NR 566 Advanced Pharmacology For Care Of The Family |
Questions And Answers | Latest Updates
β-lactam antibiotic MOA ANS All antibiotics in class share the same mechanism of action: disruption of
the bacterial cell wall.
Inhibition of cell wall synthesis
Empiric Therapy ANS start treatment without cultures or prior to receiving the results of a culture
immediate empiric antibiotics ANS Critically ill patients receive (Fill in the Answer) after the first set of
cultures obtained; do not wait for results.
Bactericidal antibiotics ANS Directly kill bacteria: Agents include aminoglycosides, beta-lactams,
fluoroquinolones, metronidazole, most antimycobacterial agents, streptogramins, and vancomycin.
preferred for immunocompromised patients such as those with diabetes, HIV, or cancer and for those who
have overwhelming infections
Bacteriostatic agents ANS inhibit bacterial proliferation while the host's immune system does the killing.
Agents include clindamycin, macrolides, sulfonamides, and tetracyclines
β-lactam Antibiotics ANS Penicillins, Cephalosporins, Carbapenems, Monobactams
Penicillins MOA ANS Weaken bacterial cell wall by two actions:
(1) inhibition of transpeptidases
(2) disinhibition (activation) of autolysins.
PBPs (Penicillin Binding Proteins) ANS Transpeptidases, Autolysins, and other bacterial enzymes are
collectively named as because antibiotic class must bind to them to produce antibacterial effects.
gram-positive bacteria ANS two layers: the cytoplasmic membrane and a relatively thick cell wall;
penicillins are generally very active against these organisms.
,gram-negative bacteria ANS three layers: the cytoplasmic membrane, a relatively thin cell wall, and an
additional outer membrane; only certain penicillins (e.g., ampicillin) are able to cross and reach penicillin
binding proteins (PBPs)
Four Major Groups of Penicillins ANS (1) narrow-spectrum penicillins that are penicillinase sensitive
(2) narrow-spectrum penicillins that are penicillinase resistant (antistaphylococcal penicillins)
(3) broad-spectrum penicillins (aminopenicillins)
(4) extended-spectrum penicillins (antipseudomonal penicillins).
narrow-spectrum penicillins: Penicillinase sensitive penicillins ANS Penicillin G, Penicillin V
narrow-spectrum penicillinase sensitive susceptible pathogens ANS Streptococci, Neisseria, anaerobes
very narrow antimicrobial spectrum and are used only against penicillinase-producing strains of staphylococci
(S. aureus and S. epidermidis). ANS narrow-spectrum penicillins: penicillinase resistant penicillins
narrow-spectrum penicillins: penicillinase resistant penicillins ANS Nafcillin, Oxacillin, Dicloxacillin
narrow-spectrum- penicillinase resistant susceptible pathogens ANS S. Aureus, S. Epidermidis
Drugs of choice for most staphylococcal infections ANS penicillinase-resistant penicillins (Nafcillin,
Oxacillin, Dicloxacillin)
Broad spectrum Penicillin: Aminopenicillins ANS Ampicillin, Amoxicillin
Broad spectrum Aminopenicillin susceptible pathogens ANS Haemophilus influenzae, Escherichia coli,
Proteus mirabilis, enterococci, Neisseria gonorrhoeae
,Extended spectrum penicillins (antipseudomonal penicillin) ANS Piperacillin
Has the same antimicrobial spectrum as penicillin G, plus increased activity against certain gram-negative
bacilli, including Haemophilus influenzae, Escherichia coli, and Salmonella and Shigella ANS Broad
spectrum Penicillin: Aminopenicillins
First line for acute otitis media and sinusitis ANS Amoxicillin
Extended spectrum penicillins suceptible pathogens ANS Haemophilus influenzae, Escherichia coli,
Proteus mirabilis, enterococci, Neisseria gonorrhoeae, pseudomonas, enterobactor, klebsiella
Principle pathogenic target of Piperacillin ANS Pseudomonas aeruginosa
beta-lactamase inhibitors to broaden penicillin spectrum ANS clavulanate, sulbactam, tazobactam
Penicillin/Beta-Lactamase Combinations ANS Ampicillin/sulbactam (Unasyn)
Amoxicillin/clavulanate (Augmentin)
Piperacillin/tazobactam (Zosyn)
MRSA Drug of Choice ANS Vancomycin
Most Important AE of Penicillins ANS Hypersensitivity Reaction
Drug of choice when history of anaphylaxis or some other severe allergic reaction to penicillins ANS
Avoid cephalosporin;
Vancomycin, erythromycin, and clindamycin are effective and safe alternatives for patients with penicillin
allergy.
