Nr562 pharmacology 2024-2025
NR565 -Advanced Pharmacology (Care of the
Family)
Review| Questions and Verified Answers 2024-2025
Β-lactam antibiotic MOA - ✔✔✔All antibiotics in class share the same mechanism of action: disruption of
the bacterial cell wall.
Inhibition of cell wall synthesis
Empiric Therapy - ✔✔✔start treatment without cultures or prior to receiving the results of a culture
Medication common for streptococcal pharyngitis - ✔✔✔Penicillin
Penicillin Risk in Pregnancy - ✔✔✔evidence suggests there is no second or third trimester fetal risk
Penicillin Risk in Infants - ✔✔✔Used safely in infants with bacterial infections, including syphilis,
meningitis, and group A streptococcus.
Amoxicillin - ✔✔✔Safe use during breastfeeding
Penicillin Use in Older Adults - ✔✔✔Doses should be adjusted in older adults with renal dysfunction.
Cephalosporins - ✔✔✔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 - ✔✔✔Bactericidal drug similar to penicillins that bind to penicillin-binding proteins
(PBPs):
(1) Disrupt cell wall synthesis
@pg. 1
, Nr562 pharmacology 2024-2025
(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) - ✔✔✔Cephalosporin eliminated largely by the liver.
Dosage reduction is not necessary in patients with renal impairment.
Cephalosporin Administration - ✔✔✔poor absorption from the gastrointestinal (GI) tract, many drugs in this
class must be administered parentally (by the intramuscular [IM] or intravenous [IV] route).
Cephalosporin Elimination - ✔✔✔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 - ✔✔✔Check renal function if prolonged therapy
Cephalosporin Main Adverse Event - ✔✔✔Hypersensitivity reactions are the most frequent adverse events.
Cephalosporins — Cefazolin, Cefotetan - ✔✔✔can induce a state of alcohol intolerance (the disulfiram
effect) if to ingest alcohol while taking drugs
Cephalosporins - Cefotetan, Cefazolin, Ceftriaxone - ✔✔✔can promote bleeding as they contain a side chain
that interferes with Vitamin K metabolism which can inhibit the formation of clotting factors; Caution if
combines with other agents that promote bleeding
First generation cephalosporins indication - ✔✔✔Narrow Spectrum
Gram+
Streptococci, Staphylococci, E.coli, K. Pneumoniae
Use in mild penicillin allergy
strep pharyngitis, skin infections, surgical prophylaxis
First generation cephalosporin examples - ✔✔✔Cephazolin; Cephelexin (Keflex)
Second generation cephalosporins indication - ✔✔✔-Gram +/-
@pg. 2
, Nr562 pharmacology 2024-2025
-H. influenzae, Klebsiella, pneumococci, staphylococci
-Otitis, sinusitis, respiratory tract infection
-More broad than first generation
Second generation cephalosporins examples - ✔✔✔ceFAclor, CeFOXitin, CeFURoxime (FAkeFOXFUR)
Third generation cephalosporin indication - ✔✔✔-Serious Gram (-) bacteria
-Pseudomonas aeruginosa, Neisseria gonorrhoeae, and Klebsiella, Serratia Meningitis
-More broad than first and second generations
-meningitis, gram (-) nosocomial infections. Limit use
Third generation cephalosporin examples - ✔✔✔ceftriaxone (Rocephin), cefotaxime, ceftazadime
Immediate empiric antibiotics - ✔✔✔Critically ill patients receive (Fill in the Answer) after the first set of
cultures obtained; do not wait for results.
Bactericidal antibiotics - ✔✔✔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 - ✔✔✔inhibit bacterial proliferation while the host's immune system does the killing.
Agents include clindamycin, macrolides, sulfonamides, and tetracyclines
Β-lactam Antibiotics - ✔✔✔Penicillins, Cephalosporins, Carbapenems, Monobactams
Penicillins MOA - ✔✔✔Weaken bacterial cell wall by two actions:
(1) Inhibition of transpeptidases
(2) Disinhibition (activation) of autolysins.
@pg. 3
, Nr562 pharmacology 2024-2025
PBPs (Penicillin Binding Proteins) - ✔✔✔Transpeptidases, Autolysins, and other bacterial enzymes are
collectively named as because antibiotic class must bind to them to produce antibacterial effects.
Gram-positive bacteria - ✔✔✔two layers: the cytoplasmic membrane and a relatively thick cell wall;
penicillins are generally very active against these organisms.
Gram-negative bacteria - ✔✔✔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 Penicillin - ✔✔✔(1) narrow-spectrum penicillin that are penicillin’s 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 - ✔✔✔Penicillin G, Penicillin V
Narrow-spectrum penicillinase sensitive susceptible pathogens - ✔✔✔Streptococci, Neisseria, anaerobes
Very narrow antimicrobial spectrum and are used only against penicillinase-producing strains of
staphylococci (S. aureus and S. epidermidis). - ✔✔✔narrow-spectrum penicillins: penicillinase resistant
penicillins
Narrow-spectrum penicillins: penicillinase resistant penicillins - ✔✔✔Nafcillin, Oxacillin, Dicloxacillin
Narrow-spectrum- penicillinase resistant susceptible pathogens - ✔✔✔S. Aureus, S. Epidermidis
Drugs of choice for most staphylococcal infections - ✔✔✔penicillinase-resistant penicillins (Nafcillin,
Oxacillin, Dicloxacillin)
@pg. 4
NR565 -Advanced Pharmacology (Care of the
Family)
Review| Questions and Verified Answers 2024-2025
Β-lactam antibiotic MOA - ✔✔✔All antibiotics in class share the same mechanism of action: disruption of
the bacterial cell wall.
