NR566-Advanced Pharmacology for Care
of the Family
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
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|Page
,(1) inhibition of transpeptidases
(2) disinhibition (activation) of autolysins.
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 Penicillins -
(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 -
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). -
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, 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)
Broad spectrum Penicillin: Aminopenicillins -
Ampicillin, Amoxicillin
Broad spectrum Aminopenicillin susceptible pathogens -
Haemophilus influenzae, Escherichia coli, Proteus mirabilis, enterococci, Neisseria
gonorrhoeae
Extended spectrum penicillins (antipseudomonal penicillin) -
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 -
Broad spectrum Penicillin: Aminopenicillins
First line for acute otitis media and sinusitis -
Amoxicillin
Extended spectrum penicillins suceptible pathogens -
Haemophilus influenzae, Escherichia coli, Proteus mirabilis, enterococci, Neisseria
gonorrhoeae, pseudomonas, enterobactor, klebsiella
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, Principle pathogenic target of Piperacillin -
Pseudomonas aeruginosa
beta-lactamase inhibitors to broaden penicillin spectrum -
clavulanate, sulbactam, tazobactam
Penicillin/Beta-Lactamase Combinations -
Ampicillin/sulbactam (Unasyn)
Amoxicillin/clavulanate (Augmentin)
Piperacillin/tazobactam (Zosyn)
MRSA Drug of Choice -
Vancomycin
Most Important AE of Penicillins -
Hypersensitivity Reaction
Drug of choice when history of anaphylaxis or some other severe allergic reaction to penicillins -
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. -
Penicillins
First line treatment for infection following animal or human bites -
Amoxicillin/clavulanate (Augmentin)
Medication common for streptococcal pharyngitis -
Penicillin
4|Page
of the Family
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
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|Page
,(1) inhibition of transpeptidases
(2) disinhibition (activation) of autolysins.
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 Penicillins -
(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 -
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). -
2|Page
, 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)
Broad spectrum Penicillin: Aminopenicillins -
Ampicillin, Amoxicillin
Broad spectrum Aminopenicillin susceptible pathogens -
Haemophilus influenzae, Escherichia coli, Proteus mirabilis, enterococci, Neisseria
gonorrhoeae
Extended spectrum penicillins (antipseudomonal penicillin) -
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 -
Broad spectrum Penicillin: Aminopenicillins
First line for acute otitis media and sinusitis -
Amoxicillin
Extended spectrum penicillins suceptible pathogens -
Haemophilus influenzae, Escherichia coli, Proteus mirabilis, enterococci, Neisseria
gonorrhoeae, pseudomonas, enterobactor, klebsiella
3|Page
, Principle pathogenic target of Piperacillin -
Pseudomonas aeruginosa
beta-lactamase inhibitors to broaden penicillin spectrum -
clavulanate, sulbactam, tazobactam
Penicillin/Beta-Lactamase Combinations -
Ampicillin/sulbactam (Unasyn)
Amoxicillin/clavulanate (Augmentin)
Piperacillin/tazobactam (Zosyn)
MRSA Drug of Choice -
Vancomycin
Most Important AE of Penicillins -
Hypersensitivity Reaction
Drug of choice when history of anaphylaxis or some other severe allergic reaction to penicillins -
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. -
Penicillins
First line treatment for infection following animal or human bites -
Amoxicillin/clavulanate (Augmentin)
Medication common for streptococcal pharyngitis -
Penicillin
4|Page
