DL - Final 4

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DL - Final 4
2015-05-13 12:10:05
DL Final
DL - Final
DL - Final
Show Answers:

  1. What are the β-lactams?
    Penicillins, cephalosporins, carbapenems, monobactams
  2. Are B-lactams Bactericidal or Bacteriostatic?
  3. What do B-lactams lack activity against?
    Atypical organisms (no cell wall)
  4. How are B-lactams eliminated?
    • Renal elimination
    • Exceptions: nafcillin, oxacillin, ceftriaxone
  5. What are the dynamics of B-lactams?
    Time dependent bactericidal activity (time > MIC)
  6. What are the AE of β-lactams?
    • Allergic or hypersensitivity reactions (~3 to 10%) - Rash, drug fever, anaphylaxis (Ampicillin rash = not true allergic reaction)
    • Seizures (high doses, renal insufficiency)
    • N/V/D
    • Interstitial nephritis (rare)
  7. Natural penicillins Counseling pearls:
    • Finish entire prescription
    • Mild diarrhea is common
    • Take at intervals around-the-clock, preferably on an empty stomach
    • Refrigerate suspension after reconstitution, discard any unused portion after 14 days
    • Penicillin allergy
  8. β-lactam/β-lactamase inhibitor combinations are used for:
    • Mixed infections – aspiration pneumonia, diabetic ulcers
    • Bite wounds (cat, dog, human)
    • Otitis media, sinusitis
  9. Counseling pearls for β-lactam/β-lactamase inhibitors:
    • Take with food to decrease stomach upset
    • Diarrhea is common due to both clavulanate and amoxicillin – might be more severe
    • Refrigerate suspension after reconstitution, discard any unused portion after 10 days
  10. First-generation cephalosporins Spectrum of activity:
    • MSSA
    • Streptococci
    • (some) Gram negatives (H. influenzae, M. catarrhalis, E. coli)
  11. What are 1st generation cephalosporins used for?
    Skin and soft tissue infections
  12. What are Second-generation cephalosporins’ spectrum of activity?
    • (some) Enteric gram negative rods (E. coli, Klebsiella, Proteus)
    • Haemophilus influenzae
    • (some) Streptococci
  13. What are Second-generation cephalosporins used for?
    • Otitis media, sinusitis – used to be used for this when amoxicillin failed, but not used much for this anymore
    • Bronchitis
    • Pneumococcal pneumonia (NOT cefaclor)
  14. What is the spectrum of activity for Third-generation cephalosporins?
    • Basically G (-) only
    • Enteric gram negative rods (E. coli, Klebsiella, Proteus)
    • Haemophilus influenzae
    • Streptococcus pneumoniae
    • Neisseria gonorrhea (cefixime)
  15. 3rd generation cephalosporins are used for what?
    • Otitis media, sinusitis, bronchitis
    • Community-acquired pneumonia
    • Urinary tract infections
    • Gonorrhea (cefixime)
  16. What is the Spectrum for Macrolides?
    • Large range of coverage G -/+ atypicals
    • Haemophilus influenzae, Moraxella catarrhalis
    • Atypicals – Mycoplasma, Chlamydia, Chlamydophila, Legionella
    • Streptococcus pneumoniae
    • Bordetella pertussis
  17. What are the Common uses for Macrolides/
    • Community-acquired pneumonia
    • Bronchitis, pertussis
    • Chlamydia (azithromycin)
    • Mycobacterium avium treatment and prophylaxis
    • H. pylori eradication (clarithromycin)
  18. What are the AE for Macrolides?
    • Nausea, vomiting, diarrhea (Erythromycin > clarithromycin > azithromycin)
    • QTc prolongation – worry about when added to other prolongers – not really a problem as monotherapy (Erythromycin, clarithromycin > azithromycin)