BIO290 Exam 2 Pharmacology Study Guide | Modules 2 & 3 Complete Review with Drug Mechanisms,
Adverse Effects, Contraindications & Key Concepts | Joyce University | 2026/2027 Update.
MODULE 2 – ANTI-INFECTIVES
1. Penicillin
Class: Natural penicillin; beta-lactam antibiotic
Mechanism of action: Penicillin binds to penicillin-binding proteins and interferes with
bacterial cell-wall synthesis. The weakened bacterial wall eventually ruptures.
Action: Bactericidal.
Major indications: Susceptible streptococcal infections, some pneumococcal infections,
syphilis, and other susceptible bacterial infections.
Major adverse effects: Nausea, diarrhea, rash, hypersensitivity reactions, and potentially severe
anaphylaxis. Broad antibiotic exposure can also alter normal flora and contribute to
superinfection.
Contraindication/caution: A history of a serious immediate hypersensitivity reaction to
penicillin requires particular caution with related beta-lactam antibiotics.
Patient teaching: Complete the prescribed course even when symptoms improve. Report rash,
wheezing, facial swelling, severe diarrhea, or other signs of a serious reaction.
Exam point: Penicillin is a cell-wall inhibitor and bactericidal antibiotic.
2. Amoxicillin
Class: Aminopenicillin; beta-lactam
Mechanism: Inhibits bacterial cell-wall synthesis.
Action: Bactericidal.
Indications: Otitis media, sinusitis, respiratory infections, certain urinary infections, dental
infections, and as part of some H. pylori treatment regimens.
Adverse effects: Diarrhea, nausea, rash, allergic reaction, and possible superinfection.
,Important interaction: A rash may occur in patients with infectious mononucleosis receiving
amoxicillin; this does not necessarily represent classic IgE-mediated penicillin allergy.
Teaching: Finish the medication course and report signs of anaphylaxis or severe persistent
diarrhea.
3. Cephalexin
Class: First-generation cephalosporin
Mechanism: Inhibits bacterial cell-wall synthesis.
Action: Bactericidal.
Indications: Skin and soft-tissue infections, uncomplicated urinary infections, and some
respiratory infections caused by susceptible organisms.
Adverse effects: GI upset, diarrhea, rash, hypersensitivity, and possible C. difficile-associated
diarrhea.
Penicillin allergy consideration: Cross-reactivity between penicillins and cephalosporins is
substantially lower than historically believed, but patients with a documented severe immediate
beta-lactam reaction require careful assessment.
Exam point: Cephalexin is a cephalosporin, not a penicillin, but both are beta-lactams.
4. Meropenem
Class: Carbapenem beta-lactam antibiotic
Mechanism: Inhibits bacterial cell-wall synthesis.
Action: Bactericidal.
Indications: Serious or complicated infections caused by susceptible organisms, including
certain intra-abdominal infections, meningitis, and infections caused by resistant gram-negative
organisms.
Adverse effects: Nausea, diarrhea, headache, rash, and seizures in susceptible patients,
especially with significant renal impairment or CNS disease.
,Special consideration: Dose adjustment may be needed with impaired renal function.
Exam point: Carbapenems have a very broad antibacterial spectrum and are generally
reserved for significant infections.
5. Aztreonam
Class: Monobactam
Mechanism: Inhibits bacterial cell-wall synthesis.
Action: Bactericidal.
Coverage: Primarily aerobic gram-negative bacteria.
Indications: Serious gram-negative infections, particularly when some other beta-lactams cannot
be used.
Adverse effects: GI upset, rash, injection-site reactions, and elevated liver enzymes.
High-yield point: Aztreonam has very low cross-reactivity with most penicillin allergies. A
special structural consideration exists with ceftazidime, which shares a similar side chain.
6. Vancomycin
Class: Glycopeptide antibiotic
Mechanism: Inhibits bacterial cell-wall synthesis through a mechanism different from beta-
lactams.
Indications: Serious gram-positive infections, particularly MRSA. Oral vancomycin can be used
for certain C. difficile infections because oral drug remains primarily in the GI tract.
Major adverse effects: Nephrotoxicity, infusion-related flushing and hypotension, and less
commonly ototoxicity.
Infusion reaction: Rapid IV infusion can produce flushing, erythema, pruritus, and hypotension.
Slowing the infusion is important.
, Monitoring: Renal function and drug exposure require monitoring. Modern management of
serious MRSA infection generally favors AUC-guided monitoring rather than relying on a
trough value alone, although older nursing exam material often emphasizes trough
measurements.
Exam point: Vancomycin is strongly associated with renal monitoring and serum drug-level
monitoring.
7. Fosfomycin
Class: Urinary anti-infective
Mechanism: Inhibits an early step in bacterial cell-wall synthesis.
Indication: Commonly used as a single-dose oral treatment for certain uncomplicated lower
urinary tract infections.
Adverse effects: Diarrhea, nausea, headache, and vaginitis.
Exam point: Think uncomplicated cystitis.
8. Tetracycline
Class: Tetracycline antibiotic
Mechanism: Binds the 30S bacterial ribosomal subunit and prevents protein synthesis.
Action: Usually bacteriostatic.
Indications: Several atypical organisms, acne-related infections, rickettsial infections, and other
susceptible organisms.
Adverse effects: GI irritation, photosensitivity, esophagitis, and tooth/bone effects.
Major interaction: Calcium, magnesium, aluminum, iron, and some dairy products can bind
tetracyclines and reduce absorption.
