kuhl antibiotics

what kind most susceptible i suppose to b lactamase

natural penicilkins (Penicillin G/Penicillin G Benzathine/Penicillin G Procaine/Procaine + Benzathine/Penicillin V Potassium)

what two toxicities are we esp worried about with vanc esp

nephrontox

ototox

which NOT renally elmianted

ceftriaxone (biliary), nafcillin/oxacillin (biliary).

what are CNS penetrating (best in meningitidis)

ceftriaxone, cefuroxime, cefepime, and the carbapenems

how does “10% rule” estimation compare to risk for dissimialr side chains

overstates

how does “10% rule” estimation compare to risk for similar side chains

understates

does cross reactivity pertain to beta ring or r1 side

r1 side chain

what are the two drugs to cover MRSA? why

cetaroline and ceftobiprole

• bind PBP2a

what are the natural penicilins DOC for

natural penicilkins (Penicillin G/Penicillin G Benzathine/Penicillin G Procaine/Procaine + Benzathine/Penicillin V Potassium)

syphilis

streptococcus pyogenes but not s. pneumonia

which kind of celwalsyni has severe delayed reactions as class effect

cephalosporin

what are the worst offenders for durg induced hemolytic anemia

cefotetan and ceftriaxone

• two cephies

what is CDAD

c dif associated diarrhea

how do cephies potentially affect INR

can kill bacteria that make vitamin K; INR can gradually increase so more bleed risk

what are the two pen G forms that form IM depots

Benzathine and procaine are repository

• weekly or monthly dosing

what is the acid stable nat peny

Penicillin VK

• the only PO

what is the oral nat peny and why

Penicillin VK bc its acid stable

bbw for natl penys (penny g’s/v’s)

BBW (benzathine, IM): NOT FOR IV USE.

why can penny G (natl) cuase hyperK

bc it is penny G potassium IM— high dose or renal impairment can cause too much K

what is rxn called for natl pennys when treating syphilis? how present? is it an allergy?

Jarisch–Herxheimer reaction

• fever/chills hours after the first dose; expected, not an allergy.

is bilicin C-R interchangable with L-A

NO

are natl pennys broad or narrow spec

VERY narrow

are natl pennys ok in preg?

PREF IN PREG benzathine penicillin G is the only recommended syphilis treatment in pregnancy; a penicillin-allergic patient must be desensitized, not switched.

list aminopeni

Amoxicillin

(Amoxil®) PO

 

Amoxicillin/Clavulanate

(Augmentin®) PO

 

Ampicillin

(Principen®) IV/IM

 

Ampicillin/Sulbactam

(Unasyn®) IV/IM

aminopeni (amox/ampi) what cover

gram + and some gram -

aminopeni (amox/ampi) what is ampi DOC for

listeriaà

aminopeni (amox/ampi) what is amox DOC for

dental proph, otitis media

what aminopeni (amox/ampi) do you take with gentamicin for enteroccus faecallis

ampicillin

do cephies cover enterococci

noooo this is what makes the pennies special

which kind of penicilin esp associated with the NON-allergic maculopapular rash

aminopeni (amox/ampi)

• esp during ebv/mononucleosis

how are aminopeni (amox/ampi) in preg

pref in preg

synomyns for anti-staph penicillins

penicillinase-resistant

list the anti-staph pennies

Nafcillin

(Nafcil®, Unipen®) IV/IM

 

Oxacillin

(Bactocill®, Prostaphlin®) IV/IM

 

Dicloxacillin

(Dynapen®, Pathocil®) PO

what do the anti-staph pennies cover (naf, oxa, diclox)

gram + only

• durp lol they are anti staph

can you use bicilin C-R (natl pen) for syphilis

NOOOO no L-A onlyyyy

what is the DOC for MSSA (methicillin-sens Staph aureus)

anti-staph (naf/oxa/diclox)

do anti-staph (naf/oxa/diclox) work on MRSA

NOOOO no mrsa has altered PBP2a

• only ceftaroline and ceftobiprole

what are the oral aminopen? what are teh ivs?

amox— the po

ampi— IV/IM

how did dr kuhl describe aminopens?

