NR566-ADVANCED PHARMACOLOGY FOR CARE OF THE FAMILY QUESTIONS WITH ANSWERS

NR566-ADVANCED PHARMACOLOGY FOR CARE OF THE
FAMILY QUESTIONS WITH ANSWERS



β-lactam antibiotic MOA - cx cx cx




ansAll antibiotics in class share the same mechanism of action: disruption of the bacterial c
cx cx cx cx cx cx cx cx cx cx cx cx cx cx cx




ell wall. cx




Inhibition of cell wall synthesis cx cx cx cx




Empiric Therapy - cx cx




ansstart treatment without cultures or prior to receiving the results of a culture
cx cx cx cx cx cx cx cx cx cx cx cx cx




immediate empiric antibiotics - cx cx cx




ansCritically ill patients receive (Fill in the Answer) after the first set of cultures obtained; do
cx cx cx cx cx cx cx cx cx cx cx cx cx cx cx cx cx




not wait for results. cx cx cx




Bactericidal antibiotics - ansDirectly kill bacteria: Agents include aminoglycosides, beta-
cx cx cx cx cx cx cx cx cx




lactams, fluoroquinolones, metronidazole, most antimycobacterial agents, streptogramins
cx cx cx cx cx cx




, and vancomycin.
cx cx




preferred for immunocompromised patients such as those with diabetes, HIV, or cancer an
cx cx cx cx cx cx cx cx cx cx cx cx




d for those who have overwhelming infections
cx cx cx cx cx cx




Bacteriostatic agents - cx cx




ansinhibit bacterial proliferation while the host's immune system does the killing. Agents in
cx cx cx cx cx cx cx cx cx cx cx cx cx




clude clindamycin, macrolides, sulfonamides, and tetracyclines
cx cx cx cx cx




β-lactam Antibiotics - ansPenicillins, Cephalosporins, Carbapenems, Monobactams
cx cx cx cx cx cx




Penicillins MOA - ansWeaken bacterial cell wall by two actions: cx cx cx cx cx cx cx cx cx cx




(1) inhibition of transpeptidases
cx cx cx




(2) disinhibition (activation) of autolysins.
cx cx cx cx




PBPs (Penicillin Binding Proteins) - cx cx cx cx




ansTranspeptidases, Autolysins, and other bacterial enzymes are collectively named as b
cx cx cx cx cx cx cx cx cx cx cx




ecause antibiotic class must bind to them to produce antibacterial effects.
cx cx cx cx cx cx cx cx cx cx




gram-positive bacteria - cx cx




anstwo layers: the cytoplasmic membrane and a relatively thick cell wall; penicillins are ge
cx cx cx cx cx cx cx cx cx cx cx cx cx cx




nerally very active against these organisms.
cx cx cx cx cx




gram-negative bacteria - cx cx




ansthree layers: the cytoplasmic membrane, a relatively thin cell wall, and an additional out
cx cx cx cx cx cx cx cx cx cx cx cx cx cx

,er membrane; only certain penicillins (e.g., ampicillin) are able to cross and reach penicillin
cx cx cx cx cx cx cx cx cx cx cx cx cx cx




binding proteins (PBPs) cx cx




Four Major Groups of Penicillins - ans(1) narrow-
cx cx cx cx cx cx cx




spectrum penicillins that are penicillinase sensitive
cx cx cx cx cx




(2) narrow-
cx




spectrum penicillins that are penicillinase resistant (antistaphylococcal penicillins)
cx cx cx cx cx cx cx




