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Pharm Exam 8 > Random Info > Flashcards

Random Info Flashcards

1
Q

Murein Hydrolase

A

Bacterial autolytic enzyme activated for autolysis and bactericidal effect of penicillin

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2
Q

Transpeptidase

A

Bacterial enzyme (and PBP) located on the outside of the cell membrane, catalyzes the final cross-linking of peptidoglycans in cell wall formation

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3
Q

Which bacteria lacks high permeability porins?

A

P. aeruginosa

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4
Q

Which bacteria has active efflux?

A

P. aeruginosa, N. gonorrhoeae, E. coli

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5
Q

Which bacteria produces large amounts of beta-lactamases when induced, which are secreted outside the bacteria?

A

S. aureus

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6
Q

Major antigenic determinant in penicillin hypersensitivity rxn

A

Benzylpenicilloyl

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7
Q

Serum Sickness is an example of a Type ____ HSN

A

III

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8
Q

Vasculitis is an example of a Type ____ HSN

A

III

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9
Q

Penicillins that are highly bound to plasma proteins

A

Nafcillin, Oxacillin, Dicloxacillin

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10
Q

Penicillins that are moderately bound to plasma proteins

A

Penicillin G, Penicillin V, Carbenicillin, Ticarcillin, Methacillin, Ampicillin, Amoxicillin

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11
Q

Structure of Penicillin includes

A

Thiazolidine ring, B-lactam ring, R goup

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12
Q

Highly Penicilin-resistant S. pneumo has

A

4/5 PBPs w decreased affinity

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13
Q

MRSA is caused by acquisition of

A

high MW PBP via a transposon

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14
Q

G(+) bacteria produce large amts of B-lactamase and secrete them

A

outside the bacterial cell

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15
Q

G(-) bacteria produce B-lactamase and secrete them

A

b/w the inner & outer membrane

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16
Q

Why are G(-) bacteria more resistant to Penicillin?

A

Outer membrane protects the peptidoglycan layer, secrete B-lactamases in the periplasma space protecting the transpeptidases

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17
Q

What is the only penicillin thats absorption is not effected by food

A

Amoxicillin

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18
Q

Which penicillin is 98% bound to plasma protein

A

Dicloxacillin

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19
Q

Which penicillin is secreted by biliary excretion?

A

Nafcillin

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20
Q

Which penicillin is secreted by biliary & kidney excretion?

A

Oxacillin & Dicloxacillin

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21
Q

How could one have penicillin Abs w/o ever taking penicillin?

A

exposure through breast milk or cows milk or other food products

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22
Q

Risk Factors for penicillin HSN rxns?

A

Adult > Children, Topical > IV > Oral, long-term use/high dose Tx

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23
Q

Type I HSN rxns involve

A

IgE production, binding of IgE to mast cells & basophils, antigen causes cross-linking of IgE Fc on mast cells (activation), release of histamine & vasoactive mediators -> vasodilation & vascular permeability & SM relaxation at periphery, SM constriction of bronchus/GI

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24
Q

IL-4

A

Drives Th0 -> Th2 immune response

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25
Q

Hyposensitizing Method to avoid Type I HSN

A

production of IgG blocking Abs that remove antigen before it binds IgE, switch from Th2 to Th1

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26
Q

Desensitization Method to avoid Type I HSN

A

Begin w/ small doses & increase over hours, this slowly induces mast cell degranulation to avoid a lethal rxn

27
Q

Contact dermatitis is an example of a Type ___ HSN rxn

A

IV

28
Q

interstitial nephritis is an example of a Type ___ HSN rxn

A

IV

29
Q

Drug fever is an example of a Type ___ HSN rxn

A

IV

30
Q

Type II HSN rxn involves

A

Immune complexes (Ag-IgG), IC deposition, C5a & C3a production -> vascular permeability, neutrophils attempt to phagocytize ICs & release inflammatory substances -> retarded BF, thrombi, rupture of vessel wall, hemorrhage, necrosis

31
Q

Hemolytic anemia is an example of a Type ___ HSN rxn

A

II

32
Q

Which penicillin is the most common cause of acute allergic interstitial nephritis & is no longer on the market?