“penicillin plus a bit more”

what is dif abt elmination of two of the anti-stpah pens?

naf/oxa biliary (h—liver) elim— NO renal dose adjust

what is the PO anti-staph (naf/oxa/diclox)

diclox

• take on empty sotmach

which natl aminopen has better bioavail

amox vs ampi— ampi not used much

which anti-staph (naf/oxa/diclox) has hypokalemia warning

nafcillin: hypokalemia — it is a non-reabsorbable anion at the distal tubule, so sodium is exchanged for potassium. Check K⁺ on high-dose IV therapy.

which class of pennies most commonn for interstital nephritis

anti-staph (naf/oxa/diclox)

which anti-staph (naf/oxa/diclox) is a cyp3a4 inducer? what does this do to INR/warf

nafcillin

• DECREASE inr

• LESS anticoag

• dif from all other antibios

what is the one extended spec pen?

Piperacillin/Tazobactam

Piperacillin/Tazobactam brand

zosyn

Piperacillin/Tazobactam formulation

IV/IM

Piperacillin/Tazobactam what is another nae for extended-spec pen

anti-pseudomonal

Piperacillin/Tazobactam (extend-spec) coverage

BROAD

• gram +

  • gram - …. includes psuedomonas, thus the name

are the anti-staph (NOD) broad or narrow

narrow durp its more staph, esp MSSAs

what is teh “workhorse” for hospital infection

Piperacillin/Tazobactam (extend-spec)

what two drugs cause the inflammed veins— thrombophlebtis

naf/oxa (anti-staph)

what does Piperacillin/Tazobactam (extend-spec) NOT cover well

ESBL producers

why is the tazo added to Piperacillin/Tazobactam (extend-spec)? does it add psuedom coveragee

NO, only added staphylococcal, some gram (−) and anaerobic coverage:

Piperacillin/Tazobactam (extend-spec) how is killing different ? how this affect administration?

time-dependant

• need extended/prolonged infusions

how long induction of CYP3a4 take to start affecting other drugs

days to weeks

which pen causes coag abnormalities

Piperacillin/Tazobactam (extend-spec)

• prolong bleedding time/plt dysfunction

does it take longer to affect or restore INR

restore— always weeks

Piperacillin/Tazobactam (extend-spec) what ion affect and what CI does this causes

high sodium load

• caution in heart failure or sodium restriction

what with Piperacillin/Tazobactam (extend-spec) cause nephrotox

vancomycin

are these drugs all cidal or static? are they concentration or time depend?

all time depend

what is the one big Amidinopenicillin to know ? how administered

Pivmecillinam

(Pivya®) PO

Amidinopenicillin (Pivmecillinam) broad or narrow? what cover?

gram -

• onlyyyy enterbacterales

what are the gram - enteracterales Amidinopenicillin (Pivmecillinam) covers

e coli, klebsiella, proteus

when si Amidinopenicillin (Pivmecillinam) given (ind?)

ONLY uncomplicated UTI

what is unique about pharmacology for Amidinopenicillin (Pivmecillinam)

PRODRUG

how Amidinopenicillin (Pivmecillinam) help target RESISTANT gram - orgs

binds pbp2

what is special about dose adjust in Amidinopenicillin (Pivmecillinam)

no renal adjust

which pen.s should really NOT be used in preg and WHY

Amidinopenicillin (Pivmecillinam)

• Sulbactam/Durlobactam not great either

bc so new safety has not been established

which drug has CI in primary or secondary carnitine def and WHY

Amidinopenicillin (Pivmecillinam)

• an interaction between carnitine adn the pivaloyl ester prodrug

what is the b-Lase inhib combo pennie?

