Pharmacology Penicillins 3

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Pharmacology Penicillins 3
2014-01-22 09:57:11
Pharmacology Penicillins
Pharmacology Penicillins 3
Pharmacology Penicillins 3
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  1. Compared to lower generation Penicillins, how does the spectrum of antipseudomonal penicillins compare?
    Similar to Aminopenicillins, just slightly expanded in terms of G-. Compared to 1st/2nd generation penicillins, has greater G+ activity against streptococci and some enterococci and G- bacilli
  2. Are antipseudomonal penicillins effective against staph?
  3. Are antipseudomonal penicillins effective against MRSA?
  4. Are antipseudomonal penicillins active against obligate anaerobes?
  5. Is you are using an antipseudomonal penicillin for a Pseudomona infection what other drug should you give?
  6. If you are giving an antipseudomonal penicillin with aminoglycoside, what patient parameters do you need to watch out for?
    Sepsis/kidney's not working well
  7. What side effects do antipseudomonal penicillins have?
    Platelte function interferences and Na salt can cause Na overload
  8. Are antipseudomonal penicillins resistant to B-lactimases?
    Not really, very little
  9. What are the Beta-lactamase inhibitors?
    Sulbactam, clavulanic acid and tazobactam
  10. What is the MOA of Beta-lactamase inhibitors?
    Act as a decoy for penicillinases, as they all contain a B-lactam ring
  11. Will Beta-lactamases expand the spectrum of a penicillin?
    Only against penicillinase containing strains
  12. Will Beta-lactamases allow penicillins effectiveness against MRSA?
  13. Penicillinases will be inhibited by B-lactamase inhibitors in what general spectrum of bacteria?
  14. Are the Beta-lactamase inhibitors bound reversibly or irreversibly to the Penicillinases?
  15. Do Beta-lactamase inhibitors have activity without being given in conjunction with an antibiotic?
  16. Which Beta-lactamase inhibitors has some activity on its own and what is the activity?
    Sulbactam, some activity against acinobacter in the mouth
  17. What is Unasyn?
    Ampicillin and sulbactam
  18. What is Augmentin?
    Amoxacillin and Clavulanic acid
  19. What is Timentin?
    Ticacillin and Clavulanic acid
  20. What is Zosyn?
    Piperacillin and tazobactam
  21. Would you need a higher dose of sulbactam or clavulanic acid in combination with a penicillin for it to be an effective B-lactamse?
    Sulbactam (b/c less potent)
  22. Which B-lactamase penicillin combos are IV?
    Unasyn, Timentin and Zosyn
  23. Which B-lactamase penicillin combos are oral?
  24. Which B-lactamase penicillin combos can be used for a pseudomonas aureuginosa infection?
    Zosyn (piperacillin/tazobactam)
  25. Which B-lactamase penicillin combos would be useful in empiric therapy?
  26. If you found that a lower generation penicillin would work as well as the B-lactamase penicillin combo you chose, would you switch or keep the same regimen?
    Switch to lower generation drug
  27. What is the clinically useful antimicrobial spectrum for Natural penicillins?
    Streptococcus species, Neisseria species, many anaerobes, spirochetes, others
  28. What is the clinically useful antimicrobial spectrum for Penicillinase resistant penicillins?
    Staphylococcus aureus (Methicillin sensitive) MSSA
  29. What is the clinically useful antimicrobial spectrum for Aminopenicillins?
    Haemophilus influenza, Escherichia coli, Proteus mirabilis, enterococci, Neisseria gonorrhoeae (the latter is not really applicable anymore)
  30. What is the clinically useful antimicrobial spectrum for Penicillinase resistant penicillins?
    Same as aminopenicillins, plus Pseudomonas aeruginosa, Enterobacter species, Proteus (indole positive), Bacteroides fragilis, many Klebsiella
  31. What is another term for aminopenicillins?
    Broad spectrum penicillins
  32. What is another term for antipseudomonal penicillins?
    Extended spectrum penicillins
  33. What are the most common side effect of Penicillins?
    Allergic reaction (rash, fever, acute interstitial nephritis and anaphylaxis), GI disruptions (superinfections)
  34. What can you use as an alternative to Penicillin if a patient has an allergic reaction?
    Cephalosprins because they only have 5-10% cross-allergic reaction, also can take vancomycin and erythromycin
  35. Can you give aminoglycosides and penicillins in the same IV bag?
    No, b/c they chemically react in the bag
  36. Are penicillins safe to give with oral contraceptives?
    Light concern, but may
  37. Probenecid will have what effect on Penicillin?
    May increase penicillin levels
  38. Why is it not recommended to give Tetracyclines and Penicillins?
    Tetracyclines decrease penicillin effectiveness because tetracyclines are static and penicillin needs growing bacteria to work
  39. Can warfarin and penicillins be given together, why or why not?
    No, effects of warfarin may potentially increase by disturbance of platelet interactions
  40. What are the symptoms of penicillin overdose?
    Neuromuscular hypersensitivity (agitation, hallucinations, confusion and seizures)
  41. Is penicillin overdose common?
  42. Why does penicillin overdose occur?
    Due to parenteral delivery and compromised renal function
  43. How can you help to ensure penicillin overdose does not occur?
    Monitor kidney function
  44. What are the oral diseases treated with Penicillins?
    Fusospirochetes, many anaerobes and strep
  45. What is the choice penicillin for Lyme disease?
  46. What non-oral infections are commonly treated with penicillins?
    Strep, Meningococcal, Endocarditis (with aminoglycosides), anthrax, Actinomycosis, Lyme disease, gas gangrene, Rate bite fever and Listeria
  47. Beta lactams include what groups?
    Penicillins, cephalosporins and some newer drugs
  48. What bacteria do Cephalosporins not treat?
    Listeria, enterococci, MRSA, acinotobacter, listeria
  49. There is a second R group on cephalosporins adds what effect?
    Makes it more difficult for Beta-lactamases to bind to and cleave
  50. What is the name of a B-lactamase that cleaves a cephalosporin called?
  51. What is the MOA for cephalosporin?
    Inhibit cell wall synthesis
  52. Are Cephalosporins cidal or static?
  53. Are Cephalosporins considered broad or narrow spectrum?
  54. 1st and 2nd generation Cephalosporins treat what primarily?
    G+ and some G-
  55. How can Cephalosporins resistance occur?
    Through B-lactamase production, alteration in binding proteins and permeability barriers
  56. Pharmacokinetically, Cephalosporins are organic acids, how would you expect them to be excreted?
    Renally, though some are excreted in the bile
  57. Would you expect probenecid to interfere with cephalosporin excretion, why or why not?
    Yes, because it is excreted renally and is an organic acid
  58. How are most cephalosporins administered?
    Injection, though some are oral
  59. The 1st generation Cephalosporins are used for what?
    Surgical prophylaxis, MSSA, G+, some G-, protease mirabalis (UTIs, Kidney stones), E. coli, Klebsiella pneumonia
  60. What are the first generation Cephalosporins?
    Cefazolin, cephalexin and cefadroxil
  61. Which 1st generation Cephalosporins are oral?
    Cephazolina dn cefadroxil
  62. What is the major use of cephazolin?
    Surgical prophylaxis
  63. If you are giving 1st generation Cephalosporins for surgical prophylaxis, how many doses would you recommend?
    1 dose prior to surgery to mitigate risk of resistance
  64. How is Cefazolin given?
    IV or IM
  65. Which 1st gen Cephalosporin is less active against B-lactamase producing staphylococci?
  66. Which 1st gen Cephalosporin has a half-life of 1.8 hours?