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Antibiotics > Penicillins > Flashcards

Penicillins Flashcards

1
Q

Penicillin MOA

A

Binds to transpeptidase enzymes in bacterial cell wall -> disrupts cell wall formation

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2
Q

Boxed warning for penicillin G benzathine

A

NOT for IV use -> cardiorespiratory arrest and death

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3
Q

Which penicillin is a vesicant?

A

Nafcillin -> central line preferred

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4
Q

Augmentin (amox/clav) and unasyn (amp/sulbactam) contraindication

A

H/o cholestatic jaundice or hepatic dysfxn associated with previous use

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5
Q

Augmentin contraindication

A

Severe renal impairment (CrCl < 30)
- Do not use XR/ER OR the 875mg strength

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6
Q

Probenecid DDI

A

Probenecid causes increased levels of beta lactam
- D/t interference w/ renal excretion
- Sometimes used in severe inf to increase abx lvls

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7
Q

MTX DDI

A

Abx -> increased MTX concentrations

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8
Q

Warfarin + beta-lactam DDI (not dicloxacin and nafcillin)

A

Enhances anticoagulant effect of warfarin
- Inhibited production of vitamin K-dependent clotting factors

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9
Q

Nafcillin + dicloxacillin (CYP inducers) + warfarin DDI

A

Inhibit anticoagulant effect of warfarin

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10
Q

Penicillin monitoring

A
  • Renal fxn
  • s/s anaphylaxis w first dose
  • CBC and LFTs and prolonged courses
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11
Q

Penicillin ADRs

A
  • Seizures (accumulation w incorrect dosing)
  • GI upset/diarrhea
  • Rash (SJS/TENS)
  • Allergic rxns and anaphylaxis
  • Hemolytic anemia (Coombs test)
  • Renal failure
  • Increased LFTs
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12
Q

Natural penicillins + dosing

A

Penicillin V potassium = PO 125-500mg q6-12h (empty stomach)

Penicillin G aqueous (Pfizerpen) = IV 2-4 million units q4-6h

Penicillin G Benzathine (Bicillin L-A) = IM 1.2-2.4 million units x1

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13
Q

Antistaphylococcal penicillins + dosing

A

Dicloxacillin = PO 125-500mg q6h

Nafcillin = IV/IM 1-2g q4-6h

Oxacillin = IV 250-2000 mg q4-6h

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14
Q

Aminopenicillins + dosing

A

Amoxicillin = PO, varies

Amox + clavulanate = PO, varies, XR tab taken q12h with food

Ampicillin = PO 250-500mg q6h empty stomach (30min before meal, 2hr after), IV/IM = 1-2g q4-6h

Ampicillin/sulbactam (unasyn) = IV 1.5-3g q6h

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15
Q

Extended-spectrum penicillin + dosing

A

Piperacillin/tazobactam (Zosyn) = IV 3.375g q6h or 4.5g q6-8h, prolonged infusion = 3.375-4g IV q8h (each dose infused over 4hrs)

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16
Q

Agents preferred for MSSA soft tissue, bone and joint, endocarditis, and bloodstream infections

A

Antistaphylococcal

17
Q

Agent preferred for ampicillin IV to PO transition

A

Amoxicillin PO

18
Q

Agent preferred for acute otitis media in children

A

Augmentin ES-600 suspension -> lower clavulanate concentration, lower risk for diarrhea

19
Q

Preferred diluent for ampicillin (including combo)

A

NS

20
Q

When may it be acceptable to use penicillins in patients with allergies?

A

Treatment of syphilis - during pregnancy, or in patients with poor compliance/follow-up

Desensitize and treat with penicillin G benzathine

21
Q

1st line agent for pharyngitis (strep throat)

A

PO penicillin VK

22
Q

1st line agent for acute otitis media + pediatric dose

A

Amoxicillin 80-90 mg/kg/day OR

Augmentin 90 mg/kg/day

23
Q

DOC for syphilis

A

Penicillin G Benzathine 2.4million units IM once

24
Q

Only penicillin active against pseudomonas

A

Piperacillin/tazobactam (Zosyn)

25
Q

Which agents are available PO?

A
  • Penicillin V potassium
  • Dicloxacillin
  • Amoxicillin (+ clav)
  • Ampicillin (poor F)
26
Q

Which agents do not require renal dose adjustment?

A

Anti-staphylococcal (nafcillin, oxacillin, dicloxacillin)

27
Q

Natural penicillin coverage

A
  • Gram-positive cocci (strep, entero)
  • Gram-positive anaerobes (mouth flora)
28
Q

Antistaphylococcal coverage

A
  • Streptococci
  • MSSA
29
Q

Aminopenicillin coverage

A
  • Streptococci
  • Enterococci
  • Gram-pos anaerobes (mouth flora)
  • Gram-negative = h influenzae, neisseria, proteus, e coli
30
Q

Aminopenicillin + beta-lactamase inhibitor coverage

A
  • MSSA
  • More resistant strains of gram-negative bacteria (haemophilus, neisseria, proteus, e coli, klebsiella) (HNPEK)
  • Gram-negative anaerobes (b fragilis)
31
Q

Extended-spectrum penicillin + beta-lactamase inhibitor coverage

A

Broad spectrum
- Same as aminopenicillins + beta-lactamase inhibitor combo
- Expanded coverage of other gram-negative bacteria (citrobacter, acinetobacter, providencia, enterobacter, serratia (CAPES), pseudomonas)

Antibiotics (1 decks)

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