Podcast
Questions and Answers
A patient with a known history of renal dysfunction is prescribed piperacillin/tazobactam. What adjustment to the typical administration of the drug should be made to ensure patient safety and efficacy?
A patient with a known history of renal dysfunction is prescribed piperacillin/tazobactam. What adjustment to the typical administration of the drug should be made to ensure patient safety and efficacy?
- No adjustment is necessary as piperacillin/tazobactam's metabolism is unaffected by renal function.
- Administer with probenecid to increase blood levels and effects, thus maintaining standard dosing intervals.
- Increase the dose to compensate for potential drug clearance issues.
- Decrease the dose and/or increase the dosing interval based on the degree of renal impairment. (correct)
A patient develops a rash after being treated with ampicillin for a respiratory infection, and is concurrently taking allopurinol for gout. What is the most likely cause of the rash?
A patient develops a rash after being treated with ampicillin for a respiratory infection, and is concurrently taking allopurinol for gout. What is the most likely cause of the rash?
- The combination of ampicillin and allopurinol has increased the risk of rash. (correct)
- The rash is most likely caused by an allergic reaction to ampicillin, unrelated to allopurinol.
- The rash is an expected side effect of allopurinol and not related to the ampicillin.
- The rash is most likely a sign of Stevens-Johnson Syndrome caused by ampicillin.
A blood culture indicates the presence of Enterococcus in a patient with a severe infection. Which penicillin derivative would offer the MOST effective coverage against this infection?
A blood culture indicates the presence of Enterococcus in a patient with a severe infection. Which penicillin derivative would offer the MOST effective coverage against this infection?
- Penicillin G benzathine
- Amoxicillin (correct)
- Dicloxacillin
- Nafcillin
Which of the following mechanisms is LEAST likely to contribute to bacterial resistance against penicillins?
Which of the following mechanisms is LEAST likely to contribute to bacterial resistance against penicillins?
A patient is diagnosed with MSSA bacteremia. Which of the following penicillin-class antibiotics would be the MOST appropriate choice for treatment?
A patient is diagnosed with MSSA bacteremia. Which of the following penicillin-class antibiotics would be the MOST appropriate choice for treatment?
A patient is prescribed amoxicillin/clavulanate for a suspected sinus infection. What is the PRIMARY purpose of including clavulanate in this formulation?
A patient is prescribed amoxicillin/clavulanate for a suspected sinus infection. What is the PRIMARY purpose of including clavulanate in this formulation?
Which of the following penicillin formulations is MOST suitable for a patient requiring intravenous therapy to treat a polymicrobial infection, including Bacteroides fragilis, suspected to be beta-lactamase producing?
Which of the following penicillin formulations is MOST suitable for a patient requiring intravenous therapy to treat a polymicrobial infection, including Bacteroides fragilis, suspected to be beta-lactamase producing?
Following prolonged use of penicillin, a patient develops signs of hemolytic anemia. Which of the following mechanisms is MOST likely responsible for this adverse effect?
Following prolonged use of penicillin, a patient develops signs of hemolytic anemia. Which of the following mechanisms is MOST likely responsible for this adverse effect?
A patient with a known penicillin allergy requires treatment for a streptococcal infection. Which of the following findings would suggest that prescribing a cephalosporin would be MOST contraindicated?
A patient with a known penicillin allergy requires treatment for a streptococcal infection. Which of the following findings would suggest that prescribing a cephalosporin would be MOST contraindicated?
Which of the following statements BEST describes the mechanism of action of penicillins on bacterial cells?
Which of the following statements BEST describes the mechanism of action of penicillins on bacterial cells?
Flashcards
Penicillins
Penicillins
Beta-lactam antibiotic class; resistance occurs through inactivation by B-lactamases, altered PBP targets, or reduced diffusion.
Penicillin Side Effects
Penicillin Side Effects
Rash, hives, N/V/D, interstitial nephritis, hemolytic anemia, and seizures (especially with renal dysfunction).
Penicillin Mechanism
Penicillin Mechanism
Bind to penicillin-binding proteins (PBPs) and inhibit cell wall cross-linking enzymes (transpeptidases).