Inhibition of cell wall synthesis
Empiric Therapy - ✔✔✔start treatment without cultures or prior to receiving the results of a culture
Medication common for streptococcal pharyngitis - ✔✔✔Penicillin
Penicillin Risk in Pregnancy - ✔✔✔evidence suggests there is no second or third trimester fetal risk
Penicillin Risk in Infants - ✔✔✔Used safely in infants with bacterial infections, including syphilis,
meningitis, and group A streptococcus.
Amoxicillin - ✔✔✔Safe use during breastfeeding
Penicillin Use in Older Adults - ✔✔✔Doses should be adjusted in older adults with renal dysfunction.
Cephalosporins - ✔✔✔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 - ✔✔✔Bactericidal drug similar to penicillins that bind to penicillin-binding proteins
(PBPs):
(1) Disrupt cell wall synthesis
@pg. 1
, Nr562 pharmacology 2024-2025
(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) - ✔✔✔Cephalosporin eliminated largely by the liver.
Dosage reduction is not necessary in patients with renal impairment.
Cephalosporin Administration - ✔✔✔poor absorption from the gastrointestinal (GI) tract, many drugs in this
class must be administered parentally (by the intramuscular [IM] or intravenous [IV] route).
Cephalosporin Elimination - ✔✔✔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 - ✔✔✔Check renal function if prolonged therapy
Cephalosporin Main Adverse Event - ✔✔✔Hypersensitivity reactions are the most frequent adverse events.
Cephalosporins — Cefazolin, Cefotetan - ✔✔✔can induce a state of alcohol intolerance (the disulfiram
effect) if to ingest alcohol while taking drugs
Cephalosporins - Cefotetan, Cefazolin, Ceftriaxone - ✔✔✔can promote bleeding as they contain a side chain
that interferes with Vitamin K metabolism which can inhibit the formation of clotting factors; Caution if
combines with other agents that promote bleeding
First generation cephalosporins indication - ✔✔✔Narrow Spectrum
Gram+
Streptococci, Staphylococci, E.coli, K. Pneumoniae
Use in mild penicillin allergy
strep pharyngitis, skin infections, surgical prophylaxis
First generation cephalosporin examples - ✔✔✔Cephazolin; Cephelexin (Keflex)
Second generation cephalosporins indication - ✔✔✔-Gram +/-
@pg. 2
, Nr562 pharmacology 2024-2025
-H. influenzae, Klebsiella, pneumococci, staphylococci
-Otitis, sinusitis, respiratory tract infection
-More broad than first generation
Second generation cephalosporins examples - ✔✔✔ceFAclor, CeFOXitin, CeFURoxime (FAkeFOXFUR)
Third generation cephalosporin indication - ✔✔✔-Serious Gram (-) bacteria
-Pseudomonas aeruginosa, Neisseria gonorrhoeae, and Klebsiella, Serratia Meningitis
-More broad than first and second generations
-meningitis, gram (-) nosocomial infections. Limit use
Third generation cephalosporin examples - ✔✔✔ceftriaxone (Rocephin), cefotaxime, ceftazadime
Immediate empiric antibiotics - ✔✔✔Critically ill patients receive (Fill in the Answer) after the first set of
cultures obtained; do not wait for results.
Bactericidal antibiotics - ✔✔✔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 - ✔✔✔inhibit bacterial proliferation while the host's immune system does the killing.
Agents include clindamycin, macrolides, sulfonamides, and tetracyclines
Β-lactam Antibiotics - ✔✔✔Penicillins, Cephalosporins, Carbapenems, Monobactams
Penicillins MOA - ✔✔✔Weaken bacterial cell wall by two actions:
(1) Inhibition of transpeptidases
(2) Disinhibition (activation) of autolysins.
@pg. 3
, Nr562 pharmacology 2024-2025
PBPs (Penicillin Binding Proteins) - ✔✔✔Transpeptidases, Autolysins, and other bacterial enzymes are
collectively named as because antibiotic class must bind to them to produce antibacterial effects.
Gram-positive bacteria - ✔✔✔two layers: the cytoplasmic membrane and a relatively thick cell wall;
penicillins are generally very active against these organisms.
Gram-negative bacteria - ✔✔✔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 Penicillin - ✔✔✔(1) narrow-spectrum penicillin that are penicillin’s 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 - ✔✔✔Penicillin G, Penicillin V
Narrow-spectrum penicillinase sensitive susceptible pathogens - ✔✔✔Streptococci, Neisseria, anaerobes
Very narrow antimicrobial spectrum and are used only against penicillinase-producing strains of
staphylococci (S. aureus and S. epidermidis). - ✔✔✔narrow-spectrum penicillins: penicillinase resistant
penicillins
Narrow-spectrum penicillins: penicillinase resistant penicillins - ✔✔✔Nafcillin, Oxacillin, Dicloxacillin
Narrow-spectrum- penicillinase resistant susceptible pathogens - ✔✔✔S. Aureus, S. Epidermidis
Drugs of choice for most staphylococcal infections - ✔✔✔penicillinase-resistant penicillins (Nafcillin,
Oxacillin, Dicloxacillin)
@pg. 4