Common drug used to treat bacterial infections in children. ANS Penicillins
First line treatment for infection following animal or human bites ANS Amoxicillin/clavulanate
(Augmentin)
, Medication common for streptococcal pharyngitis ANS Penicillin
Penicillin Risk in Pregnancy ANS evidence suggests there is no second or third trimester fetal risk
Penicillin Risk in Infants ANS Used safely in infants with bacterial infections, including syphilis,
meningitis, and group A streptococcus.
Amoxicillin ANS Safe use during breastfeeding
Penicillin Use in Older Adults ANS Doses should be adjusted in older adults with renal dysfunction.
Cephalosporins ANS β-lactam antibiotics similar in structure and actions to the penicillins.
Are bactericidal, often resistant to β-lactamases, and active against a broad spectrum of pathogens.
Useful alternative with mild penicillin allergy
Cephalosporins MOA ANS Bactericidal drug similar to penicillins that bind to penicillin-binding proteins
(PBPs):
(1) disrupt cell wall synthesis
(2) activate autolysins (enzymes that cleave bonds in the cell wall). The resultant damage to the cell wall
causes death by lysis. Most effective against cells undergoing active growth and division.
Ceftriaxone (Rocephin) ANS Cephalosporin eliminated largely by the liver.
Dosage reduction is not necessary in patients with renal impairment.
Cephalosporin Administration ANS poor absorption from the gastrointestinal (GI) tract, many drugs in this
class must be administered parenterally (by the intramuscular [IM] or intravenous [IV] route).
Cephalosporin Elimination ANS Practically all drugs in this class are eliminated by the kidneys; patients
with renal insufficiency, dosages of drugs must be reduced (to prevent accumulation to toxic levels).
Cephalosporin Monitoring ANS Check renal function if prolonged therapy
Questions And Answers | Latest Updates
β-lactam antibiotic MOA ANS All antibiotics in class share the same mechanism of action: disruption of
the bacterial cell wall.
Inhibition of cell wall synthesis
Empiric Therapy ANS start treatment without cultures or prior to receiving the results of a culture
immediate empiric antibiotics ANS Critically ill patients receive (Fill in the Answer) after the first set of
cultures obtained; do not wait for results.
Bactericidal antibiotics ANS Directly kill bacteria: Agents include aminoglycosides, beta-lactams,
fluoroquinolones, metronidazole, most antimycobacterial agents, streptogramins, and vancomycin.
preferred for immunocompromised patients such as those with diabetes, HIV, or cancer and for those who
have overwhelming infections
Bacteriostatic agents ANS inhibit bacterial proliferation while the host's immune system does the killing.
Agents include clindamycin, macrolides, sulfonamides, and tetracyclines
β-lactam Antibiotics ANS Penicillins, Cephalosporins, Carbapenems, Monobactams
Penicillins MOA ANS Weaken bacterial cell wall by two actions:
(1) inhibition of transpeptidases
(2) disinhibition (activation) of autolysins.
PBPs (Penicillin Binding Proteins) ANS Transpeptidases, Autolysins, and other bacterial enzymes are
collectively named as because antibiotic class must bind to them to produce antibacterial effects.
gram-positive bacteria ANS two layers: the cytoplasmic membrane and a relatively thick cell wall;
penicillins are generally very active against these organisms.
