Penicillin Pharmacology Quiz
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Questions and Answers

Which characteristic of cloxacillin contributes to its limited spectrum of activity compared to other penicillins?

  • Its 'suicide inhibitor' function against beta-lactamases.
  • Its enhanced affinity to penicillin-binding proteins (PBPs).
  • Its bulky side chain that projects to shield the beta-lactam ring from enzymatic degradation. (correct)
  • The presence of an amino group that enhances cell entry.

    • Why is penicillin G typically administered on an empty stomach?

  • To prevent the breakdown of clavulanic acid.
  • To ensure optimal absorption of the antibiotic since food can interfere with its uptake. (correct)
  • To enhance its activity against _Staphylococcus_ species.
  • To minimize the risk of skin rash and diarrhea.

    • What is the primary role of clavulanic acid when combined with amoxicillin?

  • To protect amoxicillin from degradation by beta-lactamase enzymes. (correct)
  • To improve amoxicillin's affinity for penicillin-binding proteins.
  • To enhance the oral absorption of amoxicillin.
  • To increase the spectrum of activity to include _Listeria monocytogenes_.

    • Which of the following best describes the spectrum of activity for ampicillin and amoxicillin?

    <p>Effective against streptococci, some enterococci like <em>E. faecalis</em>, <em>Listeria monocytogenes</em>, and MSSA <em>Staphylococcus</em>. (B)</p> Signup and view all the answers

    Why is piperacillin/tazobactam (Pip/Tazo) primarily administered intravenously?

    <p>To bypass first-pass metabolism and ensure higher bioavailability. (D)</p> Signup and view all the answers

    Which of the following statements regarding ampicillin is correct?

    <p>It should be administered on an empty stomach. (A)</p> Signup and view all the answers

    Which of the following organisms is least likely to be effectively treated by Penicillin G?

    <p><em>Escherichia coli</em>. (B)</p> Signup and view all the answers

    A patient with a creatinine clearance of 30 mL/min requires antibiotic therapy. Which of the following penicillins would likely require the least dosage adjustment?

    <p>Cloxacillin. (C)</p> Signup and view all the answers

    Which of the following bacterial species is considered an oral anaerobe that may be susceptible to penicillin?

    <p><em>Bacteroides fragilis</em>. (C)</p> Signup and view all the answers

    A physician wants to prescribe a penicillin that has enhanced activity against Pseudomonas aeruginosa. Which of the following options is the most appropriate choice?

    <p>Piperacillin. (A)</p> Signup and view all the answers

    Which of the following penicillins requires consideration for administration on an empty stomach?

    <p>Cloxacillin. (D)</p> Signup and view all the answers

    Which of the following organisms is least likely to be susceptible to amoxicillin?

    <p><em>Staphylococcus aureus</em> (MSSA). (B)</p> Signup and view all the answers

    Which cephalosporin agent provides the best coverage against B. fragilis?

    <p>Cefoxitin (B)</p> Signup and view all the answers

    Which of the following cephalosporins is available only in intravenous (IV) form?

    <p>Ceftriaxone (A)</p> Signup and view all the answers

    Which cephalosporin listed has activity against Pseudomonas aeruginosa?

    <p>Ceftazidime (C)</p> Signup and view all the answers

    Which class of cephalosporins is Ceftaroline a part of?

    <p>Fifth-generation (C)</p> Signup and view all the answers

    Which of the following is a notable limitation of cefixime?

    <p>Poor coverage of <em>S. pneumoniae</em> (A)</p> Signup and view all the answers

    Which of the following cephalosporins has some anaerobic coverage, though generally considered to be poor?

    <p>Ceftobiprole (A)</p> Signup and view all the answers

    Which of the following antibiotics is the most stable to AmpC Beta-lactamases.

    <p>Cefepime (B)</p> Signup and view all the answers

    Which of the following antibiotics is best for Streptococci?

    <p>Ceftolozane-tazobactam (A)</p> Signup and view all the answers

    Which of the following cephalosporin(s) is administered orally (PO)?

    <p>Cephalexin (D)</p> Signup and view all the answers

    Which of the following organisms is least likely to be effectively treated by ertapenem?

    <p>Enterococcus faecalis (A)</p> Signup and view all the answers

    A patient is diagnosed with a complicated intra-abdominal infection. The culture reveals a gram-negative organism with AmpC beta-lactamase production. Which antibiotic should be avoided due to its limited activity against SPICE-A organisms?

