penicillins

Question 1

B lactam family

Answer 1

penicillin
cephalosporins
carbapenem
monobactams

Question 2

chemical structure of penicillin

Answer 2

5 membered A ring with S inside the ring

Question 3

chem structure of cephalosporins

Answer 3

6 membered A ring with S inside the ring

Question 4

chem structure of carbapenem

Answer 4

5 membered A ring with S OUTSIDE of ring

Question 5

chem structure of monobactam

Answer 5

no A ring

Question 6

mechanism of b lactams

active when?

Answer 6

inhibit peptide cross linking of bacteria cell wall

active in ACTIVELY proliferating bacteria– no effect on NON dividing bacteria

Question 7

what agents can antagonize bacterial cell wall inhibitors

Answer 7

bacteriostatic agents

B lactams are bactericidal, they only work on actively proliferating bacteria

Question 8

penicillin mech of action

Answer 8

inhibit transpeptidation

bind to PBP (which are transpeptidase enzymes needed that remove remaining D alanine to cross link peptidoglycan)

Question 9

standard penicillins (3)

Answer 9

penicillin G
penicillin V
depot penicillins

Question 10

antistaphylococcal penicillins (3)

Answer 10

nafcillin
oxacillin
diclosacillin
methicillin

Question 11

extended spectrum penicillins (2)

Answer 11

amoxicillin

ampicillin

Question 12

anti pseudomonal penicillin (1)

Answer 12

piperacillin

Question 13

synergistic effect of penicillin with ____

Answer 13

penicillin and aminoglycosides

Question 14

b lactamase inhibitors (3)

Answer 14

clavulanic acid
sulbactam
tazobactam

Question 15

routes of standard penicillins

Answer 15

G- IV
V- oral
dept- IM

Question 16

targets of penicillin G

Answer 16

gram + that dont have a b lactamase
- streps (pyogenes, agalactiae, pneumo, viridans)
- enterococci 
-  bacillus 
- Clostrisdium (perfingens, tetani)
- Listeria
- Actinomyces*
meningococci (gram -) 
spirochetes
- treponema pallidum
- leptospirae

Question 17

penicillin G drug of choice for

Answer 17

gas gangrene (c. perfingens)
Menigitis (neisseria)
syphillis (treponema)

Question 18

penicillinG and Gentamycin( aminoglycoside) tx

Answer 18

enterococci

Question 19

penicillin G route

Answer 19

IV

Question 20

penicillin V route

tx

Answer 20

PO- [ due to acid stability]
tx orpharyngeal infections
- pharyngitis- strep throat
- tonsillitis
- scarlet fever [RF] (s pyogenes) 
URT 
- otitis media*
- sinusitis

Question 21

which penicillin best for syph

Answer 21

Benzanthine Penicillin G ( bicillin LA)– long lasting

Question 22

routes for antistaphylococcal pncn

Answer 22

nafcillin - IV IM
oxacillin - IV IM
diclosacillin- PO
methicillin - not used anymore

Question 23

spectrum for antistaphylococcal pncn

Answer 23

Staph producing b lactamases

Question 24

route for extended [broad] spectrum pncn

Answer 24

amoxicillin- oral

ampicillin- iv

Question 25

spectrum for extended spectrum

Answer 25

same as penicillin G (gram + without b lactamases, meningococci, spirochetes)

+ MORE GRAM -

• e coli
• proteus
• salmonella
• shigella
• Hib (r)
• moraxella (r)

Question 26

amoxicillin drug of choice for

Answer 26

(most prescribed penicillin)

• prophylaxis for BACTERIAL endocarditis [ like dental procedures]
• tx tonsillitis and pharyngitis s. pyogenes
• otitis media

Question 27

ampicillin drug of choice for

Answer 27

• listeria monocytogenes**

- over amoxicillin for GI ( salmonella and shigella– bc 50% absorbed and 50% left)

Question 28

anti pseudomonal and route

Answer 28

piperacillin IV IM

(zosyn )- has b lactamase inhibitor

Question 29

piperacillin drug of choice for

Answer 29

pseudomonal infections

Question 30

piperacillin spectrum

Answer 30

BROADEST spectrum penicillin

gram + without b lactamases, meningococci, spirochetes)

+ MORE GRAM - e coli - proteus- salmonella- shigella- Hib -moraxella

+ MORE GRAM -

• pseudomonas
• klebsiella
• serratia
• bacteroides
• enterobacter
• citrobacter

Question 31

resistance for penicillins

Answer 31

intrinsic- chromosomal b lactamase

acquired- plasmid: B lactamase (MOST commmon)

Question 32

what is the basis of development of MRSA

Answer 32

altered target site— structural changes in PBP — lowe affinity of antibiotics

Question 33

pharmakokinetics of penicillins

• oral
• food
• BBB
• excretion

Answer 33

oral: penicillin V, dicloxacillin, amoxicillin, need to be given one hour before meals

dont cross BBB except during inflammation ( G V)

excreted by the kidney

Question 34

which drug blocks penicillin excretion

Answer 34

probenecid-

Question 35

which penicillins ARENT excreted by kidney

meaning?:

Answer 35

Nafcillin- BILE
oxacillin- bile and kidney
dicloxacillin- bile and kidney

• means that they can be given in pts with REDUCED renal function !!!!

Question 36

adverse effect of pncn

Answer 36

allergic hypersensitivity reaction
- if you are allergic to pncn you have cross sensitivity with other b lactams EXCEPT monobactam ) bc it doesnt have A ring )

Question 37

pncn with b lactamase inhibitors

augmentin
unasyn
zosyn

Answer 37

augmentin: amoxicillin and clavulonic acid
unasyn: ampicillin and sulbactam
zosyn: piperacillin and tazobactam

tx penicillinase + organisms

• e coli
• hib
• moraxella

Question 38

use of clavulonic acid
sulfabactam
tazobactam

Answer 38

b lactamase inhibitors- they have the ring but no actual antibiotic activity—
but they protect the penicillins from degradation

Question 39

use for nafcillin oxacillin and dicloxacillin

Answer 39

for penicillin resistant staph
[- skin abcesses
- endocarditis
- osteomyelitis ]