NR566-Advanced Pharmacology for
Care of the Family
β-lactam antibiotic MOA - Answer-All antibiotics in class share the same mechanism of action: disruption
of the bacterial cell wall.
Inhibition of cell wall synthesis
Empiric Therapy - Answer-start treatment without cultures or prior to receiving the results of a culture
immediate empiric antibiotics - Answer-Critically ill patients receive (Fill in the Answer) after the first set
of cultures obtained; do not wait for results.
Bactericidal antibiotics - Answer-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 - Answer-inhibit bacterial proliferation while the host's immune system does the
killing. Agents include clindamycin, macrolides, sulfonamides, and tetracyclines
β-lactam Antibiotics - Answer-Penicillins, Cephalosporins, Carbapenems, Monobactams
Penicillins MOA - Answer-Weaken bacterial cell wall by two actions:
,(1) inhibition of transpeptidases
(2) disinhibition (activation) of autolysins.
PBPs (Penicillin Binding Proteins) - Answer-Transpeptidases, Autolysins, and other bacterial enzymes are
collectively named as because antibiotic class must bind to them to produce antibacterial effects.
gram-positive bacteria - Answer-two layers: the cytoplasmic membrane and a relatively thick cell wall;
penicillins are generally very active against these organisms.
gram-negative bacteria - Answer-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 - Answer-(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 - Answer-Penicillin G, Penicillin V
narrow-spectrum penicillinase sensitive susceptible pathogens - Answer-Streptococci, Neisseria,
anaerobes
,very narrow antimicrobial spectrum and are used only against penicillinase-producing strains of
staphylococci (S. aureus and S. epidermidis). - Answer-narrow-spectrum penicillins: penicillinase
resistant penicillins
narrow-spectrum penicillins: penicillinase resistant penicillins - Answer-Nafcillin, Oxacillin, Dicloxacillin
narrow-spectrum- penicillinase resistant susceptible pathogens - Answer-S. Aureus, S. Epidermidis
Drugs of choice for most staphylococcal infections - Answer-penicillinase-resistant penicillins (Nafcillin,
Oxacillin, Dicloxacillin)
Broad spectrum Penicillin: Aminopenicillins - Answer-Ampicillin, Amoxicillin
Broad spectrum Aminopenicillin susceptible pathogens - Answer-Haemophilus influenzae, Escherichia
coli, Proteus mirabilis, enterococci, Neisseria gonorrhoeae
Extended spectrum penicillins (antipseudomonal penicillin) - Answer-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 -
Answer-Broad spectrum Penicillin: Aminopenicillins
First line for acute otitis media and sinusitis - Answer-Amoxicillin
Extended spectrum penicillins suceptible pathogens - Answer-Haemophilus influenzae, Escherichia coli,
Proteus mirabilis, enterococci, Neisseria gonorrhoeae, pseudomonas, enterobactor, klebsiella
Principle pathogenic target of Piperacillin - Answer-Pseudomonas aeruginosa
, beta-lactamase inhibitors to broaden penicillin spectrum - Answer-clavulanate, sulbactam, tazobactam
Penicillin/Beta-Lactamase Combinations - Answer-Ampicillin/sulbactam (Unasyn)
Amoxicillin/clavulanate (Augmentin)
Piperacillin/tazobactam (Zosyn)
MRSA Drug of Choice - Answer-Vancomycin
Most Important AE of Penicillins - Answer-Hypersensitivity Reaction
Drug of choice when history of anaphylaxis or some other severe allergic reaction to penicillins - Answer-
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. - Answer-Penicillins
First line treatment for infection following animal or human bites - Answer-Amoxicillin/clavulanate
(Augmentin)
Medication common for streptococcal pharyngitis - Answer-Penicillin
Penicillin Risk in Pregnancy - Answer-evidence suggests there is no second or third trimester fetal risk
Penicillin Risk in Infants - Answer-Used safely in infants with bacterial infections, including syphilis,
meningitis, and group A streptococcus.