    <p>Piperacillin/Tazobactam (C)</p> Signup and view all the answers

    Aztreonam is being considered for a patient with a severe penicillin allergy. Which of the following organisms would not be appropriately treated with aztreonam?

    <p>Staphylococcus aureus (D)</p> Signup and view all the answers

    A child presents with acute otitis media. Considering the common causative organisms, which of the following antibiotic choices would provide the most comprehensive coverage without promoting unnecessary resistance?

    <p>Amoxicillin (A)</p> Signup and view all the answers

    Which of the following factors is least associated with increased risk of otitis media in children?

    <p>Advanced age (geriatric) (B)</p> Signup and view all the answers

    A patient with a known ESBL-producing E. coli infection requires antibiotic treatment. Which of the following would be the most appropriate choice?

    <p>Meropenem (A)</p> Signup and view all the answers

    Which of the following statements regarding carbapenems and their spectrum of activity is most accurate?

    <p>Carbapenems generally have broad-spectrum activity, but do not cover atypicals (A)</p> Signup and view all the answers

    Which of the following organisms is least likely to cause Otitis Media?

    <p>Staphylococcus aureus (A)</p> Signup and view all the answers

    Which of the following is an appropriate treatment for Treponema pallidum?

    <p>Doripenem (D)</p> Signup and view all the answers

    Flashcards

    Penicillin G/VK

    A beta-lactam antibiotic primarily effective against Gram-positive bacteria.

    Amoxicillin/Clavulanic acid

    A combination antibiotic with broad activity, including bacteria resistant to amoxicillin alone.

    Piperacillin/Tazobactam

    An extended-spectrum penicillin combined with a beta-lactamase inhibitor, used IV.

    MSSA vs MRSA

    MSSA (methicillin-sensitive) can be treated with beta-lactams; MRSA (methicillin-resistant) cannot.

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    Gram-positive spectrum

    The range of bacteria affected by beta-lactam antibiotics, mainly Gram-positive organisms.

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    Ampicillin

    An aminopenicillin antibiotic primarily for Gram-negative bacteria like E. coli.

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    Cloxacillin

    A penicillinase-resistant penicillin effective against MSSA, requiring hepatic metabolism.

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    Renal Adjustment

    Most penicillins need dosage changes in kidney impairment, but cloxacillin does not.

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    Empty Stomach Requirement

    Certain penicillins, like Ampicillin and Cloxacillin, should be taken without food for effectiveness.

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    Enhanced Activity

    Refers to antibiotics with increased efficacy against certain bacteria, like Haemophilus.

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    Anaerobes

    Bacteria that thrive without oxygen, include Clostridia and oral anaerobes.

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    Natural Penicillins

    Penicillin G and VK; effective against Gram-positive bacteria without resistance.

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    AmpC beta-lactamases

    Enzymes providing resistance to penicillins and some cephalosporins.

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    SPICE-A organisms

    Organisms producing AmpC: Serratia, Providencia, Indole-positive Proteus, Citrobacter, Enterobacter, Acinetobacter.

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    Carbapenems

    Broad-spectrum antibiotics effective against many bacteria, including Gram-negative.

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    ESBL bacteria

    Extended-spectrum beta-lactamases confer resistance to certain penicillins and cephalosporins.

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    Gram-negative entry

    Carbapenems enter Gram-negative bacteria via OprD porin.

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    Otitis Media (OM)

    Infection and inflammation of the middle ear, common in children.

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    S.pneumoniae in OM

    Common organism causing Otitis Media, especially in infancy.

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    Risk factors for OM

    Immature immune development in children increases Otitis Media risk.

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    Diagnosis criteria for OM

    Diagnosis requires two criteria: ear pain and fever over 40.5°C.

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    Moraxella catarrhalis

    A bacterium commonly associated with respiratory infections and often resistant to beta-lactams.

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    Enterococcus

    A genus of bacteria that can cause infections, especially in the urinary tract and is known for resistance to many antibiotics.

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    B-lactamases

    Enzymes produced by some bacteria that provide resistance to beta-lactam antibiotics.

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    Ceftazidime

    A third-generation cephalosporin antibiotic effective against Pseudomonas aeruginosa.

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    Cefoxitin

    A cephalosporin antibiotic known for its effectiveness against Bacteroides fragilis.

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    Cefixime

    A third-generation cephalosporin with limited effectiveness against certain Gram-negative bacteria.

