Shared Flashcard Set

Details

MUSCULOSKELETAL DRUGS 3
BETA LACTAMS
94
Pharmacology
Professional
03/04/2012

Additional Pharmacology Flashcards

 


 

Cards

Term
What two components of the Beta Lactam chemical structure are required for action?
Definition
Thiazolidine Ring and Beta Lactam Ring with secondary amino group
Term
What reaction is inhibited by Beta Lactams?
Definition
Transpeptidation of cell wall synthesis
-formation of the PEP to PEP bond by cleavage of a D-alanine
Term
What do Beta Lactams bind to?
Definition
Penicillin Binding Protein, in the active site-
this is the enzyme that makes cell walls
Term
What is autolysin?
Definition
Helps degrade bacterial cell walls at the same time that new cell wall is being made-
Activity is enhanced by Beta Lactams
Term
What do Beta Lactams mimic?
Definition
The D-alanines on peptidoglycan, thus bunging up the formation of bacterial cell wall because PBP binds covalently to the drug
Term
Name the REGULAR penicillins:
Definition
Penicillin G, Benzathine Penicillin G
Term
Name the Extended Spectrum penicillins:
Definition
Amoxicillin, Ampicillin, Piperacillin, Ticarcillin
Term
Name the Antistaphylococcal Penicillins:
Definition
Oxacillin, Nafcillin, Methicillin
Term
What's the big deal about the antistaphylococcal penicillins?
Definition
They are resistant to Beta Lactamase
Term
What Beta Lactam's absorption is NOT impaired by food?
Definition
Amoxicillin
Term
What two antistaphylococcal penicillins are stable to penicillinase?
Definition
Oxacillin, methacillin
Term
What two extended spectrum penicillins are stable to penicillinase?
Definition
Amoxicillin+Clavulonic Acid
Ampicillin+Sulbactam
Term
What two antipseudomonal drugs are stable to penicillinase?
Definition
Ticarcillin+clavulonic acid
Piperacillin+tazobactam
Term
In what chemical state are Beta Lactams?
Definition
Weak acids- DOSAGE MODIFICATION FOR RENAL IMPAIRMENT
Term
When do penicillin drugs penetrate the CNS?
Definition
Only if meninges are inflamed
Term
How are Beta Lactamase resistant penicillins excreted?
Definition
Renal and biliary routes
Term
What drugs is given to keep blood levels appropriate when giving penicillin drugs in the hospital?
Definition
PROBENACID
Term
Which penicillin is always given IV?
Definition
Penicillin G is Given IV
Term
How do we cure syphillis?
Definition
A single treatment with penicillin is curative for primary and secondary syphilis- no resistance reported
Term
How do we prevent gonococcal opthalmia in newborns?
Definition
Silver nitrate drops in the eyes
Term
How do we treat penicillinase-producing strains of gonorrhea, and what is the backup?
Definition
Ceftriaxone, with spectinomycin as the backup
Term
What 5 groups of bugs are treated with Penicillin G?
Definition
Gm+ Cocci-S. Pneumo,S. Pyogenes,S. Virid

Gm+bacilli- anthrax, diptheria

Gm-cocci- neisseria gon and mening

Anaerobes- c. perfringens

Spirochetes- Syphilis, Yaws
Term
What happens to penetration of penicillin into the CNS as meningitis is treated?
Definition
Penetration goes down because meninges get less inflamed
Term
What do we use to treat Beta Hemolytic Strep Pharyngitis (strep throat) and Syphilis?
Definition
Benzathine Penicillin G
Term
What two penicillins are given IM to yield low but prolonged drug levels?
Definition
Benzathine Penicillin G
Procaine Penicillin G
Term
What do we give for MSSA?
Definition
Nafcillin and Oxacillin
Term
What do we give for MRSA?
Definition
Vanco
Term
What drugs do we use for mild to moderate localized staph infections?
Definition
OCD- Oxacillin, Cloxacillin, Dicloxacillin
Term
How do we treat serious systemic staph infections?
Definition
IV Nafcillin
Term
What do we give for penicillin resistant pneumococci?
Definition
Amoxicillin and Ampicillin
Term
What do we use to treat Listeria?
Definition
AMPICILLIN
Term
What is similar between amoxicillin and ampicillin and what is different?
Definition
Similar spectrum of action to Penicillin G (both)
Drugs of choice for resistant pneumo.
AMOXICILLIN HAS BETTER ORAL ABSORPTION
AMPICILLIN TO TREAT LISTERIA
Term
Ticarcillin and piperacillin are used to treat?
Definition
PSEUDOMONAS, UTIs
-gram (-) rods- Enterobacter, E. Coli, Proteus, H. Influenza, Pseudomonas
Term
What are the 3 Beta Lactamase inhibitors and what do they do?
Definition
Clavulanic Acid
Sulbactam
Tazobactam
-they inhibit many Beta Lactamases
-given in conjunction with other drugs
(have little or no intrinsic antibiotic properties)
Term
Amoxicillin is given in combination with what Beta Lactamase inhibitor?
Definition
Clavulonic Acid- together they make Augmentin
Term
Ampicillin is given in combination with what Beta Lactamase inhibitor?
Definition
Sulbactam- together they make Unasyn
Term
Piperacillin is given in combination with what Beta Lactamase inhibitor?
Definition
Tazobactam- together they make Zosyn
Term
Ticarcillin is given in combination with what Beta Lactamase inhibitor?
Definition
Clavulanic Acid- together they make Timentin
Term
If a 23 year old soccer player comes to you with a serious addiction to Diazepam, what do you do?
Definition
Blame Dr. Ngu
Term
What are the two most important adverse effects of penicillins?
What are some less common ones?
Definition
HYPERSENSITIVITY- ANAPHYLAXIS
SKIN RASH- Bazillions of red welts