Teaching: Do not take at the same time as antacids or mineral supplements unless instructed.
Use sun protection.
Adverse Effects, Contraindications & Key Concepts | Joyce University | 2026/2027 Update.
MODULE 2 – ANTI-INFECTIVES
1. Penicillin
Class: Natural penicillin; beta-lactam antibiotic
Mechanism of action: Penicillin binds to penicillin-binding proteins and interferes with
bacterial cell-wall synthesis. The weakened bacterial wall eventually ruptures.
Action: Bactericidal.
Major indications: Susceptible streptococcal infections, some pneumococcal infections,
syphilis, and other susceptible bacterial infections.
Major adverse effects: Nausea, diarrhea, rash, hypersensitivity reactions, and potentially severe
anaphylaxis. Broad antibiotic exposure can also alter normal flora and contribute to
superinfection.
Contraindication/caution: A history of a serious immediate hypersensitivity reaction to
penicillin requires particular caution with related beta-lactam antibiotics.
Patient teaching: Complete the prescribed course even when symptoms improve. Report rash,
wheezing, facial swelling, severe diarrhea, or other signs of a serious reaction.
Exam point: Penicillin is a cell-wall inhibitor and bactericidal antibiotic.
2. Amoxicillin
Class: Aminopenicillin; beta-lactam
Mechanism: Inhibits bacterial cell-wall synthesis.
Action: Bactericidal.
Indications: Otitis media, sinusitis, respiratory infections, certain urinary infections, dental
infections, and as part of some H. pylori treatment regimens.
Adverse effects: Diarrhea, nausea, rash, allergic reaction, and possible superinfection.
,Important interaction: A rash may occur in patients with infectious mononucleosis receiving
amoxicillin; this does not necessarily represent classic IgE-mediated penicillin allergy.
Teaching: Finish the medication course and report signs of anaphylaxis or severe persistent
diarrhea.
3. Cephalexin
Class: First-generation cephalosporin
Mechanism: Inhibits bacterial cell-wall synthesis.
Action: Bactericidal.
Indications: Skin and soft-tissue infections, uncomplicated urinary infections, and some
respiratory infections caused by susceptible organisms.
Adverse effects: GI upset, diarrhea, rash, hypersensitivity, and possible C. difficile-associated
diarrhea.
Penicillin allergy consideration: Cross-reactivity between penicillins and cephalosporins is
substantially lower than historically believed, but patients with a documented severe immediate
beta-lactam reaction require careful assessment.
Exam point: Cephalexin is a cephalosporin, not a penicillin, but both are beta-lactams.
4. Meropenem
Class: Carbapenem beta-lactam antibiotic
Mechanism: Inhibits bacterial cell-wall synthesis.
Action: Bactericidal.
Indications: Serious or complicated infections caused by susceptible organisms, including
certain intra-abdominal infections, meningitis, and infections caused by resistant gram-negative
organisms.
Adverse effects: Nausea, diarrhea, headache, rash, and seizures in susceptible patients,
especially with significant renal impairment or CNS disease.
,Special consideration: Dose adjustment may be needed with impaired renal function.
Exam point: Carbapenems have a very broad antibacterial spectrum and are generally
reserved for significant infections.
5. Aztreonam
Class: Monobactam
Mechanism: Inhibits bacterial cell-wall synthesis.
Action: Bactericidal.
Coverage: Primarily aerobic gram-negative bacteria.
Indications: Serious gram-negative infections, particularly when some other beta-lactams cannot
be used.
Adverse effects: GI upset, rash, injection-site reactions, and elevated liver enzymes.
High-yield point: Aztreonam has very low cross-reactivity with most penicillin allergies. A
special structural consideration exists with ceftazidime, which shares a similar side chain.
6. Vancomycin
Class: Glycopeptide antibiotic
Mechanism: Inhibits bacterial cell-wall synthesis through a mechanism different from beta-
lactams.
Indications: Serious gram-positive infections, particularly MRSA. Oral vancomycin can be used
for certain C. difficile infections because oral drug remains primarily in the GI tract.
Major adverse effects: Nephrotoxicity, infusion-related flushing and hypotension, and less
commonly ototoxicity.
Infusion reaction: Rapid IV infusion can produce flushing, erythema, pruritus, and hypotension.
Slowing the infusion is important.
, Monitoring: Renal function and drug exposure require monitoring. Modern management of
serious MRSA infection generally favors AUC-guided monitoring rather than relying on a
trough value alone, although older nursing exam material often emphasizes trough
measurements.
Exam point: Vancomycin is strongly associated with renal monitoring and serum drug-level
monitoring.
7. Fosfomycin
Class: Urinary anti-infective
Mechanism: Inhibits an early step in bacterial cell-wall synthesis.
Indication: Commonly used as a single-dose oral treatment for certain uncomplicated lower
urinary tract infections.
Adverse effects: Diarrhea, nausea, headache, and vaginitis.
Exam point: Think uncomplicated cystitis.
8. Tetracycline
Class: Tetracycline antibiotic
Mechanism: Binds the 30S bacterial ribosomal subunit and prevents protein synthesis.
Action: Usually bacteriostatic.
Indications: Several atypical organisms, acne-related infections, rickettsial infections, and other
susceptible organisms.
Adverse effects: GI irritation, photosensitivity, esophagitis, and tooth/bone effects.
Major interaction: Calcium, magnesium, aluminum, iron, and some dairy products can bind
tetracyclines and reduce absorption.
Teaching: Do not take at the same time as antacids or mineral supplements unless instructed.
Use sun protection.