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    Ceftolozane-tazobactam

    A combination antibiotic effective against resistant Pseudomonas and Streptococci.

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    Ceftaroline

    A fifth-generation cephalosporin antibiotic with activity against MRSA.

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    Study Notes

    Beta-Lactam Antibiotics: Penicillins, Cephalosporins, Carbapenems/Monobactams

    • Penicillins are a group of beta-lactam antibiotics with a broad spectrum of activity.
    • They work by inhibiting the synthesis of bacterial cell walls.
    • Various penicillins have different spectra of activity and resistance profiles.
    • Penicillin G/VK is effective against streptococci and some enterococci but has issues with resistance.
    • Cloxacillin is resistant to penicillin-splitting enzymes.
    • Ampicillin/Amoxicillin is active against streptococci, enterococci, and Listeria monocytogenes. Amoxicillin is less likely to cause diarrhea.
    • Amoxicillin/clavulanate has enhanced activity against certain bacteria like Haemophilus influenzae.
    • Piperacillin/tazobactam offers the broadest spectrum of activity within the penicillin class.

    Cephalosporins - Spectrum of Activity

    • Cephalosporins are beta-lactam antibiotics that are effective against various Gram-positive bacteria.
    • Different generations of cephalosporins have varying spectra. Generally, newer generations show greater efficacy against Gram-negative bacteria, but also against Gram-positive bacteria.
    • 1st generation cephalosporins are primarily active against Gram-positive bacteria.
    • 2nd generation cephalosporins show improved activity against some gram-negative bacteria.
    • 3rd generation cephalosporins are better than previous generations at targeting gram-negative microbes.
    • 4th generation cephalosporins have extended activity against gram-negative bacteria.
    • 5th generation cephalosporins are the most effective against various bacteria including MRSA.
    • Newer generations are more likely to be effective against multi-drug resistant or more difficult-to-treat infections.
    • B-lactamase inhibitors can improve the effectiveness of some cephalosporins against bacteria producing these enzymes.

    Carbapenems/Monobactams - Spectrum of Activity

    • Carbapenems and monobactams are broad-spectrum beta-lactam antibiotics.
    • These drugs are effective against a wide range of Gram-positive and Gram- negative bacteria.
    • Key antibiotics in this class include Imipenem, Meropenem, Ertapenem, and Aztreonam.
    • Carbapenems have advanced resistance levels against bacteria.

    Otitis Media (OM)

    • Otitis media is an inflammation of the middle ear.
    • Symptoms include pain, fever, irritability, and restlessness.
    • Risk factors for Otitis Media include children under 2, immature immune systems, and viral infection.
    • Diagnosis typically involves physical examination, consideration of symptoms.
    • Complications can include ear drum perforation.

    Pharyngitis

    • Pharyngitis is inflammation of the pharynx.
    • The most common cause is viral infections. However, a bacterial infection, particularly by Streptococcus pyogenes (commonly called strep throat), can also cause this condition.
    • Symptoms of pharyngitis typically include a sore throat, fever, and some discomfort or pain associated with swallowing, cough, runny nose.
    • Accurate diagnosis can be challenging given overlap in symptoms for viral and bacterial causes.
    • Management typically includes symptomatic relief like pain management and hydration.

    Sinusitis

    • Sinusitis is an inflammation of the sinuses and is also frequently associated with respiratory infections like viral upper respiratory infections.
    • Symptoms include fever, nasal congestion, facial pain, headache, cough and significant nasal discharge.
    • Complications are rare, but significant when they occur.

    Pneumonia

    • Pneumonia is an inflammation of the lungs.
    • It is frequently caused by viral or bacterial agents such as Streptococcus pneumoniae, Haemophilus influenzae amongst others.
    • Risk factors include older adults and individuals who were recently or currently infected with viruses.
    • Symptoms include fever, cough, shortness of breath, and chest pain.

    Bacterial Pathogens (Gram (+))

    • Includes staphylococci, streptococci, listeria, Enterococci, c. diphtheriae and others.
    • Various types within each group have different susceptibilities to antibiotics and other treatments.
    • Bacterial properties, including Gram stain, shapes and arrangements of bacteria, and antibiotic resistance, differ between groups.

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    Description

    Test your knowledge on the pharmacology of penicillins, including their spectrum of activity, clinical applications, and combinations with other drugs. This quiz covers important concepts such as the administration of penicillin G, the role of clavulanic acid, and dosing adjustments for different penicillins.

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