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Pharm - Ch. 83

Penicillins

QuestionAnswer
Describe the mechanism of action for penicillins Weakens the cell wall by causing bacteria to take up excessive water and lyse.
Describe three factors leading to bacterial resistance of penicillins 1) inability of penicillins to reach penicillin-binding proteins (targets), 2) inactivation of penicillins by bacterial enzymes (penicillinases), 3) production of PBPs that have low affinity for penicillins
True or false: penicillinases are beta-lactamases that act specifically on penicillin True
True or false: penicillins can work even when the bacteria are NOT dividing or growing False. Can only work during bacterial division/growth
What is a beta-lactam ring and what is its relationship with penicillin? Beta-lactam rings are necessary for acting with penicillin-binding proteins, which disrupt the cell wall. They are also a unique characteristic of penicillin family
True or false: penicillins are among our "safest" drugs True because eukaryotic cells (present in humans) do not contain cell walls
List the classifications of penicillins Narrow-spectrum penicillinase sensitive, narrow spectrum penicillinase resistant, broad spectrum, and extended spectrum
List prototypes for each classification of penicillins Narrow-spectrum penicillinase sensitive (Penicillin G). Narrow spectrum penicililnase resistant (Nafcillin). Broad-spectrum (amoxicillin). Extended spectrum (ticarcillin).
A patient with strep throat has an infection with beta-lactamases present. Would you give Penicillin G? No, because penicillin G is penicillinase sensitive.
After stepping on a rusty nail, sleeping with a hooker, and opening up a suspicious letter, Michael Scott comes into the hospital with tetanus, syphilis, and anthrax. Which of the following would you use to treat him? Nafcillin, amoxicillin, penicillin G Penicillin G since it can be used to treat certain G- organisms that can cause tetanus, anthax, syphilis (also gangrene)
A nurse has a patient with MRSA. Should she administer nafcillin? No, because MRSA (methicillin resistant staph aureus) refers to lack of susceptibility to methicillin AND all other penicililnase-resistance penicillins including nafcillin.
True or false: amoxcillin isn't the optimal drug to give for staphylococcus infections True, because amoxicillin is inactivated by beta-lactamases
List some treatment uses of amoxicillin H. influenzae, e. coli, n. gonorrhoeae, h. pylori
A woman comes in complaining of a UTI. You would give what type of penicililn? Ticarcillin
True or false: aminopenicillins (broad-spectrum) are penicillinase sensitive True
True or false: ticarcillin are NOT useful for peduomonal infections False. They are useful. Hence being called extended spectrum penicillins, otherwise known as antipsedomonal penicillins
What routes of administration are available for penicillin G? IM (most common), and IV
One can use penicillinase inhibitors with broad/extended spectrum penicillinases. What is this penicillinase inhibitor called? Clavulanic acid. (Can be combined with amoxicillin or ticarcillin)
List side effects of penicillins GI = Heartburn, diarrhea, stomatitis, discolored tongue. Neuro: seizures, hallucinations, confusion with high dose toxicity. Hyperkalemia with IV.
A nursing student accidentally mixes penicillin with _______ in the same IV bag, thus inactivating the drug. Aminoglycosides
You are giving patient teaching about penicillin treatment to a young woman on warfarin. What must you mention? Penicillin and anticoagulants can interact to cause increased bleeding time. (Also since she is young, mention there is decreased efficacy with oral contraceptives.)
A patient mentions that she had an allergic reaction to amoxicillin once. The nurse checks the order and sees a prescription for tiacardin. What is the appropriate action? Call the doctor about the order, as ALL penicillins are contraindicated for patients with an allergy to any penicillins.
True or false: a penicillin allergy can show up weeks after administration True. Allergic reactions occur immediately (2-30 min), accelerated (1-72 hrs), or late (days-weeks).
A patient displays the following signs: largyneal edema, bronchoconstriction, and severe hypotension. These are all signs of _____ Anaphylaxis
A person entering penicillin-induced anaphylactic shock should be treated with... Epinephrine, respiratory support. Antihistamines and GCs may be useful as well.
How can one prevent penicillin-induced anaphylactic shock? Conduct a skin test for pencillin allergies
Nafcillin is indicated for... Staphylococcus aureus (the methicillin sensitive kind)
Penicillin G is for indicated... Streptococcus sp., and some gram- organisms
Created by: choel
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