Types of Penicillin Quiz

Penicillins

• Natural Penicillins: Benzyl Penicillin (Penicillin G)
  • ROA: IM, combined with Probenecid to prevent early excretion
  • Indications: Syphilis, treatment of infections caused by gram-positive agents
• Aminopenicillins: Amoxicillin
  • Extended effect due to amino group
  • ROA: Oral, combined with Clavulanic Acid (Co-Amoxiclav)
  • Indications: Part of triple therapy for H. pylori GI Infection
• Penicillinase Resistant: Methicillin
  • Not used clinically in the US due to cases of interstitial nephritis
  • Indications: Treatment of infections caused by penicillinase-producing staphylococci, including MRSA
• Antipseudomonal Penicillins:
  • Carboxypenicillin: Ticarcillin
  • Ureidopenicillin: Piperacillin
    • ROA: IV, combined with Tazobactam (Piptaz, Tazocin)
    • Indications: Skin infections, UTI, Bacterial sepsis
    • ADR: Hypersensitivity (5%), Diarrhea, Nephritis

Cephalosporins

• 1st Generation: Cefazolin, Cephalexin
• 2nd Generation: Cefuroxime, Cefaclor
• 3rd Generation: Cefdinir, Cefotaxime, Ceftriaxone
• 4th Generation: Cefepime
• MOA: Beta-lactam rings bind to the penicillin-binding protein and inhibit its physiological activity
• Indications: Syphilis, Uncomplicated Gonorrhea, potentially indicated in treating Lyme disease caused by B. burgdorferi
• ROA: IV, IM
• ADR: Acute renal failure, Gl upset, Pain at injection site

Carbapenems

• Thienamycin: First carbapenem produced from S. cattleya
• Imipenem: Easily degraded dehydropeptidase, usually combined with Cilastatin (DHP inhibitor)
  • Contraindicated in epileptic patients
• Meropenem: Not easily degraded by DHP, greater potency in gram-negative and anaerobic bacteria

Monobactams

• Aztreonam: Effective against gram-negative bacteria

Polypeptides

• Vancomycin
  • MOA: Inhibits cell wall synthesis by binding firmly to the D-Ala-D-Ala terminus, preventing further growth and cross-linking
  • Indications: MRSA, Epidermidis, Colitis
• Other Polypeptides: Not listed

Antimetabolites

• Methotrexate
  • MOA: Dihydrofolate reductase (DHFR) inhibitor
  • Indications: Breast cancer, Head & Neck cancer, Bladder cancer, Non-Hodgkin's lymphoma
  • ADR: Mucositis, Diarrhea
• 6-Mercaptopurine
  • MOA: Inhibits de novo purine synthesis
  • Indications: Acute myelogenous leukemia
  • ADR: Nausea, Myelosuppression, Immunosuppression, Hepatotoxicity
• 5-Fluorouracil
  • MOA: Inhibits thymidylate synthase and its metabolites
  • Indications: Gl cancers, Breast cancer, Hepatocellular cancer
  • ADR: Nausea, Mucositis, Diarrhea, Hepatotoxicity

NSAIDs

• Indomethacin: Must be taken with food, highly irritating
  • Indications: Rheumatoid arthritis, OA, Gout
  • ADR: Edema
• Sulindac: Prodrug → converted to its active sulfide form
• Diclofenac Sodium (Voltaren): Analgesic, often used after ophthalmic surgery, minimal to no antipyretic effects
• Propionic Acid Derivatives: Ibuprofen
• Fenamates: Mefenamic acid
  • ADR: Flatulence, impaction, excessive bowel activity
  • Contraindications: Hypersensitivity, bowel obstruction, symptoms of appendicitis or acute surgical abdomen, GI ulceration/adhesions, fecal impaction, dysphagia, rectal bleeding

Laxatives

• Stool Softeners or Wetting Agents: Docusate
  • MOA: Increases the amount of water the stool absorbs in the gut, making the stool softer and easier to pass
  • ADR: Stomach pain, diarrhea or cramping
  • Contraindications: Intestinal obstruction, symptoms of appendicitis or acute abdominal pain, fecal impaction; concomitant use of mineral oil; nausea or vomiting
• Saline Laxatives or Enemas: Glycerin
  • MOA: Hygroscopic and/or local irritant action, drawing water from the tissues into the feces and reflexively stimulating evacuation
  • ADR: Hypersensitivity
  • ROA: Rectally
  • Contraindications: Acute abdominal pain, N/V, symptoms of appendicitis or undiagnosed abdominal pain
• Lubricant Laxatives: Castor oil
  • MOA: Ricinoleic acid acts as an anionic surfactant that reduces net absorption of fluid and electrolytes and stimulates intestinal peristalsis
  • ADR: Stomach/abdominal pain or cramping, nausea, diarrhea, or weakness
  • Contraindications: Hypersensitivity, GI obstruction or perforation, severe impaction, symptoms of appendicitis or acute surgical abdomen, ulcerative colitis, rectal fissures

Adrenergic Blockers

• Alpha-1 Adrenergic Blockers: -zosin
  • MOA: Bind to and inhibit type 1 alpha-adrenergic receptors and thus inhibit smooth muscle contraction
  • ADR: Postural hypotension, weakness, palpitations, dizziness
  • Precautions: Use cautiously in older adult patients because of hypotension
• Beta Adrenergic Blockers: -olol
  • MOA: Block the effects of the hormone adrenaline, making the heartbeat slower and relaxing the blood vessels, which reduces blood pressure
  • ADR: Bradycardia, insomnia, fatigue, sexual dysfunction, bizarre dreams, decreased HDL cholesterol
  • Precautions: Not for use in patients with asthma, COPD, CHF, heart block, and sick sinus syndrome. Use with caution in patients with diabetes and peripheral vascular disease
• Combined Alpha- and Beta- Adrenergic Blockers
  • MOA: Combined MOA of Alpha-Adrenergic Blocker and Beta-Adrenergic Blocker
  • ADR: Nausea, fatigue, dizziness, asthma, headache
  • Precautions: Not for use in sick sinus syndrome or heart block; used in caution in CHF, bronchial asthma, COPD, and diabetes mellitus
• Peripheral Adrenergic Antagonists
  • MOA: Target the presynaptic adrenergic neurons in the peripheral nervous system and prevent them from effectively releasing the catecholamines norepinephrine and epinephrine
  • ADR: Sexual dysfunction, nasal congestion, postural hypotension, diarrhea, lethargy
  • Precautions: Use very cautiously in older adult patients because of hypotension