Term
| what are the 4 categories of B-lacctam drugs |
|
Definition
| penicillins, cephalosporins, carbapentems, monobactams |
|
|
Term
| what are the 4 types of penicillins, what is the penicillinase resistance status |
|
Definition
natural - susceptible
anti-staph - resistant
amino - susceptible
anti-pseudomonas - susceptible |
|
|
Term
| what kind of antibiotic is penicillin (2) |
|
Definition
B-lactam cell wall drug
bactericidal |
|
|
Term
| what are the 2 natural penicillins |
|
Definition
| penicillin G, penicillin V |
|
|
Term
| what are the 4 anti-staph penicillins |
|
Definition
| naficillin, methacillin, oxacillin, dicloacollin |
|
|
Term
| what are the 2 amino penicillins |
|
Definition
| amoxicilliin and ampicillin |
|
|
Term
| what are the 2 anti-pseudomonas penicillins |
|
Definition
|
|
Term
| what parts of the body does penicillin distribute to (3) |
|
Definition
| bones, CNS, placenta (not tertogenic) |
|
|
Term
| how are penicillins metabolized and excreted |
|
Definition
little metabolism
WA excreted in PCT of kidney (adjust for renal dysfunction) |
|
|
Term
| what are the three parts to the MOA of all penicillins |
|
Definition
inactivate PBP on cell memrane stopping cell wall synthsis, allowing autolysins to proceede, breaking cross links in peptidoglycan
stop trans-peptidase preventing cross linking
active against peptidoglycan wall |
|
|
Term
| what 4 ways can a microbe get resistance to a B-lactam |
|
Definition
has no cell wall
plasmid B-lactaminase transfer
porin mutation: drug can't get through LPS to PBP
modify PBP so drug cannot bind |
|
|
Term
| what 3 side effects to penicillins cause, what triggers them |
|
Definition
hypersensitivity: triggered by penicilloic acid. maculopapular rash, angioedema, anaphylaxis
GI reaction (especially ampicillin)
acute interstitial nephritis (rare) |
|
|
Term
| can someone have penicillin after an allergic reaction, how does this change other drug perscriptions |
|
Definition
if they had a mild reaction (rash) they don't get penicilliin anymore but can have other B-lactams
if they had a severe reaction (anaphylaxis) they can never have all B-lactam drugs |
|
|
Term
| what are the 2 MOA of B-lactaminase inhibitors |
|
Definition
irreversibly bind B-lactaminase and alter its structure
allows for antibiotics to kill, not killers |
|
|
Term
| do B-lactaminase inhibitors penetrate the CNS well |
|
Definition
|
|
Term
| what are B-lactaminase / penicillin combos, what is their method of administration (4) |
|
Definition
cavulanic A / amoxicillin - oral
cavulanic A / tricarcillin - IV or IM
taxobactam / piperacillin - IV or IM
sublactam / ampicillin - parentrail |
|
|
Term
| what are the five categories of cephalosporins, what is their penicillinase resistance status |
|
Definition
1st generation - none really
2nd generation - some
3rd generation - basically all resistant
4th generation - resistant
5th generation - resistant? |
|
|
Term
| what 2 drugs are 1st generation cephalosporins |
|
Definition
|
|
Term
| what 4 drugs are 2nd generation cephalosporins |
|
Definition
cefaclor
cegoxitin
cefuroxime
cefmandole |
|
|
Term
| what 4 drugs are 3rd generation cephalosporins |
|
Definition
ceftaxime
ceftazidime
ceftriaxone
cefoperazone |
|
|
Term
| what 1 drug is a 4th generation cephalosporin |
|
Definition
|
|
Term
| what 2 drug is a 5th generation cephalosporin |
|
Definition
|
|
Term
| what type of antibiotic is a cephalosporin (2) |
|
Definition
b-lactam cell wall drug
bactericidial |
|
|
Term
| how are cephalosporins administered, why |
|
Definition
| IV or IM because they are absorbed poorly |
|
|
Term
| what pharmological principals to cephalosporins have in common with penicillins |
|
Definition
| MOA, resistance issues, side effects, metabolism, clearance |
|
|
Term
| what happens when a patient overuses cephalosporins |
|
Definition
| enterococcal superinfections |
|
|
Term
| what three drugs are cerbapenems, what are their B-lactaminase resistances |
|
Definition
imipenem
neropenem
entrapenem
all resistant |
|
|
Term
| how are carbapenems administered |
|
Definition
|
|
Term
| what side effect do carbapenems do that isnt the same as penicillin |
|
Definition
| seizures (especially imipenem) |