,gram-negative bacteria ANS three layers: the cytoplasmic membrane, a relatively thin cell wall, and an
additional outer membrane; only certain penicillins (e.g., ampicillin) are able to cross and reach penicillin
binding proteins (PBPs)
Four Major Groups of Penicillins ANS (1) narrow-spectrum penicillins that are penicillinase sensitive
(2) narrow-spectrum penicillins that are penicillinase resistant (antistaphylococcal penicillins)
(3) broad-spectrum penicillins (aminopenicillins)
(4) extended-spectrum penicillins (antipseudomonal penicillins).
narrow-spectrum penicillins: Penicillinase sensitive penicillins ANS Penicillin G, Penicillin V
narrow-spectrum penicillinase sensitive susceptible pathogens ANS Streptococci, Neisseria, anaerobes
very narrow antimicrobial spectrum and are used only against penicillinase-producing strains of staphylococci
(S. aureus and S. epidermidis). ANS narrow-spectrum penicillins: penicillinase resistant penicillins
narrow-spectrum penicillins: penicillinase resistant penicillins ANS Nafcillin, Oxacillin, Dicloxacillin
narrow-spectrum- penicillinase resistant susceptible pathogens ANS S. Aureus, S. Epidermidis
Drugs of choice for most staphylococcal infections ANS penicillinase-resistant penicillins (Nafcillin,
Oxacillin, Dicloxacillin)
Broad spectrum Penicillin: Aminopenicillins ANS Ampicillin, Amoxicillin
Broad spectrum Aminopenicillin susceptible pathogens ANS Haemophilus influenzae, Escherichia coli,
Proteus mirabilis, enterococci, Neisseria gonorrhoeae
,Extended spectrum penicillins (antipseudomonal penicillin) ANS Piperacillin
Has the same antimicrobial spectrum as penicillin G, plus increased activity against certain gram-negative
bacilli, including Haemophilus influenzae, Escherichia coli, and Salmonella and Shigella ANS Broad
spectrum Penicillin: Aminopenicillins
First line for acute otitis media and sinusitis ANS Amoxicillin
Extended spectrum penicillins suceptible pathogens ANS Haemophilus influenzae, Escherichia coli,
Proteus mirabilis, enterococci, Neisseria gonorrhoeae, pseudomonas, enterobactor, klebsiella
Principle pathogenic target of Piperacillin ANS Pseudomonas aeruginosa
beta-lactamase inhibitors to broaden penicillin spectrum ANS clavulanate, sulbactam, tazobactam
Penicillin/Beta-Lactamase Combinations ANS Ampicillin/sulbactam (Unasyn)
Amoxicillin/clavulanate (Augmentin)
Piperacillin/tazobactam (Zosyn)
MRSA Drug of Choice ANS Vancomycin
Most Important AE of Penicillins ANS Hypersensitivity Reaction
Drug of choice when history of anaphylaxis or some other severe allergic reaction to penicillins ANS
Avoid cephalosporin;
Vancomycin, erythromycin, and clindamycin are effective and safe alternatives for patients with penicillin
allergy.
Common drug used to treat bacterial infections in children. ANS Penicillins
First line treatment for infection following animal or human bites ANS Amoxicillin/clavulanate
(Augmentin)
, Medication common for streptococcal pharyngitis ANS Penicillin
Penicillin Risk in Pregnancy ANS evidence suggests there is no second or third trimester fetal risk
Penicillin Risk in Infants ANS Used safely in infants with bacterial infections, including syphilis,
meningitis, and group A streptococcus.
Amoxicillin ANS Safe use during breastfeeding
Penicillin Use in Older Adults ANS Doses should be adjusted in older adults with renal dysfunction.
Cephalosporins ANS β-lactam antibiotics similar in structure and actions to the penicillins.
Are bactericidal, often resistant to β-lactamases, and active against a broad spectrum of pathogens.
Useful alternative with mild penicillin allergy
Cephalosporins MOA ANS Bactericidal drug similar to penicillins that bind to penicillin-binding proteins
(PBPs):
(1) disrupt cell wall synthesis
(2) activate autolysins (enzymes that cleave bonds in the cell wall). The resultant damage to the cell wall
causes death by lysis. Most effective against cells undergoing active growth and division.
Ceftriaxone (Rocephin) ANS Cephalosporin eliminated largely by the liver.
Dosage reduction is not necessary in patients with renal impairment.
Cephalosporin Administration ANS poor absorption from the gastrointestinal (GI) tract, many drugs in this
class must be administered parenterally (by the intramuscular [IM] or intravenous [IV] route).
Cephalosporin Elimination ANS Practically all drugs in this class are eliminated by the kidneys; patients
with renal insufficiency, dosages of drugs must be reduced (to prevent accumulation to toxic levels).
Cephalosporin Monitoring ANS Check renal function if prolonged therapy
