benzathine PCN (IM)

Common Indications:

  • strep pharyngitis* / cellulitis
  • various stages of syphilis*

Benzathine IM - think of as long acting IM shot

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8
Q

Anti-Staphylococcal PCNs

A
  • Nafcillin (IV) or dicloxacillin (tab)

Common Indications:
- SSTIs* (esp when S. aureus suspected)

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9
Q

AminoPCNs

A
  • Ampicillin (IV) or amoxicillin

Common Indications:

  • URTIs* (pharyngitis, AOM secondary bacterial infection)
  • streptococcal skin infections
  • endocarditis prophylaxis for dental procedures*
  • lyme disease*
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10
Q

Augmented AminoPCN

A
  • amp/sul (IV) or amox/clav

Common Indications:

  • animal/human bite prophylaxis or tx*
  • amoxicillin failure URTIs (AOM, sinusitis, AE-COPD)*
  • recurrent streptococcal pharyngitis
  • SSTIs
  • dental infections*
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11
Q

How do you prescribe amoxicillin/clavulanate?

A

Dose is based on amoxicillin component.

Determine appropriate dose and choose correct product (products are not interchangeable)

“Hardest abx to prescribe,” says Paxty

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12
Q

Extended-Spectrum PCNs

A
  • Pip/Taz (IV)

Common Indications:

  • mostly nosocomial infections
  • “serious outpatient –> inpatient infections (e.g. perforated diverticulum)
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13
Q

PO Cephalosporins

A

1st gen - cephalexin
2nd gen - cefuroxime
3rd gen - cefpodoxime

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14
Q

IV Cephalosporins

A 
1st gen - cefazolin
2nd gen - cefuroxime 
3rd gen - ceftriaxone
4th gen - cefepime
5th gen - ceftaroline
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15
Q

Cephalosporin Pharmacology

A
  • minimal drug interactions
  • most renal excretion (least with ceftriaxone)
  • time-dependent killing
  • bactericidal

Coverage:

  • 1st/2nd gen: good G+
  • increase generations generally lose G+ and gain G- (except 5th gen)
  • no cephalosporin covers Enterococci or Listeria*
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16
Q

Cephalosporin ADRs

A

Class effect

  • hypersensitivity rxn
  • drug fever (rare)

Unique effects

  • serum-sickness like rxn common w/cefaclor
  • ceftriaxone & neonates* –> precipitates w/Ca2+ –> pseudocholelithiasis (precipitates in baby’s lungs)
17
Q

1st Gen Cephalosporin

A
  • cefazolin (IV) or cephalexin

Common Indications:

  • SSTIs*
  • Streptococcal pharyngitis
  • Lower UTI (cystitis) - good in pregnancy*
  • perioperative prophylaxis (cefazolin)*
18
Q

2nd Gen (Respiratory*) Cephalosporins

A
  • cefuroxime (tab, IV)

Common indications

  • amoxicillin failure URTIs (AOM, sinusitis, AE-COPD)*
  • SSTIs
19
Q

3rd Gen Cephalosporin - PO

A
  • cefpodoxime, cefdinir

Common Indications:
- essentially the same as cefuroxime

20
Q

3rd Gen Cephalosporin - PAR

A
  • ceftriaxone (IM, IV)

Common Indications:

  • refractory AOM
  • CAP (w/azithromycin)*
  • meningitis*
  • gonorrhea*
  • intraabdominal infection (e.g. pyelonephritis, diverticulitis)*
  • serious lyme disease (heart, CNS)
21
Q

4th Gen Cephalosporins

A
  • cefepime (IV)

Common Indications
- mostly nosocomial infections

22
Q

5th Gen Cephalosporins

A
  • ceftaroline (IV)

strong affinity for PBP2a (modified PBP in MRSA) & PBP2x (modified PBP in PCN-resistant S. pneumoniae) –> 1st cephalosporin with any MRSA activity*

doesn’t have extended GNB coverage that you might expect from higher-generation cephalosporin*

23
Q

Natural PCN Coverage

A 
PCN G (IV) or PCN VK
Benzathine (IM)
  • S. pyogenes (GAS) & T. pallidum
24
Q

Anti-Staphylococcal PCN Coverage

A

Nafcillin (IV) or dicloxacillin (tab)

  • S. aureus (MRSA) & S. pyogenes (GAS)
25
Q

AminoPCNs Coverage

A

Ampicillin (IV) or amoxicillin

  • S. pyogenes
  • S. pneumoniae
  • S. galactiae (GBS)
  • Enterococci
  • B. burgdorferi
  • P. multocida
  • Proteus
  • Listeria

Some: H. influenzae, E. coli

26
Q

Augmented AminoPCN Coverage

A

Amp/Sul (IV) or Amox/Clav

Same as AminoPCN PLUS
- M. catarrhalis
- H. influenzae
- Most anaerobes
Some: E. coli, Klebsiella
27
Q

Extended Spectrum PCN Coverage

A

Pip/Taz (IV)

GPC:

  • S. pyogenes
  • S. pneumoniae
  • S. agalactiae (GBS)
  • Enterococci

GNB:

  • M. catarrhalis
  • H. influenzae
  • Proteus
  • E. coli
  • Klebsiella
  • Enterobacter
  • Serratia
  • Pseudomonas ** - only anti-pseudomonal PCN

Most anaerobes

“Thou shall not use Zosyn every time”

28
Q

1st Gen Ceph Coverage

A

Cefazolin (IV) or cephalexin

  • S. pyogenes (GAS)
  • S. aureus (MSSA)

Some: E. coli, Klebsiella, Proteus

29
Q

2nd Gen Ceph Coverage

A

Cefuroxime (tab, IV)

Same as 1st gen PLUS

  • S. pneumoniae
  • M. catarrhalis
  • H. influenzae
  • Pasteurella

“Similar to augmentin-ish”

30
Q

3rd Gen Ceph PO Coverage

A

Cefpodoxime & Cefdinir

Similar coverage as cefuroxime BUT more GNB acitivity…but cefuroxime is no longer suspension*

31
Q

3rd Gen Ceph PAR Coverage

A

Ceftriaxone (IV, IM)

“wimpy” GNB

  • E. coli
  • Klebsiella
  • Proteus
  • M. catarrhalis
  • H. influenzae

Some GPC

  • S. pneumoniae
  • most other “strep”
32
Q

4th Gen Ceph Coverage

A

Cefepime (IV)

“Resistant” GNB

  • Pseudomonas
  • Enterobacter
  • Serratia
  • S. pneumoniae
33
Q

5th Gen Ceph Coverage

A

Ceftaroline (IV)

“Ceftriaxone with MRSA activity”
** only B-lactam that kills MRSA

Clinical Pharmacology (54 decks)

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