|
|
Term
| what pharmological principals to carbapenems have in common with penicillins |
|
Definition
| MOA, resistance issues, side effects, metabolism, clearance |
|
|
Term
| what drugs are monobactams, what are their B-lactaminase resistance status |
|
Definition
|
|
Term
| what pharmological principals to monobactams have in common with penicillins |
|
Definition
| MOA, resistance issues, metabolism, clearance |
|
|
Term
| why are monobactams different from all the other B-lactams |
|
Definition
| they only have one ring (B-lactam), their allergies do not cross react with other B-lactam drugs |
|
|
Term
| what side effects do monobactams cause (2) |
|
Definition
|
|
Term
| how are monobactams administered |
|
Definition
|
|
Term
| what are the four non-B-lactam cell wall drugs, what type of antibiotic are they |
|
Definition
vancomycin- bactericidia
bacitracin
polymyxins
tricoplanin- bacteriacidial |
|
|
Term
|
Definition
| binds to D-ala-D-ala terminal stopping protein elongation inhibitng cell wall synthesis |
|
|
Term
| vancomycin resistance (3) |
|
Definition
VRSA, VREnterococcus
change binding site to D-ala-D-lactate |
|
|
Term
| how is vancomycin administered |
|
Definition
IV
oral for GI infection (not absorbed. C. diff) |
|
|
Term
|
Definition
| kidney, adjust for failre |
|
|
Term
| vancomycin side effects (4) |
|
Definition
| fever, chills, phlebitis, red man syndrome |
|
|
Term
| what is the cause of red man syndrome, what is the solution |
|
Definition
if IV infusion is too wuick, histamine flushes face via macrophages causing hypotension
infuse of 1h |
|
|
Term
| baitracin: administration, for what microbes, how to use |
|
Definition
topical
for gram positive bacteria
use with neomycin and polymyxins |
|
|
Term
| polymyxins: administration, for what microbes, how to use |
|
Definition
topical
for gram negativebacteria
use with neomycin and polymyxins |
|
|
Term
| trichoplanin: what drug is this like, what does it kill (2) |
|
Definition
| simillar to vancomycin, kills gram positive and MRSA |
|
|
Term
| what is penicillin G combined with (5) and why, when combined like this how is it administered, what is this combination good at treating |
|
Definition
depot forms: procaine or benzathine to increase duration and increase stability
Na or K to increase stability
given IV to treat syphillis |
|
|
Term
| what is the benifit of a penicillin V over G, how is it administered |
|
Definition
oral
more resistant to gastric A |
|
|
Term
| what is the most often used anti-staph drug, why, how is it administered |
|
Definition
| naficillin, it has lower nephrotoxicity, IV |
|
|
Term
| what penicillins are not excreted by the kidney |
|
Definition
| all 4 anti-staph penicillins, do not need to be adjusted in renal failure |
|
|
Term
| what penicllins are only oral (3) |
|
Definition
| penicillin V, amoxicillin, amoxicillin/clavuonic A |
|
|
Term
| what penicillins reach the meninges well |
|
Definition
|
|
Term
| how are aminopenicillins administered |
|
Definition
orally
IV/IM for ampicillin/B-lactaminase inhibitor |
|
|
Term
| what is the most absorbed penicillins, why is this good and bad |
|
Definition
amoxicillin
good because it gets into the body well
bad because it has no effect on gut infections unlike all the other penicillins |
|
|
Term
| what penicillins are only IV/IM (4) |
|
Definition
| antipseudomonals, ampicillin/sublactam, ticaricillin/clauvonic acid, piperacillin/tazobactam |
|
|
Term
| what penicillins are oral, IV, and IM (2) |
|
Definition
ampicillin
anti-staph penicillins |
|
|
Term
| what do aminopenicillins need to wrk |
|
Definition
|
|
Term
| which cephalosporins are not metabolized in the kidney, where is it excreted |
|
Definition
| ceftriaxone, excreted into bile. use for renal disease |
|
|
Term
| which cephalosporins are not IV/IM, they are oral (3) |
|
Definition
| cephalexin, cefaclor, cefuroxime |
|
|
Term
| which cephalosporins penetrate the CNS (6) |
|
Definition
cefuroxime - not as good
ceftaxime, ceftaxidime, fectriaxone, cefperazone
cefepime |
|
|
Term
| which cephalosporins are good for surgical prophylaxis |
|
Definition
|
|
Term
| which cephalospirins are good for skin, UTI, respiratory infections, otitis media |