Sulbactam/Durlobactam

what is carnitine

vitamin-liek substance that helps make amino acids

• CI with teh pivoxils— tebipenem, Pivmecillinam

Sulbactam/Durlobactam (b-Lase inhib combo) what is the ONLY thing ind for

Acinetobacter baumannii-calcoaceticus complex (ABC) ONLY.

what is Acinetobacter baumannii-calcoaceticus complex liek where come from? what cover?

Hospital-acquired and ventilator-associated pneumonia (HABP/VABP) caused by ABC.

• Sulbactam/Durlobactam (b-Lase inhib combo)

Sulbactam/Durlobactam (b-Lase inhib combo) why “role reversal?”

bc sulb normallly used as one of the “kamikaze” b-Lase inhibitors but in this case it acts as the active beta lactam

list the monobactams

Aztreonam

(Azactam®) IV

 

Aztreonam/Avibactam

(Emblaveo®) IV

◆ NEW 2025

what is the new antibiotic from 2025?

Aztreonam/Avibactam

(Emblaveo®) IV

a monobactam

monobactams (aztreonam, aztre/avibactam) coverage

gram (-) bacili ONLY

• including pseudomonas

  • no gram + or anaerobic

what is the “niche” for monobactams (aztreonam, aztre/avibactam)

it can be used even in severe penicillin allergy

what is the unique monobactam that can hit the ambler class B metallo-b-Lases

aztre/avibactam

why are monobactams (aztreonam, aztre/avibactam) stable to many b-Lases and non-cross reactive

bc monocyclic ring

what is huge major side effect for aztre/avibactam

liver injury

what is the ONE pen that is the exception to acceptable use of monobactams (aztreonam, aztre/avibactam) in pen allergy

CEFTAZIDIME— its R1 side chain is very similar

what is the rule with ceph in terms of niche and generation

gets more negative with time== like humans!

list the first gen cephies

Cefazolin

(Ancef®) IV

 

Cephalexin

(Keflex®) PO

 

Cefadroxil

(Duricef®) PO

coverage of first gen cephies (cefazolin, cephalexin, cefadroxil)

gram + cocci

• BUT NOT enterococci or MRSA

what is the first gen cephie cefazolin the DOC for (Ancef®, Kefzol®)

surgical proph

which generation of cephies best choice for MSSA coverage

first gen (cefazolin, cephalexin, cefadroxil)

how do first gen cephies (cefazolin, cephalezin, cefadroxil) compare to pennies in regard to b-Lases

MORE resistant to b-Lases

what is BIG CI for cephalexin (its a ddi )

with dofetilide

list 2nd gen cephies

Cefoxitin

(Mefoxin®) IV

 

Cefotetan

(Cefotan®) IV

 

Cefuroxime

(Zinacef® IV; Ceftin® PO)

 

Cefaclor

(Ceclor®) PO

 

Cefprozil

(Cefzil®) PO

2nd gen cephies (cefoxitin, cefotetan, cefuroxime, cefaclor, cefprozil)

what gen of ceph are teh two cephamycins and what are they

Cefoxitin and cefotetan

• 2nd gen cephies

what is the only 2nd gen cephie with good CNS penetration

Cefuroxime

• remember “furious me?” well it goes straight to brain

is Cefuroxime and Cefuroxime axetil bioequivalent?

NO the axetil is a prodrug

warning for ceftotetan? what is class

2nd gen cephie

• causes disulfiram-like rxn with alcohol

• increases INR

• bc of “MTT side chain”

what needs to be monitored in ceftotetan

PT/INR

list third gen cephies

Ceftazidime (Fortaz®, Tazicef®) IV/IM   Ceftazidime/Avibactam (Avycaz®) IV   Ceftriaxone (Rocephin®) IV/IM   Ceftolozane/Tazobactam (Zerbaxa®) IV   Cefixime (Suprax®) PO Cefpodoxime proxetil (Vantin®) PO Cefdinir (Omnicef®) PO

what is DOC for bacterial meningitis and what gen of cephie?

ceftriaxone

• third gen

what is teh BEST cns penetrating drug of the cephies

ceftriaxone