Pharm: Cell wall synthesis inhibitors

Question 1

What are the five types of penicillins?

Answer 1

1. Penicillin G
2. Aminopenicillins
3. Anti-staph
4. Anti-pseudomonas
5. Combo with beta-lactamase

Question 2

What are the components of augmentin?

Answer 2

amoxicillin and clavulanate

Question 3

What are the components of unasyn?

Answer 3

ampicillin and sulbactam

Question 4

What are the components of zosyn?

Answer 4

piperacillin and tazobactam

Question 5

What property makes nafcillin and dicloxacillin good for most staph?

Answer 5

It has resistance to the beta lactamase produced by s. aureus

Question 6

What is piperacillin good for?

Answer 6

pseudomonas, klebsiella and other GRAM NEGATIVE RODS.

NOT effective against MRSA

Question 7

Is piperacillin resistant to beta lactamase?

Answer 7

No, it’s degraded

Question 8

What is penicillin G good for?

Answer 8

Strep (pharyngitis/pneumonia/meningitis/endocarditis), enterococcus, meningococcus, and syphilis. Also oral/dental infections. Also to prevent GAS rheumatic fever

Question 9

What does the procaine suspension of penicillin do?

Answer 9

IM, lasts 1-2 days

Question 10

What does the benzathine suspension do?

Answer 10

IM, lasts for 1-4 WEEKS!

Question 11

What is the formulation of ampicillin?

Answer 11

IV/PO

Question 12

What is the formulation of amoxicillin?

Answer 12

ONLY po (it’s got an O in the name!)

Question 13

When would you use ampicillin?

Answer 13

otitis media, neonatal sepsis, URI

Question 14

What does amoxicillin have that ampicillin does not?

Answer 14

amoxicillin has more oral availability and a wider spectrum. It’s also less likely to cause diarrhea

Question 15

Which tx for MSSA is oral/IV?

Answer 15

dicloxacillin is oral

Nafcillin and oxacillin are IV and for more serious infections

Question 16

Which one of the MSSA drugs is NOT effective against gram - rods?

Answer 16

nafcillin

Question 17

What form does piperacillin come in?

Answer 17

IV ONLY

Question 18

What are the beta lactams not that good for?

Answer 18

The SPACEK creatures

Question 19

Why don’t we use methacillin anymore?

Answer 19

Because it causes allergic interstitial nephritis

Question 20

What’s different about the structure of monobactams (aztreonam)?

Answer 20

It only has one ring and is less likely to cause an allergic cross reaction

Question 21

Why do cephalosporins have a wide spectrum?

Answer 21

Resistant to beta lactamases

Question 22

What do cephalosporins NOT cover?

Answer 22

enterococcus and listeria

Question 23

What do first generation cephalosporins cover?

Answer 23

staph and strep

Question 24

What do later generation cephalosporins cover?

Answer 24

GNR

Question 25

What is the name of the first generation cephalosporin?

Answer 25

cefazolin

Question 26

What does cefazolin cover?

Answer 26

Strep and Staph. Good for UTIs (covers some E coli), and surgical prophylaxis

Question 27

What form does cefazolin come in?

Answer 27

Not PO! But cephalexin is PO

Question 28

When would you use ceftriaxone?

Answer 28

MENINGITIS, also serious pneumonia

Question 29

Which bugs do ceftriaxone cover?

Answer 29

Strep (most common cause of meningitis) Strep pneumo (serious pneumonia) Can also cover MSSA and GNRs

Question 30

What is the other 3rd gen cephalosporin?

Answer 30

Ceftazidine

Question 31

When would you use ceftazidine?

Answer 31

It's better at GNR and PSEUDOMONAS***

Question 32

Patients who are given cephalosporins are at increased risk of getting what infections?

Answer 32

fungal infections

Question 33

What is the broadest spectrum Abx we have?

Answer 33

meropenem

Question 34

What does meropenem not cover?

Answer 34

MRSA. Covers GPC, GNR, pseudomonas

Question 35

What type of situation would we want to use meropenems for?

Answer 35

abdominal infections

Question 36

What does aztreonam cover?

Answer 36

Aerobic, GNR (E coli and pseudomonas)

Question 37

What situations would you use aztreonma?

Answer 37

UTI or intraabdominal infection. However, coverage is pretty narrow so you need to be sure that the infection is only from aerobic GNRs! Think SPACEK

Question 38

Describe the structure of vancomycin. How does this work?

Answer 38

No beta lactam ring--huge structure | --It inhibits cell wall cross linking by altering COOH of D-ala-D-ala

Question 39

When would you use vancomycin acid from MRSA?

Answer 39

Coagulase negative staph enterococcus strep pneumo that's resistant C difficile (po)

Question 40

What is a serious contraindication to daptomycin?

Answer 40

pneumonia--interferes with surfactant in lungs | Also, don't use with a statin

Question 41

What is a side effect of daptomycin?

Answer 41

myopathy

Question 42

In what formulation does daptomycin come

Answer 42

IV only

Question 43

What is best for enterococcus?

Answer 43

penicillin. Much better than cephalosporins

Question 44

What do you use for listeria?

Answer 44

Ampicillin or penicillin

Question 45

When would you use cefazolin?

Answer 45

strep/staph covered but also oral anaerobes and GNR: use in abdominal infections

Question 46

Are cephalosporins effective in MRSA?

Answer 46

NO

Question 47

Why do you add vancomycin to the empiric treatment of strep pneumo?

Answer 47

Because 10% of pneumococcus is resistant to ceftriaxone

Question 48

What is the only cephalosporin that we can use for MRSA?

Answer 48

cefarolin(5th generation)

Question 49

What do you use to treat N. Meningitidis?

Answer 49

Penicillin G--it has excellent penetration of the CSF

Question 50

Side effect of vanc?

Answer 50

red man syndrome, with large release of histamine. Need to infuse slowly over 60 minutes

Question 51

When would you use Daptomycin?

Answer 51

Drug of last resort in VRE