less common: diarrhea, nephritis (especially underlying renal disease), neurotoxicity, cation toxicity, hematologic toxicity
Term
How are cephalosporins different from penicillins?
Definition
Broader spectrum of action
More stable to many Beta Lactamases
Term
What generation cephalosporin is Cefadroxil?
Definition
First
Term
What generation cephalosporin is Cefazolin?
Definition
First
Term
What generation cephalosporin is Cephalexin?
Definition
First
Term
What generation cephalosporin is Cephradine?
Definition
First
Term
What generation cephalosporin is Cefaclor?
Definition
Second
Term
What generation cephalosporin is Cefuroxime?
Definition
Second
Term
What generation cephalosporin is Cefoxitin?
Definition
Second, but is a cephamycin
Term
What generation cephalosporin is Cefotetan?
Definition
Second, but is a cephamycin
Term
What generation cephalosporin is Cefotaxime?
Definition
Third
Term
What generation cephalosporin is Ceftazidime?
Definition
Third
Term
What generation cephalosporin is Ceftriaxone?
Definition
Third
Term
What generation cephalosporin is Cefipime?
Definition
Fourth
Term
What are the cephamycins, and what's the big deal with them?
Definition
Cefoxitin, Cefotetan- similar activity to second generation cephalosporins, but enhanced activity against anaerobes
Term
What is the spectrum of action of the first generation cephalosporins?
Definition
Similar to penicillin- GRAM + COCCI EXCEPT MRSA
GRAM - Against PROTEUS, E COLI, KLEBSIELLA (P e.C K)
(rarely the drug of choice for anything) NO CNS PENETRATION
Term
What first generation cephalosporins do we give to treat UTI's, staph or strep infections, CELLULITIS, or SOFT TISSUE ABSCESSES?
Definition
Cefadroxil, cephalexin, cephradine
Term
What first generation cephalosporin penetrates most tissues well and is the drug of choice for SURGICAL PROPHYLAXIS?
Definition
CEFAZOLIN
Term
If we know the infection is not MRSA, we don't need to penetrate the CNS, and we want to give prophylactic treatment, what drug do we use?
(Hint: first gen cephalosporin)
Definition
Cefazolin
Term
What is the spectrum of action of second generation cephalosporins?
Definition
Same as first generation, plus extended coverage of gram negatives
NO CNS PENETRATION
Term
What do we use Cefuroxime to treat?
Definition
Sinusitis, otits, lower RTI
COMMUNITY ACQUIRED PNEUMONIA
(H. Influenzae, Moraxella, Klebsiella, Penicillin-Resistant Pneumo.)
Term
What do we give to treat MIXED ANAEROBIC INFECTIONS?
Definition
Cefoxitin and Cefotetan
-peritonitis or diverticulitis
Term
What is the spectrum of action of third generation cephalosporins?
Definition
Same as first and second generation, BUT:
More expanded Gram - coverage
Some can cross BBB (Cefotaxime, Ceftriaxone)
Activity against BETA-LACTAMASE-PRODUCING HAEMOPHILUS AND NEISSERIA
Term
What class of drugs is effective against Beta-lactamase producing strains of haemophilus and neisseria?
Definition
Third Generation Cephalosporins
THINK CEFTRIAXONE! IT'S THE BIGGIE
Term
What do we give to treat meningitis?
(3rd Gen)
Definition
Ceftriaxone and Cefotaxime are both approved
-Pneuomo, meningococci, H. Influenzae, susceptible enteric gram-
Term
What do we give for meningitis caused by highly resistant strains of pneumococci?
Definition
Ceftriaxone or Cefotaxime in combination with VANCOMYCIN
Term
Ceftriaxone and Cefotaxime are most active against what?
Definition
PENICILLIN-RESISTANT STRAINS OF PNEUMOCOCCI
Term
What is the drug of choice for empirical therapy of serious infections?
Definition
Ceftriaxone or Cefotaxime
Term
What do we give for empirical therapy of sepsis with unknown cause?
Definition
Third Generation Cephalosporin: CEFTRIAXONE or Cefotaxime
Term
In neutropenic, febrile, immunocompromised patients, 3rd generation cephalosporins are given in combination with what?
Definition
Aminoglycoside
Term
This FOURTH GENERATION cephalosporin is effective against (who cares, just know the name) P. aeruginosa, enterobacteriaceae, S. aureus, and S. pneumoniae:
Definition
CEFEPIME- FOURTH GENERATION
CEFEPIME- FOURTH GENERATION
CE-FOURTH-PIME
Get it?
Ok
Term
How are most cephalosporins excreted? What is the exception?
Definition
Most in the urine
Ceftriaxone is excreted in the bile
Term
Organisms that are not covered by cephalosporins are sooooo LAME:
(what does LAME stand for?)
Definition
Listeria
ATYPICALS- chlamydia, mycoplasma
MRSA
Enterococci
Term
If a patient has an anaphylactic response to a penicillin drug, can we give them cephalosporins?
Definition
Sure, if we want a law suit!
NO: Cephalosporins may induce hypersensitivity reactions identical to penicillins- if the patient is allergic to penicillin, cephalosporins are OFF THE TABLE
Term
What is the side effect risk with cefotetan?
What causes this?
Definition
Hypoprothrombinemia
Disulfiram-like reactions (mimics the effects of antibuse- NO ALCOHOL)