(3) broad-spectrum penicillins (aminopenicillins)
cx cx cx




(4) extended-spectrum penicillins (antipseudomonal penicillins).
cx cx cx cx




narrow-spectrum penicillins: Penicillinase sensitive penicillins - ansPenicillin G, Penicillin Vcx cx cx cx cx cx cx cx cx




narrow-spectrum penicillinase sensitive susceptible pathogens - cx cx cx cx cx




ansStreptococci, Neisseria, anaerobes
cx cx cx




very narrow antimicrobial spectrum and are used only against penicillinase-
cx cx cx cx cx cx cx cx cx




producing strains of staphylococci (S. aureus and S. epidermidis). - ansnarrow-
cx cx cx cx cx cx cx cx cx cx




spectrum penicillins: penicillinase resistant penicillins
cx cx cx cx




narrow-spectrum penicillins: penicillinase resistant penicillins - cx cx cx cx cx




ansNafcillin, Oxacillin, Dicloxacillin
cx cx cx




narrow-spectrum- penicillinase resistant susceptible pathogens - cx cx cx cx cx




ansS. Aureus, S. Epidermidis
cx cx cx cx




Drugs of choice for most staphylococcal infections - anspenicillinase-
cx cx cx cx cx cx cx cx




resistant penicillins (Nafcillin, Oxacillin, Dicloxacillin)
cx cx cx cx




Broad spectrum Penicillin: Aminopenicillins - ansAmpicillin, Amoxicillin
cx cx cx cx cx cx




Broad spectrum Aminopenicillin susceptible pathogens -
cx cx cx cx cx




ansHaemophilus influenzae, Escherichia coli, Proteus mirabilis, enterococci, Neisseria go
cx cx cx cx cx cx cx cx cx




norrhoeae

Extended spectrum penicillins (antipseudomonal penicillin) - ansPiperacillin
cx cx cx cx cx cx




Has the same antimicrobial spectrum as penicillin G, plus increased activity against certain
cx cx cx cx cx cx cx cx cx cx cx cx cx




gram-
negative bacilli, including Haemophilus influenzae, Escherichia coli, and Salmonella and S
cx cx cx cx cx cx cx cx cx cx




higella - ansBroad spectrum Penicillin: Aminopenicillins
cx cx cx cx cx




First line for acute otitis media and sinusitis - ansAmoxicillin
cx cx cx cx cx cx cx cx cx

,Extended spectrum penicillins suceptible pathogens -cx cx cx cx cx




ansHaemophilus influenzae, Escherichia coli, Proteus mirabilis, enterococci, Neisseria go
cx cx cx cx cx cx cx cx cx




norrhoeae, pseudomonas, enterobactor, klebsiella cx cx cx




Principle pathogenic target of Piperacillin - ansPseudomonas aeruginosa
cx cx cx cx cx cx cx




beta-lactamase inhibitors to broaden penicillin spectrum - cx cx cx cx cx cx




ansclavulanate, sulbactam, tazobactam
cx cx cx




Penicillin/Beta-Lactamase Combinations - ansAmpicillin/sulbactam (Unasyn) cx cx cx cx cx




Amoxicillin/clavulanate (Augmentin) cx




Piperacillin/tazobactam (Zosyn) cx




MRSA Drug of Choice - ansVancomycin
cx cx cx cx cx




Most Important AE of Penicillins - ansHypersensitivity Reaction
cx cx cx cx cx cx cx




Drug of choice when history of anaphylaxis or some other severe allergic reaction to penicill
cx cx cx cx cx cx cx cx cx cx cx cx cx cx




ins - ansAvoid cephalosporin;
cx cx cx cx




Vancomycin, erythromycin, and clindamycin are effective and safe alternatives for patients
cx cx cx cx cx cx cx cx cx cx cx




with penicillin allergy.
cx cx




Common drug used to treat bacterial infections in children. - ansPenicillins
cx cx cx cx cx cx cx cx cx cx




First line treatment for infection following animal or human bites - ansAmoxicillin/
cx cx cx cx cx cx cx cx cx cx cx




clavulanate (Augmentin) cx




Medication common for streptococcal pharyngitis - ansPenicillin
cx cx cx cx cx cx




Penicillin Risk in Pregnancy - cx cx cx cx




ansevidence suggests there is no second or third trimester fetal risk
cx cx cx cx cx cx cx cx cx cx cx




Penicillin Risk in Infants - cx cx cx cx




ansUsed safely in infants with bacterial infections, including syphilis, meningitis, and group
cx cx cx cx cx cx cx cx cx cx cx cx c




