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Flashcards in Allman - Penicillins Deck (33):
1

Where does B-lactamase attack?

Beta-Lactam Ring of Penicillin (GARAGE)

2

Penicillin mechanism of action

Inhibit bacterial cell wall synthesis by blocking cross linking of adjacent peptidoglycan strands with subsequent lysis.

3

B-Lactam Antibiotics target WHAT

Penicillin-Binding Proteins (PBP); include Transpeptidases, Transglycolases, and D-Alanine Carboxykinase

4

Penicillin Mechanism of Resistance (3)

1. B-Lactamase Production (most important) - staph and H.flu

2. Failure of antibiotic to penetrate to PBP targets - gram negative only

3. Low affinity binding of antibiotic to PBPs - pneumococcus, MRSA, Enterococcus

5

Acid Stable Penicillins (7)

Penicillin VK
Oxacillin
Cloxacillin
Dicloxacillin
Nafcillin
Ampicillin
Amoxicillin

6

Acid Labile Penicillins (6)

Penicillin G
Methicillin
Carbenicillin
Ticarcillin
Mezlocillin
Pipercillin

7

Penicillin Distribution

Well distributed; Insoluble in lipid -- therefore, unless inflammation is present there is poor distribution to brain, CSF, and prostate.

8

Penicillin Excretion

Renal = most important THEREFORE adjustment for renal insufficiency is a MUST

Biliary Excretion happens with ampicillin, nafcillin, and antipseudomonal penicillins.

9

Most common Penicillin adverse effect?

Hypersensitivity (MACULOPAPULAR RASH)
- this reaction to one means probable same reaction to all penicillins
-may not occur on re-exposure or may occur without precious reaction

10

Anaphylaxis (Immediate Reaction)

IgE Mediated (E sends you to the ER!)

11

Delayed Reaction (Rash)

IgM or IgG Mediated

12

Hypersensitivity (definition)

a state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign agent

13

Other adverse reactions to Penicillins (3)

Hematologic (Inc Eosinophils -- NAACP)
Interstitial Nephritis
Pseudomembranous Colitis

14

Agents (6)

1. Penicillin G/VK
2. Aminopenicillins
3. Penicillinase Resistant Penicillins
4. Carboxypenicillins
5. Ureidopenicillins
6. B-Lactamase Inhibitor / Penicillin Combinations

15

Penicillin G/VK Spectrum of Activity (2)

GRAM POSITIVE:
1. Streptococcus
2. Enterococcus

DOESN'T WORK FOR:
Staph (bc of b-lactamase)
Strep Pneumonia (in some areas)

16

Penicillin G/VK Facts

K, Na salt (????)

1. Procain Penicillin G - Intramuscular; SLOW acting
2. Benzanthine Penicillin - (IM); sustained release, prophylaxis in some patients

VK must be given for ORAL bc it is acid-soluble. G is acid labile.

17

Aminopenicillin Facts

Types:
1. Ampicillin (QID) -- more diarrhea bc absorbed less
2. Amoxicillin (TID)

* Amino group allows for penetration into gram negative cell wall.

18

Aminopenicillin Spectrum of Activity

Gram +:
1. Streptococcus
2. Enterococcus

Gram -:
Haemophilus (non-b lactamase producing)
Proteus Mirabilis
E. Coli
Klebsiella

19

Aminopenicillin Adverse Effects

DIARRHEA -- take with food (amoxicillin absorption is not impaired by food)

Ampicillin > Amoxicillin (for diarrhea causation)

20

Penicillinase Resistant Penicillins (IV)

Oxacillin
Nafcillin

21

Penicillinase Resistant Penicillins (PO)

Cloxacillin
Dicloxacillin

22

Penicillinase Resistant Penicillin USED FOR:

Staph + Strep ONLY

23

Carboxypenicillins FACTS

Increased permeability to cell wall

Types:
Ticarcillin
Carbenicillin (not on market....good for UTI)

24

Carboxypenicillins Spectrum of Activity

Gram + = Strep
Gram - = PEK, SPACE

Enterobacter

** FIRST group in PCN family discussed that covers PSEUDOMONAS AERUGINOSA**

25

Carboxypenicillins Brands (2)

Ticarcillin = not good for patients with salt issues....like heart failure ... choose Piperacillin

Carbenicillin = high urine concentrations; great for UTI; not available; body cannot stand concentrations needed to treat systemic infections so only used for UTI

26

Carboxypenicillins Adverse Effects (3)

Hypersensitivity
Carboxy group can cause platelet dysfunction
Sodium overload (hypernatremia)

27

Ureidopenicillins Facts

Piperacillin = STRONGS; much lower sodium load that ticarcillin so great even in patients with Na issues

28

Ureidopenicillins Spectrum of Activity (4)

Streptococcus
Enterococcus
PEK
SPACE

29

Why use B-Lactamase Inhibitor PLUS Penicillin?

Gives coverage for Staph AND Anaerobic organisms

30

Augmentin

Amoxicillin + Clavulanic Acid (PO)

31

Unasyn

Ampicillin + Sulbactam (IV)

32

Timentin

Ticarcillin + Clavulanic Acid (IV)

33

Zosyn

Piperacillin + Tazobactam (IV)