Caused by THIOL group
Term
What class of drug is Aztreonam, and what is its mechanism of action?
Definition
Aztreonam is a monobactam
It has the same MOA as penicillin
It is resistant to most Beta Lactamases
Term
What drug can be given to penicillin-allergic patients without reaction and has a similar spectrum of activity to 3rd generation cephalosporins?
Definition
Aztreonam
Term
What drug can we use to treat pneumonia, meningitis, and sepsis caused by Gram-negative pathogens that does NOT cause a reaction in penicillin-allergic patients?
Definition
Aztreonam
Term
What drug, which has a very huge spectrum of action, is only reserved for highly resistant bugs?
Definition
IMIPENEM (du du duhhhhhhh.....)
Term
What must imipenem always be given in combination with and why?
Definition
Cilastatin- to prevent inactivation by DEHYDROPEPTIDASE in renal tubules
Term
What are the adverse effects of imipenem?
Definition
Nause, vomiting, diarrhea
Rashes, reactions at infusion site
CAN CAUSE SEIZURES IN RENAL PATIENTS SO MUST MONITOR RENAL FUNCTION
Patients allergic to penicillins MAY be allergic to imipenem
Term
What is the mechanism of action of Vancomycin?
Definition
Binds to D-Ala-D-Ala terminus preventing peptidoglycan elongation and cross-linking
Term
How is resistance to Vanco established?
Definition
Those sneaky bugs convert their terminal D-Ala (the target of Vanco) to D-LACTATE
(brought to you by VRSA)
Term
What is the spectrum of action of Vanco?
Definition
Gram +
Anaerobes
(S. aureus, S. epi, Strep A, B, C, Strep Pneumo, Entero. Faecalis, Actinomyces, Listeria, Clostridium)
Term
What are the clinical uses of Vanco?
Definition
Sepsis or endocarditis of MRSA
Used in combo with ceftriaxone or cefotoxime for treatment of MENINGITIS caused by highly resistant PNEUMOCOCCUS
Term
How do we give Vanco for Enterocolitis?
Definition
Orally
Term
What is important about the administration and clearance of vancomycin?
Definition
USE A SLOW IV!!!!
-it is DIRECTLY proportional to Creatinine Clearance
-DOSAGE REDUCED IN RENAL PATIENTS
Term
Does Vanco cross the Blood Brain Barrier?
Definition
Only if the meninges are inflamed
Term
What are the adverse effects of Vanco?
Definition
RED MAN SYNDROME- if infusion rate too high
Ototoxicity and Nephrotoxicity when given with other drugs that have these side effects (like AMINOGLYCOSIDES)
Term
What is the mechanism of action of Bacitracin?
Definition
Inhibits cell wall synthesis by interfering with the LIPID CARRIER that transfers peptidoglycan subunits to the growing cell wall
Term
When is bacitracin used?
Definition
Against gram +
ONLY USE TOPICALLY- HIGHLY NEPHROTOXIC
Use for surface lesions, in wounds, or mucous membranes
Term
What modification occurs at the terminal end of the peptidoglycan pentapeptide to make RESISTANCE TO VANCO?
Definition
D-alanine becomes D-LACTATE
Term
What drug is inactivated by dehydropeptidase and must be given with cilastatin?
Definition
Imipenem
Term
A 25 year old pharmacy student comes down with gonorrhea. What do we give him?
Definition
Ceftriaxone
Term
If a kiddo has honey crusted lesions with pus that are gram+ cocci in both grape like clusters and chains, and the little dude has swollen lymph nodes too, what two diseases does he have and how do we treat?
Definition
Impetigo and strep- S. Pyogenes, and S. Aureus
PENICILLIN G and Cephalexin
Supporting users have an ad free experience!