Penicillin Quiz: Test Your Knowledge of Types of Penicillin

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

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

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

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

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

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

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

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