Care of the Family
β-lactam antibiotic MOA - Answer-All antibiotics in class share the same mechanism of action: disruption
of the bacterial cell wall.
Inhibition of cell wall synthesis
Empiric Therapy - Answer-start treatment without cultures or prior to receiving the results of a culture
immediate empiric antibiotics - Answer-Critically ill patients receive (Fill in the Answer) after the first set
of cultures obtained; do not wait for results.
Bactericidal antibiotics - Answer-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 - Answer-inhibit bacterial proliferation while the host's immune system does the
killing. Agents include clindamycin, macrolides, sulfonamides, and tetracyclines
β-lactam Antibiotics - Answer-Penicillins, Cephalosporins, Carbapenems, Monobactams
Penicillins MOA - Answer-Weaken bacterial cell wall by two actions:
,(1) inhibition of transpeptidases
(2) disinhibition (activation) of autolysins.
PBPs (Penicillin Binding Proteins) - Answer-Transpeptidases, Autolysins, and other bacterial enzymes are
collectively named as because antibiotic class must bind to them to produce antibacterial effects.
gram-positive bacteria - Answer-two layers: the cytoplasmic membrane and a relatively thick cell wall;
penicillins are generally very active against these organisms.
gram-negative bacteria - Answer-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 - Answer-(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 - Answer-Penicillin G, Penicillin V
narrow-spectrum penicillinase sensitive susceptible pathogens - Answer-Streptococci, Neisseria,
anaerobes
,very narrow antimicrobial spectrum and are used only against penicillinase-producing strains of
staphylococci (S. aureus and S. epidermidis). - Answer-narrow-spectrum penicillins: penicillinase
resistant penicillins
narrow-spectrum penicillins: penicillinase resistant penicillins - Answer-Nafcillin, Oxacillin, Dicloxacillin
narrow-spectrum- penicillinase resistant susceptible pathogens - Answer-S. Aureus, S. Epidermidis
Drugs of choice for most staphylococcal infections - Answer-penicillinase-resistant penicillins (Nafcillin,
Oxacillin, Dicloxacillin)
Broad spectrum Penicillin: Aminopenicillins - Answer-Ampicillin, Amoxicillin
Broad spectrum Aminopenicillin susceptible pathogens - Answer-Haemophilus influenzae, Escherichia
coli, Proteus mirabilis, enterococci, Neisseria gonorrhoeae
Extended spectrum penicillins (antipseudomonal penicillin) - Answer-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 -
Answer-Broad spectrum Penicillin: Aminopenicillins
First line for acute otitis media and sinusitis - Answer-Amoxicillin
Extended spectrum penicillins suceptible pathogens - Answer-Haemophilus influenzae, Escherichia coli,
Proteus mirabilis, enterococci, Neisseria gonorrhoeae, pseudomonas, enterobactor, klebsiella
Principle pathogenic target of Piperacillin - Answer-Pseudomonas aeruginosa
, beta-lactamase inhibitors to broaden penicillin spectrum - Answer-clavulanate, sulbactam, tazobactam
Penicillin/Beta-Lactamase Combinations - Answer-Ampicillin/sulbactam (Unasyn)
Amoxicillin/clavulanate (Augmentin)
Piperacillin/tazobactam (Zosyn)
MRSA Drug of Choice - Answer-Vancomycin
Most Important AE of Penicillins - Answer-Hypersensitivity Reaction
Drug of choice when history of anaphylaxis or some other severe allergic reaction to penicillins - Answer-
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. - Answer-Penicillins
First line treatment for infection following animal or human bites - Answer-Amoxicillin/clavulanate
(Augmentin)
Medication common for streptococcal pharyngitis - Answer-Penicillin
Penicillin Risk in Pregnancy - Answer-evidence suggests there is no second or third trimester fetal risk
Penicillin Risk in Infants - Answer-Used safely in infants with bacterial infections, including syphilis,
meningitis, and group A streptococcus.
