Penicillin

Question 1

General structure (3)

Penicillin

Answer 1

• Acyl side chain
• Beta-lactam ring
• Thiazolidine Ring

Question 2

Beta-lactamase inhibitor

Penicillin

Answer 2

Clavulanic acid
sulbactam
Tazobactam

Question 3

Drug for better porin penetration
- Gram negatives

(Penicillin)

Answer 3

Ampicillin

Question 4

Mechanism of Action

Penicillin

Answer 4

inhibit cell wall synthesis

target Penicillin-binding proteins (PBPs)

Question 5

PBPs

Penicillin

Answer 5

Transpeptidase, transglycolases, D-Ala carboxykinase

peptidoglycan transpeptidase

Question 6

Resistance

Penicillin

Answer 6

B-lactamase production

Decreased penetration to site of action (G- / porin channel)

Question 7

Most imp route of elimination

Penicillin

Answer 7

Renal excretion

Question 8

Why do infants excrete PCN at a slower rate

Answer 8

immature transport systems

Question 9

Equation used for renally excreted drugs

Answer 9

Cockroft-Gault Equation

[(140-age)(Weight)]/[(Serum Creatinine)(72)]

multiply by 0.85 for female. weight in Kg

Question 10

How long does it take for PCN to yield peak levels

Answer 10

1-2 hrs after ingestion

Question 11

What areas does PCN distribute to

Answer 11

Lung
liver
muscle
kidney
bone
placenta

Question 12

Lowest distributions are found in (2)

Answer 12

Lung and bone

Question 13

Highest concentration found in

Answer 13

Urine

Question 14

Most common hypersensitivity reaction

Penicillin

Answer 14

Maculopapular rash

Question 15

Which Ig mediates immediate reaction - anaphylaxis ?

Answer 15

IgE

anaphylaxis –> to the ER

Question 16

Which Igs mediate delayed reaction?

Answer 16

IgM or IgG

Question 17

Adverse effects

Penicillin

Answer 17

Eosinophilia
Interstitial nephritis (Methicillin)
Pseudomembranous Colitis

Question 18

Other causes of Eosinophilia

Answer 18

NAACP

Neoplasm
Asthma
Allergic reaction
Connective tissue
Parasite

Question 19

What should you be be careful with Pen G?

Answer 19

hyperkalemia

Question 20

Which Pen G is the best option? Why?

Answer 20

Benzanthine Penicilin (IM)

Sustained (slow) release
Prophylaxis in rheumatic fever

Question 21

Causes/types of/for Pen G/VK resistance (3)

Answer 21

G+

Staph –> produce B-lactamases
Strep –> PBP changes (patients who’ve recieved abx recently)
Gonorrhea resitance

Question 22

Penicillinase resitant penecillins

Answer 22

Antistaphylococcal penicillins

• IV - methicillin, oxacillin, nafcillin (hepatic elim)
• PO - cloxacillin, dicloxacillin

Question 23

Amino group allows for penetration into which bacterium cell wall? (aminopenicillin)

Answer 23

G-

Question 24

Two types of aminopenicillins

Answer 24

ampicillin

amoxicillin

Question 25

adverse effects of aminopenicillin

Answer 25

hypersensitivity

Diarrhea

Question 26

What is special about Carboxypenicllin?

Answer 26

increased permeability to cell wall
includes SPACE bugs
no Enterococcus coverage

Question 27

Two types of Carboxypenicillin?

which is more active against Pseudomonas?

Answer 27

Carbenicillin

Ticarcillin - more active

Question 28

Ticarcillin has a high ___ load. Patients with ____ could have issues with its excretion.

Answer 28

Na+

Congestive Heart failure

Question 29

Adverse effects of Carboxypenicillin

Answer 29

hypersensitivity
Platelet dysfunction (dose dependent)
Na+ overload

Question 30

Which penicillin is better than Ticarcillin? why?

Answer 30

Piperacillin (Ureidopenicillin)
lower Na+ load
also covers enterococcus

Question 31

Why is B-Lactamase inhibitor and penicillin combos important/more useful?

Answer 31

Adds Staph and anaerobe coverage

Question 32

Examples of Combo products:

Penicillin

Answer 32

Timentin - ticarcillin/clavulanic acid

Zosyn - piperacillin/tazobactam