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23 Cards in this Set
- Front
- Back
Natural Penicillin
Drugs |
1) Penicillin G (IV, IM, Oral?)
2) Benzathine penicillin (IM depot) 3) Procaine Penicillin G (IM) 4) Penicillin V (acid resistant, Oral) |
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Natural Penicillin
Characteristics |
1) Highest activity against G+
2) Some G- coverage 3) Some anaerobic coverage 4) Inactivated by B-lactamase 5) No antipseudomonal activity 6) Eliminated by kidney 7) No CNS penetration |
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Penicillinase resistant Penicillins
(Antistaphyloccocal penicillins) Drugs |
1) Nafcillin (IV/IM, liver metabolism)
2) Cloxacillin (Liver metabolism) 3) Oxacillin (Liver metabolism) 4) Dicloxacillin 5) Methicillin |
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Penicillinase resistant Penicillins
(Antistaphyloccocal penicillins) Characteristics |
1) Lower activity against some G+
2) Some G- and anaerobe coverage 3) Some acid stable 4) DOC penicillinase making S.Aureus 5) Hepatic metabolism and Renal excretion |
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Extended spectrum penicillins
Drugs |
Ampicillin
Amoxacillin |
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Extended spectrum penicillins
Characteristics |
1) Lower G+ coverage
2) Extended G- coverage (E.Coli, Salmonella, Shigella, H. Flu, Proteus) 3) Anaerobic coverage with penicillinase inhibitor 4) Acid resistant 5) Urinary excretion |
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Antipsuedomonal penicillins
Drugs |
1) Piperacillin
2) Ticaricillin 3) Mezlocillin 4) Carbenicillin In order of most activity |
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Antipsuedomonal penicillins
Characteristics |
1) Spectrum: all covered by extended spectrum penecillins, plus some G- bacteria (Proteus, Enterobacter, Providencia, Serratia)
2) Major use: Pseudomonas and actinetobacter 3) Suceptible to B-lactamase 4) Acid sensative 5) Renal excretion |
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Combinations with B-lactamase inhibitors
Drugs |
1) Ampicillin and Sulbactam
2) Amoxicillin and Clavulanic Acid 3) Piperacillin and Tazobactam 4) Ticarcillin and Clavulanic acid |
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Combinations with B-lactamase inhibitors
Characteristics |
1) Addition of B-lactamase inhibitors extends spectrum of these agents
2) Not all B-lactamases are inhibited 3) MRSA as resistant still. |
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Penicillin G
Bacteria susceptibility |
Short list
1) Strep pneumo 2) N. Gonorrhea 3) Clostridia |
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Penicillin G
Mechanism |
1) Bactericidal
2) Inhibit final stage of bacterial cell wall synthesis 3) Leads to lysis |
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Penicillin G
Bacterial resistance |
1) B-lactamase
2) Decrease permeability of outer membrane 3) Alter PBPs 4) Autolytic enzymes not being activated 5) Lack of cell wall 6) Non peptidoglycan based cell wall |
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Penicillin G
Pharmacokinetics Oral |
not good, especially for syphilis, subacute bacterial endocarditis, actinomycosis
|
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Penicillin G
Pharmacokinetics Parenteral |
IM/IV high but transient concentration
Painful Intrathecal should never be done=seizures IM=procaine penicillin G Benzathine Penicillin G-long lasting but low concentrations, used for syphilis |
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Penicillin G
Distribution |
1) Widely distributed
2) Poor CNS penetration 3) Bound in excess of 70% 4) Need to give twice the loading dose |
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Penicillin G
Excretion |
1) Most rapidly excreted drug by normal kidney.
2) Can excrete 3million U per hour 3) Partially blocked by probenecid |
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Penicillin G
Toxicity |
1) Allergy
2) Tissue irritation 3) Excess Na+/K+ (Cardiac/renal) 4) Superinfection 5) Soft frothy stools, diarrhea 6) Jarisch-Herxheimer Reaction |
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Penicillin G
Allergy |
Penicillin are the foremost
Cross allergic potential and cross sensitizing Ampicillin Rash not allergy |
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Monobactams
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Aztreonam
G - rods no activity against G+ or anaerobes Safe in patients with a penicillin allergy |
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Carbapenems
Drug |
1) Imipenem
2) Cilastatin 3) Meropenem 4) Ertapenem |
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Carbapenems
Characteristics |
1) G+, G-, anaerobic
2) Imipenem can cause seizures 3) Combination of Cilastatin and imipenem to increase half life 4) Metabolite nephrotoxic |
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Carbapenems
Ertapenem |
1) Highly stable against beta lactamases
2) Has activity against G-, G+, anaerobic particular Enterobacteriaceae 3) IV/IM |