A

Methicillin

33
Q

Skin testing can detect Type ____ HSN

A

Type I

34
Q

Pre-Pen

A

Skin testing; analogue of the major antigenic determinant (Benzylpenicilloyl)

35
Q

Which penicillins may cause non-allergic rashes?

A

Ampicillin & Amoxicillin

36
Q

Which penicillin’s absorption is least affected by food?

A

Amoxicillin

37
Q

Ampicillin & Amoxicillin have an extended spectrum of coverage that includes

A

HELPSS ME: H. influenzae, E. coli, Listeria, Proteus, Salmonella, Strep (pyogenes & pneumo), Moraxella, Enterococcus

38
Q

Why do Ampicillin & Amoxicillin have an extended spectrum of coverage

A

better penetration into the G(-) Outer Membrane

39
Q

Which penicillins cause decreased efficacy to oral contraceptive?

A

Ampicillin & Amoxicillin

40
Q

Broadest spectrum penicillin?

A

Imipenem

41
Q

AOM - most likely agents

A

strep pneumo, hib, moraxella catarrhalis

42
Q

Which bacteria may alter its porin channels or actively efflux penicillin?

A

P. aeruginosa

43
Q

if creatinine clearance is <10 mL/min give dose adjust penicillin by administering

A

1/4 to 1/3 of normal dose

44
Q

Which drugs would you need to adjust dosage for in liver failure pts?

A

Nafcillin & Oxacillin

45
Q

If pt has renal impairment & the dose is not adjusted, what outcomes may result?

A

Seizures (CNS toxicity)

46
Q

If pt requires Penicillin (as in Syphilis) how can we provide them Tx?

A

Desensitize (low dose, increase every 15-20m)

47
Q

During a desensitization protocol make sure to have wha on hand?

A

Epinephrine in case of a severe Type I Rxn

48
Q

AOM caused by S. pneumo may acquire resistance d/t

A

altered PBPs - low affinity

49
Q

AOM caused by HiNT may acquire resistance d/t

A

B-lactamase production

50
Q

AOM caused by M. catarrhalis may acquire resistance d/t

A

B-lactamase production

51
Q

How would you Tx AOM caused by S. pneumo w/ acquired resistance

A

Increase dose + B-lactamase inhibitor

52
Q

AOM Tx if pt is allergic to Penicillin?

A

2nd gen cephalosporin (Cefuroxime axetil, Cefprozil)

or 3rd Gen (Ceftriaxone)

53
Q

Which drug interferes w/ the secretion of penicillin?

A

Probenacid (Gout Tx)

54
Q

Bacterial meningitis in a young child is found to be Listeria, what penicillin could you use to Tx them?

A

Ampicillin

55
Q

Salmonella infections should be Tx w/

A

Fluoroquinolones - Ciprofloxacin

56
Q

Prophylaxis for surgery to prevent infection w/ S. aureus

A

Cefazolin

57
Q

B. fragilis coverage

A

Cefoxitin

58
Q

Empirical therapy for sepsis in immunocompetent or immunocompromised pt

A

3rd Gen Cephalosporin

59
Q

Only cephalosporin excreted in bile

A

Ceftriaxone

60
Q

Neurological complications d/t Lymes

A

Ceftriaxone

61
Q

Gonorrhea Tx

A

Ceftriaxone or Cefixime

62
Q

May cause bleeding disorders

A

Cefazolin

63
Q

EtOH Intolerance

A

Cefazolin

64
Q

cephalosporin w/ P. aeruginosa coverage

A

Cefepime, Ceftazidime

Pharm Exam 8 (5 decks)

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