PCNs

Question 1

What is the MOA of all penicillins?

Answer 1

Prevent transpeptidation (cross linking) of peptidoglycan layers of the cell wall by binding to penicillin binding proteins

Question 2

What are the natural penicillins?

Answer 2

Penicillin V, and Penicillin G

Question 3

What is the route for Penicillin V and Penicillin G?

Answer 3

Penicillin V: PO

Penicillin G: IV and PO

Question 4

What non-beta-lactamase producing gram positive bacteria are natural penicillins effective against?

Answer 4

Streptococci

Question 5

What anaerobes are natural penicillins effective against?

Answer 5

1. Actinomyces
2. Prevotella
3. Peptostreptococci
4. Clostridium (not dificile)

Question 6

What gram negative bacteria are natural penicillins effective against?

Answer 6

1. Neisseria

Question 7

What treponema pallidium are natural penicillins effective against?

Answer 7

1. Syphilis

Question 8

What are the common clinical uses for natural penicillins?

Answer 8

1. Strep infections
A. Pharyngitis
B. Cellulitis
C. Endocarditis
2. Syphilis

Question 9

What are the SE of natural penicillins?

Answer 9

1. Hypersensitivity

2. Seizures at high doses

Question 10

What are the antistaphylococcal PCNs?

Answer 10

1. Oxacillin
2. Nafcillin
3. Dicloxicillin

Question 11

What are the routes for Oxacillin, Nafcillin, and Dicloxicillin?

Answer 11

1. Oxacillin: IV
2. Nafcillin: IV
3. Dicloxicillin: PO

Question 12

What agents are the antistaphylococcal PCNs effective against?

Answer 12

1. MSSA

2. Streptococci

Question 13

What are the clinical uses for Oxacillin, Nafcillin, and Dicloxicillin?

Answer 13

1. MSSA infections: superior to vanco for MSSA infections

Question 14

What are the SE of Oxacillin, Nafcillin, and Dicloxicillin?

Answer 14

1. Oxacillin: hepatotoxicity, neutropenia

2. Nafcillin: hepatotoxicity, neutropenia, thrombophlebitis

Question 15

What are the aminopenicillins?

Answer 15

1. Ampicillin

2. Amoxicillin

Question 16

What are the routes for ampicillin and Amoxicillin?

Answer 16

1. Ampicillin: IV

2. Amoxicillin: PO

Question 17

What gram positive agents are ampicillin and Amoxicillin effective against?

Answer 17

1. Streptococci
2. Enterococci
3. Listeria

Question 18

What gram negative agents are ampicillin and Amoxicillin effective against?

Answer 18

1. Non-beta lactamase producing Haemophilus

2. E. Coli: resistance is 40-50%

Question 19

What other agents are ampicillin and Amoxicillin effective against?

Answer 19

Oral anaerobes

Question 20

What are the clinical uses for ampicillin and Amoxicillin?

Answer 20

1. Otitis media
2. URIs
3. UTIs
4. Endocarditis from enterococci: IV ampicillin
5. Listeria meningitis: IV ampicillin

Question 21

What are the SE of ampicillin and Amoxicillin?

Answer 21

1. Hypersensitivity
2. Rash
3. GI

Question 22

What are the extended spectrum PCN-B-lactamase inhibitor combination meds?

Answer 22

1. Amoxicillin/clavulanate: Augmentin

2. Pipercillin/tazobactam: Zosyn

Question 23

What are the routes for Amoxicillin/clavulanate: Augmentin

and Pipercillin/tazobactam: Zosyn?

Answer 23

1. Amoxicillin/clavulanate: Augmentin: PO

2. Pipercillin/tazobactam: Zosyn: IV

Question 24

What is the spectrum of activity for Amoxicillin/clavulanate: Augmentin
and Pipercillin/tazobactam: Zosyn?

Answer 24

1. Retained activity against strep and enterococci
2. improved activity against MSSA
3. Improved activity against gram negative rods (E. coli)
4. Improved activity against B. fragilis
5. ONLY zosyn has activity against pseuodmonas

Question 25

What agents do Amoxicillin/clavulanate: Augmentin | and Pipercillin/tazobactam: Zosyn has poor activity against?

Answer 25

1. MRSA | 2. Extended spectrum B-lactamase producing gram negative rods

Question 26

What are the clinical uses for Amoxicillin/clavulanate: Augmentin and Pipercillin/tazobactam: Zosyn?

Answer 26

``` 1. Mixed infections A. Intr-abdominal infections B. Diabetic foot problems C. Nosocomial pneumonia: zosyn D. Aspiration pneumonia ```

Question 27

What are the SE of Amoxicillin/clavulanate: Augmentin | and Pipercillin/tazobactam: Zosyn?

Answer 27

1. Amoxicillin/clavulanate: Augmentin A. Diarrhea 2. Pipercillin/tazobactam: Zosyn A. Immune-mediated thrombocytopenia, aplastic anemia