Penicillin Spectrum
Penicillin Spectrum
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Natural Penicillin Spectrum
Natural Penicillin Spectrum
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Aminopenicillin Spectrum
Aminopenicillin Spectrum
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H. pylori treatment
H. pylori treatment
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Penicillin Contraindications
Penicillin Contraindications
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Amino-Penicillin + BLI Coverage
Amino-Penicillin + BLI Coverage
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Anti-Pseudomonal + BLI Coverage
Anti-Pseudomonal + BLI Coverage
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Study Notes
- Penicillins belong to the beta-lactam class.
- Resistance to penicillins can occur through beta-lactamase drug inactivation, altered penicillin-binding protein (PBP) targets, and reduced diffusion via porin channels.
- Side effects of penicillins include hypersensitivity reactions (rash, hives, dyspnea, throat swelling), N/V/D, interstitial nephritis, positive direct Coombs test, hemolytic anemia (with prolonged use), and seizures (especially with renal dysfunction).
- Penicillins mechanism of action involves binding to penicillin-binding proteins (PBPs), including cell wall cross-linking enzymes and transpeptidases.
- Penicillins act on both gram-negative and gram-positive bacteria.
Spectrum of Activity
- Streptococcus pneumoniae
- Streptococcus pyogenes
- Streptococcus viridans
- Enterococci
- Staphylococcus aureus (MSSA and MRSA)
- Pseudomonas
- CRE
- ESBL
- SPACE
- Non-BLP and BLP
- E. coli
- Klebsiella
- H. influenzae
- Neisseria meningitidis
- Peptostreptococcus
- Bacteroides species
Natural Penicillins
- Includes Penicillin G (IV), Penicillin G benzathine (IM, used for syphilis), and Penicillin VK.
- Spectrum includes Streptococcus viridans, Streptococcus pyogenes, Streptococcus pneumoniae (increased resistance), mouth anaerobes, and Neisseria meningitidis.
Aminopenicillins
- Includes amoxicillin and ampicillin.
- Spectrum is similar to natural penicillins, with better coverage of Streptococcus pneumoniae, H. influenzae, E. coli, Proteus mirabilis, Salmonella, and Shigella.
- Amoxicillin can be used in a 3 or 4 drug regimen for H. pylori.
- Dosage adjustment is necessary in cases of renal impairment.
- Contraindications include allergy to penicillins, cephalosporins, or carbapenems.
- Drug interactions: Probenecid increases penicillin blood levels and effects.
- Combination of ampicillin and allopurinol increases rash risk.
- May decrease the effectiveness of oral contraceptives.
Aminopenicillins + Beta-Lactamase Inhibitors
- Includes amoxicillin/clavulanate (PO) and ampicillin/sulbactam (IV).
- Spectrum is similar to aminopenicillins, with additional coverage of beta-lactamase producing Staphylococcus aureus (MSSA), H. influenzae, M. catarrhalis, E. coli, and K. pneumoniae.
- Better activity against anaerobes and SPACE organisms.
- Dosage adjustment needed for renal impairment.
- AMP/Sulbactam is administered intravenously (IV).
- SPACE organisms: Serratia marcescens, Proteus vulgaris, Acinetobacter species, Citrobacter species, and Enterobacter species.
Antipseudomonal Penicillins + Beta-Lactamase Inhibitors
- Includes piperacillin/tazobactam.
- Spectrum is similar to aminopenicillins + beta-lactamase inhibitors, with added coverage of Pseudomonas aeruginosa.
- Better anaerobic coverage and SPACE coverage (Serratia marcescens, Proteus vulgaris, Acinetobacter species, Citrobacter species, Enterobacter species).
- Decent anaerobic coverage.
- Dosage adjustment needed for renal impairment; tazobactam is a beta-lactamase inhibitor.
Penicillinase-Resistant Penicillins
- Includes dicloxacillin, nafcillin, and oxacillin.
- Spectrum includes Staphylococcus aureus (MSSA) and Streptococcus.
- Side effects include hepatitis (especially with oxacillin).
- Penicillins are bactericidal.
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