A streptococcus.
x cx




Amoxicillin - ansSafe use during breastfeeding cx cx cx cx cx




Penicillin Use in Older Adults - cx cx cx cx cx




ansDoses should be adjusted in older adults with renal dysfunction.
cx cx cx cx cx cx cx cx cx cx




Cephalosporins - ansβ-lactam antibiotics similar in structure and actions to the penicillins. cx cx cx cx cx cx cx cx cx cx cx cx




Are bactericidal, often resistant to β-
cx cx cx cx cx




lactamases, and active against a broad spectrum of pathogens. cx cx cx cx cx cx cx cx




Useful alternative with mild penicillin allergy
cx cx cx cx cx

, Cephalosporins MOA - ansBactericidal drug similar to penicillins that bind to penicillin- cx cx cx cx cx cx cx cx cx cx cx




binding proteins (PBPs): cx cx




(1) disrupt cell wall synthesis
cx cx cx cx cx




(2) activate autolysins (enzymes that cleave bonds in the cell wall). The resultant damage t
cx cx cx cx cx cx cx cx cx cx cx cx cx cx




o the cell wall causes death by lysis. Most effective against cells undergoing active growth a
cx cx cx cx cx cx cx cx cx cx cx cx cx cx cx




nd division. cx




Ceftriaxone (Rocephin) - ansCephalosporin eliminated largely by the liver. cx cx cx cx cx cx cx cx cx




Dosage reduction is not necessary in patients with renal impairment.
cx cx cx cx cx cx cx cx cx




Cephalosporin Administration - cx cx




anspoor absorption from the gastrointestinal (GI) tract, many drugs in this class must be ad
cx cx cx cx cx cx cx cx cx cx cx cx cx cx cx




ministered parenterally (by the intramuscular [IM] or intravenous [IV] route).
cx cx cx cx cx cx cx cx cx




Cephalosporin Elimination - cx cx




ansPractically all drugs in this class are eliminated by the kidneys; patients with renal insuff
cx cx cx cx cx cx cx cx cx cx cx cx cx cx cx




iciency, dosages of drugs must be reduced (to prevent accumulation to toxic levels).
cx cx cx cx cx cx cx cx cx cx cx cx




Cephalosporin Monitoring - ansCheck renal function if prolonged therapy cx cx cx cx cx cx cx cx




Cephalosporin Main Adverse Event - cx cx cx cx




ansHypersensitivity reactions are the most frequent adverse events.
cx cx cx cx cx cx cx cx




Cephalosporins — Cefazolin, Cefotetan - cx cx cx cx




anscan induce a state of alcohol intolerance (the disulfiram effect) if to ingest alcohol while t
cx cx cx cx cx cx cx cx cx cx cx cx cx cx cx cx




aking drugs cx




Cephalosporins - Cefotetan, Cefazolin, Ceftriaxone - cx cx cx cx cx




anscan promote bleeding as they contain a side chain that interferes with Vitamin K metab
cx cx cx cx cx cx cx cx cx cx cx cx cx cx cx




olism which can inhibit the formation of clotting factors; Caution if combines with other agen
cx cx cx cx cx cx cx cx cx cx cx cx cx cx




ts that promote bleeding
cx cx cx




First generation cephalosporins indication - ansNarrow Spectrum
cx cx cx cx cx cx




Gram+
Streptococci, Staphylococci, E.coli, K. Pneumoniae cx cx cx cx




Use in mild penicillin allergy
cx cx cx cx




strep pharyngitis, skin infections, surgical prophylaxis
cx cx cx cx cx




First generation cephalosporin examples - ansCephazolin; Cephelexin (Keflex)
cx cx cx cx cx cx cx




Second generation cephalosporins indication - ans-Gram +/-
cx cx cx cx cx cx




-H. influenzae, Klebsiella, pneumococci, staphylococci
cx cx cx cx




-Otitis, sinusitis, respiratory tract infection
cx cx cx cx




-More broad than first generation cx cx cx cx