|
Definition
|
|
Term
| which cephalosporins work for anaerobes |
|
Definition
|
|
Term
| what are the side effects of 2nd gen cephalosporins (2) |
|
Definition
cefmandole: disulfiram (acetylaldehyde accumulation) and anti vitamin K (bleeding)
the rest: same as penicillins |
|
|
Term
| which cephalosporins are used for biliary tract infections |
|
Definition
|
|
Term
| what are 5th generation cephalosporins used for (5) |
|
Definition
acute bacterial and skin structure infections (ABSSI)
community acquired bacterial pneumonia (CABP)
MRSA, enterococci, listeria |
|
|
Term
| what does imipenem have to be combined with to work, why |
|
Definition
| cilastatin (dihydropeptidase inhibitor) to protect from nephrotixic metabolites forming |
|
|
Term
| what is the broadest spectrum B-lactam of the amm |
|
Definition
|
|
Term
| what is used for surgery prophylaxis in a MRSA high area |
|
Definition
| non b-lactam cell wall drugs (vancomycin) |
|
|
Term
| what is used for endocarditis prophylaxis |
|
Definition
| non b-lactam cell wall drugs (vancomycin) |
|
|
Term
| what are anti-staph penicillins used for |
|
Definition
|
|
Term
| what are natural penicillins used for |
|
Definition
| gram positive cocci - strep, enterococcus (but use amino penicillin first), staph (but use anti-staph first), syphillis (pen G). AEROBIC |
|
|
Term
| what are amino penicillins used for |
|
Definition
| strep, enterococci, listeria (ampicillin). AEROBIC |
|
|
Term
| what are anti-pseudomonal penicillins used for |
|
Definition
| MUST be used for pseudomonas, can be used fo all gram negative that are AEROBIC |
|
|
Term
| which penicillins can be used as "broad spectrum" why. how do you determine which one do use |
|
Definition
enough gram negative coverage.
if it is an unknown gram negative use anti-pseudomonas. if it is known to not be pesudomonas than use amino penicillin |
|
|
Term
| explain the general trend of gram negative and positive coverage in penicillins |
|
Definition
| better gram positive - antistaph, natural, amino, antipseudomonas - better gram negative |
|
|
Term
| what is the best penicillin for strep |
|
Definition
|
|
Term
| what is another name for syphillis, what is the best drug for it |
|
Definition
| treponema, benzathine pen G |
|
|
Term
| what penicillin kills lysteria |
|
Definition
|
|
Term
| what are the general trands of the cephalosporins for their clinical actions |
|
Definition
become more broad from 1 to 4 because they increase in gram negative coverage
none kill listeria, enterococci, or MRSA (5th gen kills MRSA) |
|
|
Term
| what cephalosporins killa anaerobic |
|
Definition
| second generation kills bacteroides and clostridium (not diff) |
|
|
Term
| what do 1st gen cephalosporins kill(6) |
|
Definition
staph, strep, E. coli, klebsiella, proteus
best gram positive coverage of the cephalosporiins |
|
|
Term
| what do 2nd gen cephalosporins kill (4) |
|
Definition
| clostridium not diff, bacteroides, everything 1st gen killed, more gram negatitive than 1st gen |
|
|
Term
| what does 3rd and 4th gen cephalosporins kill (7) |
|
Definition
all CNS infections but listeria
more gran negative rods and cocci than 1st and 2nd gen without anaerobic (enteric, pseudomonas, gonorrhea)
3rd does meningitis biliary tract infections
everything 1st gen killed |
|
|
Term
| what drug combo is preferred for an unknown CNS infection |
|
Definition
| ampicillin (to cover listeria) + 3rd gen cephalosporin to cover everything else |
|
|
Term
| what is the back up drug for listeria |
|
Definition
|
|
Term
| carbapenem clinical use (6), what are they not good at (2) |
|
Definition
emperic therapy: b lactaminase resistant, gram positive or negative, klebsiella pneumonia, anaerobes, pseudomonas
not good at enterococci, MRSA |
|
|
Term
| monobactams clinical use (3), what are they not good at (2) |
|
Definition
aerobic gram negative rods including enterics and pseudomonas
not good at gram positive, anaerobes |
|
|
Term
| what is the clinical use of vancomycin (7) |
|
Definition
| MRSA!!, SERIOUS gram positive infections when allergic to b-lactam, C. diff!! that didnt respond to metronidazole, surgical prophylaxis in MRSA high area, gram positive, arobic, anaerobic |
|
|
