NR566 questions and answers.docx

NR566-Advanced Pharmacology for Care of
the Family.

β-lactam antibiotic MOA - ANS >> All antibiotics in class share the same mechanism of action: disruption
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of the bacterial cell wall.
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Inhibition of cell wall synthesis
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Empiric Therapy - ANS >> start treatment without cultures or prior to receiving the results of a culture
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immediate empiric antibiotics - ANS >> Critically ill patients receive (Fill in the Answer) after the first set
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vof cultures obtained; do not wait for results.
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Bactericidal antibiotics - ANS >> Directly kill bacteria: Agents include aminoglycosides, beta-lactams,
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fluoroquinolones, metronidazole, most antimycobacterial agents, streptogramins, and vancomycin.
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preferred for immunocompromised patients such as those with diabetes, HIV, or cancer and for those
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who have overwhelming infections
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Bacteriostatic agents - ANS >> inhibit bacterial proliferation while the host's immune system does the
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killing. Agents include clindamycin, macrolides, sulfonamides, and tetracyclines
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β-lactam Antibiotics - ANS >> Penicillins, Cephalosporins, Carbapenems, Monobactams
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Penicillins MOA - ANS >> Weaken bacterial cell wall by two actions:
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(1) inhibition of transpeptidases
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(2) disinhibition (activation) of autolysins.
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PBPs (Penicillin Binding Proteins) - ANS >> Transpeptidases, Autolysins, and other bacterial enzymes are
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collectively named as because antibiotic class must bind to them to produce antibacterial effects.
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gram-positive bacteria - ANS >> two layers: the cytoplasmic membrane and a relatively thick cell wall;
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penicillins are generally very active against these organisms.
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,gram-negative bacteria - ANS >> three layers: the cytoplasmic membrane, a relatively thin cell wall, and
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an additional outer membrane; only certain penicillins (e.g., ampicillin) are able to cross and reach
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penicillin binding proteins (PBPs)
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Four Major Groups of Penicillins - ANS >> (1) narrow-spectrum penicillins that are penicillinase sensitive
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(2) narrow-spectrum penicillins that are penicillinase resistant (antistaphylococcal penicillins)
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(3) broad-spectrum penicillins (aminopenicillins)
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(4) extended-spectrum penicillins (antipseudomonal penicillins).
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narrow-spectrum penicillins: Penicillinase sensitive penicillins - ANS >> Penicillin G, Penicillin V
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narrow-spectrum penicillinase sensitive susceptible pathogens - ANS >> Streptococci, Neisseria,
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anaerobes
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very narrow antimicrobial spectrum and are used only against penicillinase-producing strains of
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staphylococci (S. aureus and S. epidermidis). - ANS >> narrow-spectrum penicillins: penicillinase
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resistant penicillins
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narrow-spectrum penicillins: penicillinase resistant penicillins - ANS >> Nafcillin, Oxacillin, Dicloxacillin
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narrow-spectrum- penicillinase resistant susceptible pathogens - ANS >> S. Aureus, S. Epidermidis
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Drugs of choice for most staphylococcal infections - ANS >> penicillinase-resistant penicillins (Nafcillin,
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Oxacillin, Dicloxacillin)
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Broad spectrum Penicillin: Aminopenicillins - ANS >> Ampicillin, Amoxicillin
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Broad spectrum Aminopenicillin susceptible pathogens - ANS >> Haemophilus influenzae, Escherichia
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coli, Proteus mirabilis, enterococci, Neisseria gonorrhoeae
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Extended spectrum penicillins (antipseudomonal penicillin) - ANS >> Piperacillin
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Has the same antimicrobial spectrum as penicillin G, plus increased activity against certain gram-
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negative bacilli, including Haemophilus influenzae, Escherichia coli, and Salmonella and Shigella - ANS
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>> Broad spectrum Penicillin: Aminopenicillins
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First line for acute otitis media and sinusitis - ANS >> Amoxicillin
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,Extended spectrum penicillins suceptible pathogens - ANS >> Haemophilus influenzae, Escherichia coli,
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Proteus mirabilis, enterococci, Neisseria gonorrhoeae, pseudomonas, enterobactor, klebsiella
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Principle pathogenic target of Piperacillin - ANS >> Pseudomonas aeruginosa
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beta-lactamase inhibitors to broaden penicillin spectrum - ANS >> clavulanate, sulbactam, tazobactam
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Penicillin/Beta-Lactamase Combinations - ANS >> Ampicillin/sulbactam (Unasyn) v v v v v v v




