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Pharmacology Block III > Penicillins > Flashcards

Penicillins Flashcards

1
Q

Where in the body do the penicillins NOT distribute?

A
  1. Eye 2. Prostate
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2
Q

What factors affect the distribution of penicillins?

A
  1. Molecular configuration of the penicillin 2. Protein binding “Penicillins Meet Proteins”
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3
Q

When are adequate concentrations of penicillins in the CSF attained?

A

Only in the presence of INFLAMED MENINGES when HIGH DOSES of parenteral penicillins are used

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4
Q

Give 2 examples of penicillins that bind to serum proteins and their respective binding percentages.

A
  1. Aminopenicillins - 15% 2. Dicloxacillin (Penicillinase-Resistant) - 97%
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5
Q

List the penicillins that are NOT primarily eliminated by the kidneys, and list their appropriate route of elimination.

A
  1. Nafcillin (Penicillinase-Resistant Penicillin)
    - Elimination via liver
  2. Oxacillin (P-R-P)
    - Elimination via liver
  3. Dicloxacillin (P-R-P)
    - Renal with some hepatic
  4. Piperacillin (Ureidopenicillin)
    - Dual elimination: liver and kidneys
  5. Piperacillin-Tazobactam (Beta-lactamase Inhibitor Combination)
    - Dual elimination
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6
Q

Which penicillins are NOT removed during hemodialysis?

A
  1. Nafcillin (P-R-P) 2. Oxacillin (P-R-P) 3. Dicloxacillin (P-R-P) THINK: “N.ot O.ut from D.ialysis”
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7
Q

What is the general half-life characteristic for ALL penicillins?

A

-Relatively short elimination half-life -2 hours half-life

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8
Q

Which penicillins do NOT require dosing changes for renal insufficiency?

A
  1. Nafcillin (P-R-P) 2. Oxacillin (P-R-P) 3. Dicloxacillin (P-R-P) THINK: “N.O. D.ose changes”
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9
Q

In what situation would you use aqueous penicillin G (IV)?

A

-Serious infections in hospitalized patients (rapid effect and high serum concentrations)

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10
Q

What situation would call for penicillin VK (oral)?

A

-Mild to moderate infections (pharyngitis or prophylaxis) due to low serum concentrations of the drug

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11
Q

Natural penicillins are a drug of choice for which infection types?

A
  1. S. pneumoniae (IV or IM): penicillin susceptible or intermediate strains
  2. Neisseria meningitis (IV)
  3. Clostridium perfringens or tetani
  4. Actinomycosis
  5. Viridans streptococci pharyngitis (PO or IM)
  6. Treponema Pallidium: syphillis

“Pen CAN Stop The Virulence”

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12
Q

For what type of infection would Benzathine penicillin or aqueous penicillin be a drug of choice?

A

Streptococci like S. pyogenes

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13
Q

Bacteremia treatment and endocarditis prophylaxis could be accomplished with what classes of penicillins as a drug of choice?

A
  1. Natural penicillins (along with an aminoglycoside) 2. P-R-Ps
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14
Q

In treating Treponema pallidum, or syphilis, what would be the drug(s) of choice?

A

Benzathine penicillin or IV (aqueous) penicillin

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15
Q

What is another name for the Penicillinase-Resistant Penicillins?

A

Antistaphylococcal Penicillins

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16
Q

What agents are useful for the treatment of infections due to methicillin-susceptible Staphylococcus aureus (MSSA)?

A

Penicillinase Resistant Penicillins (Antistaphylococcal Penicillins)

17
Q

Give some examples of diseases caused by MSSA?

A

-Skin and soft tissue infections -Septic arthritis -Osteomyelitis -Bacteremia -Endocarditis

18
Q

Oral dicloxacillin is useful for treatment of type of infection?

A

-Mild to moderate skin and soft tissue infections -As a follow-up therapy after parenteral therapy for the treatment of more serious infections (i.e. osteomyelitis and septic arthritis)

19
Q

What class of penicillins work best for pathogens of the respiratory tract (i.e. mild to moderate pharyngitis, sinusitis, otitis media, bronchitis)?

A

Aminopenicillins (PO)

20
Q

Parenteral Ampicillin is used for treatment of what types of infections?

A

-Enterococcal infections (with an aminoglycoside for endocarditis) -Listeria monocytogenes (meningitis) “Ampicillin Eats Listeria” or “AmpLE”

21
Q

Due to their enhanced activity against gram-negative bacteria, which classes of penicillins are useful towards hospital-acquired infections?

A

Carboxypenicillins and Ureidopenicillins active against: P. Aeruginosa

22
Q

List some examples of hospital acquired infections.

A

Serious infections such as:

  • Bacteremia
  • Pneumonia
  • Complicated UTIs
  • Peritonitis
  • Skin and soft tissue infections
  • Bone and joint infections
  • Meningitis
23
Q

What is the most active penicillin for infections due to Pseudomonas aeruginosa?

A

Piperacillin (Ureidopenicillin class)

24
Q

Amoxicillin-clavulanate (Augmentin-PO) is useful for treatment of what diseases?

A
  • Otitis media
  • Sinusitis
  • Bronchitis
  • Lower Respiratory Infections
  • Bites (human or animal)

“BLOBS”

25
Q

What group of penicillins are utilized in the treatment of polymicrobial infections (i.e. intra-abdominal infections, gynecological infections, diabetic foot infections)?

A

Parenteral combination agents (Beta-lactamase Inhibitor Combination Products)

26
Q

Ampicillin-sulbactam (IV) is useful for the treatment of which type of infections?

A

Mixed aerobic/anaerobic infections (limited gram-negative coverage)

27
Q

What is the treatment option for infections caused by Stenotrophomonas maltophilia?

A

Ticarcillin-clavulanate (IV)

28
Q

Why is Piperacillin-tazobactam more tolerable than Ticarcillin-clavulanate?

A

Ticarcillin has a higher sodium load

29
Q

What does Piperacillin-tazobactam (IV) treat?

A
  • Polymicrobial infections
  • Gram-negative, hospital-acquired infections
  • Empiric therapy for febrile neutropenia
30
Q

What is the most frequently occurring side effect of penicillins?

A

Hypersensitivity (3-10%)

-less frequent with oral administration

31
Q

What causes cross-allergenicity among natural and semi-synthetic penicillins?

A
  • Their common nucleus
  • If allergic to one type of penicillin = allergic to other members of the penicillin family (and caution used with other beta-lactams)
32
Q

What are some neurologic adverse effects of penicillins?

A

-Seizures -Irritability -Jerking -Confusion

33
Q

List some gastrointestinal adverse effects of penicillins?

A
  • Nausea, vomiting
  • Diarrhea (esp. amoxicillin-clavulanate)
  • Pseudomembranous colitis (C. difficile diarrhea)
34
Q

What types of penicillins typically cause interstitial nephritis (immune-mediated damage to renal tubules)?

A

-Methicillin (PRP) -Nafcillin (PRP)

35
Q

What are some physical manifestations of interstitial nephritis?

A
  • Fever
  • Eosinophiluria
  • Abrupt increase in serum creatinine
36
Q

How does Ticarcillin cause hypokalemia?

A

It acts as non-reabsorbable anions resulting in increased excretion of potassium

37
Q

What types of penicillin cause sodium overload and fluid retention?

A

Ticarcillin and piperacillin

Pharmacology Block III (8 decks)

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