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Block 3: Pharm & MHD Exam (by Richie) > Penicillin (Dr. Grim) - 9/1/15 > Flashcards

Penicillin (Dr. Grim) - 9/1/15 Flashcards

1
Q

What gram (+) bugs are addressed with the natural penicillin class?

A

Group A, B, C, F, G Streptococci

Viridans streptococci

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2
Q

What gram (-) bugs are addressed by the natural penicillin class?

A

Neisseria meningitidis

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3
Q

What anaerobic bugs are addressed by the natural penicillin class?

A

Clostridium spp.

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4
Q

Treponema pallidum (syphillus) is best treated with what class of penicillins?

A

Natural penicillins

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5
Q

What gram (+) bugs are addressed with penicillinase-resistant penicillins? Eg. Nafcillin (IV) and Dicloxacillin (PO)

A

Methicillin-susceptible Staphylococcus aureus (MSSA)

“Naf for Staph”

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6
Q

Name 2 aminopenicillins

A

Amipicillin (IV)

Amoxicillin (PO)

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7
Q

What gram (+) bugs are addressed by aminopenicillins, such as ampicillin or amoxicillin?

A

Enterococcus

Listeria monocytogenes

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8
Q

Name a drug in the carboxypenicillin class

A

Ticarcilin

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9
Q

Ticarcilin (carboxypenicillin class) shows optimal activity for what bugs?

A

Mostly gram (-) bugs, such as:

Pseudomonas spp.
Stenotrophomonas maltophilia

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10
Q

Name a drug in the ureidopenicillin drug class

A

Piperacillin (IV)

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11
Q

Main use for peperacillin

A

Broad gram (-) coverage including P. aeruginosa

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12
Q

Ampicillin + _______ for B-lactamase producing strains

A

sulbactam

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13
Q

Amoxicillin + _______ for B-lactamase producing strains

A

clavulanate

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14
Q

Piperacillin + _______ for B-lactamase producing strains

A

tazobactam

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15
Q

_________ enhance the antibacterial activity of their companion penicillin in situations where the resistance is primarily the result of B-lactamase production.

A

B-lactamase inhibitors

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16
Q

ALL penicillins have relatively short ______.

A

Elimination half-lives (

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17
Q

Ampicillin and amoxicillin fall into WHAT CLASS of penicillins?

A

Aminopenicillins

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18
Q

Aqueous penicillin G, benzathine penicillin G, procaine penicillin G, penicillin VK. What class are these?

A

“Natural” penicillins

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19
Q

As an exception, penicillins show BACTERIOSTATIC activity against

A

Enterococcus spp.

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20
Q

As exceptions, nafcillin and oxacillin are eliminated primarily by ________, whereas piperacillin undergoes __________

A

Liver, dual elimination (liver + kidney)

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21
Q

B-lactamase inhibitors show enhanced activity against B-lactamase producing strains of what anaerobes?

A

B. fragilis and

B. fragilis group (DOT) organisms.

22
Q

B-lactams are bactericidal, or bacteriostatic?

A

Bactericidal (except in the case of Enterococcus spp)

23
Q

Bactericidal activity (via synergy) can be achieved against Enterococcus spp. by adding an __________.

A

Aminoglycoside (gentamicin or streptomycin)

24
Q

Do penicillins rely on binding proteins?

A

Wide range - it depends!

  1. 15% binding for aminopenicillins
  2. 97% for dicloxacillin
25
Q

Class of penicillins developed to further enhance activity against gram-negative bacteria. These agents are derived from the ampicillin molecule with acyl side chain adaptations that allow for greater cell wall penetration and increased PBP affinity.

A

Ureidopenicillins

eg. Piperacillin

26
Q

Cross-allergenicity is observed between __________ due to their common nucleus

A

natural and semisynthetic penicillins

27
Q

Describe 3 primary mechanisms of resistance to penicillin antibiotics

A
  1. B-lactamase enzymes
  2. Altered PBP structure (decreasing affinity)
  3. Antibiotic can’t penetrate outer membrane of G- bacteria
28
Q

Example of a ureidopenicillin

A

Piperacillin

29
Q

Give an example of a carboxypenicillin drug

A

Ticarcillin

30
Q

In the case of inflammed meninges - how do you achieve adequate concentrations of penicillins?

A

High dose of parenteral

31
Q

MOST penicillins are eliminated unmetabolized primarily by the ________

A

kidneys (via glomerular filtration and tubular secretion)

32
Q

Most penicillins are removed during hemodialysis or peritoneal dialysis, and require supplemental dosing after a hemodialysis procedure. But what are the exceptions?

A

nafcillin and oxacillin

33
Q

Name 2 key penicillinase-resistant penicillins

A
  1. Nafcillin
  2. Dicloxacillin

note: handout also mentioned methicillin (not avail anymore), and oxacillin. These weren’t bolded.

34
Q

Natural penicillins have very little activity against

A

Staphylococcus spp. (gram +) due to penicillinase production

35
Q

Parenteral ampicillin is used for the treatment of_________ infections (with an aminoglycoside for endocarditis) and Listeria monocytogenes meningitis.

A

Enterococcal

36
Q

Penicillin G is still considered to be a DRUG OF CHOICE for the treatment of (~6)?

A
  1. Treponema pallidum (syphilis***)
  2. Neisseria meningitidis
  3. Corynebacterium diphtheriae
  4. Bacillus anthracis (anthrax)
  5. Clostridium perfringens and tetani
  6. viridans and Group Streptococci.
37
Q

Penicillins display ______-dependent bactericidal activity.

A

Time

38
Q

Piperacillin is the most active penicillin for infections due to _______

A

Pseudomonas aeruginosa.

39
Q

Piperacillin shows good activity against what gram-negative bug?

A

Pseudomonas aeruginosa

40
Q

Stenotrophomonas maltophilia is treated by penicillin combo with ____?

A

Ticarcillin/clavulanate

41
Q

The B-lactamase inhibitors ticarcillin/clavulanate are active against what bug?

A

Stenotrophomonas maltophilia

42
Q

The pharmacodynamic parameter that correlates with clinical efficacy of the penicillins is _____________

A

Time above the MIC

43
Q

This pharmacological consideration must be considered in patients with cardiac or renal dysfunction.

A

Na load

44
Q

Ticarcillin falls under what class of penicillin drug?

A

Carboxypenicillin

45
Q

Ticarcillin is an example of a drug with a very high ___________; be careful with cardiac and renal dysfunction patients.

A

Sodium load (5.2 mEq per gram)

46
Q

Ticarcillin is the drug of choice for?

A

Pseudomonas aeruginosa

Note: NOT active against Klebsiella spp., Serratia spp., or Actinobacter spp.

47
Q

Typical route of administration for penicillins

A

Parenteral (many are degraded by stomach acid)

48
Q

As exceptions, what 4 penicillin drugs are NOT eliminated via kidneys?

A

nafcillin
oxacillin
ceftriaxone
cefoperazone

49
Q

The following penicillin drugs are exceptions to what rule?

ceftriaxone, cefoperazone, cefotetan, cefixime, ertapenem

A

Unlike most penicillins, these don’t have short elimination half-lives

50
Q

All penicillins exhibit cross-allergenicity between classes, except _________

A

aztreonam

51
Q

aztreonam is an exception to what rule, for penicillin drugs?

A

aztreonam does not exhibit cross-allerginicity between drug classes!

Block 3: Pharm & MHD Exam (by Richie) (7 decks)

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