Amoxicillin/clavulanate (Augmentin) v




Piperacillin/tazobactam (Zosyn) v




MRSA Drug of Choice - ANS >> Vancomycin
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Most Important AE of Penicillins - ANS >> Hypersensitivity Reaction
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Drug of choice when history of anaphylaxis or some other severe allergic reaction to penicillins - ANS >>
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Avoid cephalosporin;
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Vancomycin, erythromycin, and clindamycin are effective and safe alternatives for patients with
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penicillin allergy.
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Common drug used to treat bacterial infections in children. - ANS >> Penicillins
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First line treatment for infection following animal or human bites - ANS >> Amoxicillin/clavulanate
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(Augmentin)
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Medication common for streptococcal pharyngitis - ANS >> Penicillin
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Penicillin Risk in Pregnancy - ANS >> evidence suggests there is no second or third trimester fetal risk
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Penicillin Risk in Infants - ANS >> Used safely in infants with bacterial infections, including syphilis,
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meningitis, and group A streptococcus.
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Amoxicillin - ANS >> Safe use during breastfeeding
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Penicillin Use in Older Adults - ANS >> Doses should be adjusted in older adults with renal dysfunction.
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Cephalosporins - ANS >> β-lactam antibiotics similar in structure and actions to the penicillins.
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Are bactericidal, often resistant to β-lactamases, and active against a broad spectrum of pathogens.
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Useful alternative with mild penicillin allergy
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Cephalosporins MOA - ANS >> Bactericidal drug similar to penicillins that bind to penicillin-binding
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proteins (PBPs):
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(1) disrupt cell wall synthesis
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, (2) activate autolysins (enzymes that cleave bonds in the cell wall). The resultant damage to the cell
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vwall causes death by lysis. Most effective against cells undergoing active growth and division.
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Ceftriaxone (Rocephin) - ANS >> Cephalosporin eliminated largely by the liver.
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Dosage reduction is not necessary in patients with renal impairment.
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Cephalosporin Administration - ANS >> poor absorption from the gastrointestinal (GI) tract, many drugs
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in this class must be administered parenterally (by the intramuscular [IM] or intravenous [IV] route).
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Cephalosporin Elimination - ANS >> Practically all drugs in this class are eliminated by the kidneys;
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patients with renal insufficiency, dosages of drugs must be reduced (to prevent accumulation to toxic
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levels).
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Cephalosporin Monitoring - ANS >> Check renal function if prolonged therapy
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Cephalosporin Main Adverse Event - ANS >> Hypersensitivity reactions are the most frequent adverse
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events.
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Cephalosporins — Cefazolin, Cefotetan - ANS >> can induce a state of alcohol intolerance (the
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disulfiram effect) if to ingest alcohol while taking drugs
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Cephalosporins - Cefotetan, Cefazolin, Ceftriaxone - ANS >> can promote bleeding as they contain a side
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chain that interferes with Vitamin K metabolism which can inhibit the formation of clotting factors;
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Caution if combines with other agents that promote bleeding
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First generation cephalosporins indication - ANS >> Narrow Spectrum
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Gram+

Streptococci, Staphylococci, E.coli, K. Pneumoniae v v v v




Use in mild penicillin allergy
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strep pharyngitis, skin infections, surgical prophylaxis
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First generation cephalosporin examples - ANS >> Cephazolin; Cephelexin (Keflex)
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Second generation cephalosporins indication - ANS >> -Gram +/-
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-H. influenzae, Klebsiella, pneumococci, staphylococci
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-Otitis, sinusitis, respiratory tract infection
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-More broad than first generation
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Second generation cephalosporins examples - ANS >> ceFAclor, CeFOXitin, CeFURoxime (FAkeFOXFUR)
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Third generation cephalosporin indication - ANS >> -Serious Gram (-) bacteria
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