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🄼 💊M2 PHARM EXAM 3 Rx > 9-10 Cephalosporin/Carbapenems/Monobactams > Flashcards

9-10 Cephalosporin/Carbapenems/Monobactams Flashcards

1
Q

A: [B-Lactams] = INHIBITS ______ SYNTHESIS

B: MOST are [Renal Eliminated] Except ….. (2)

C: All [B-lactams] have [Cross-Allergenitcity] except ______

——————————————————————————D: Cephalosporins contain a [______ ring] attached to a [6-membered ______ ring] —> confers stability against [______ enzymes]

E: Cephalosporins have ___ half lives EXCEPT CefTriaxone = ____ hours

A

A: B-Lactams = INHIBITS CELL WALL SYNTHESIS

B: MOST are [Renal Eliminated] Except:

(x) CefTriaxone {eliminated by Biliary}
(x) CefoPerazone {eliminated by Liver}

C: All [B-lactams] have [Cross-Allergenitcity] except Aztreonam

D: Cephalosporins contain a [B-lactam ring] attached to a [6-membered Dihydrothiazine ring] —> confers STABILITY against [B-LactaMase enzymes].

E: Cephalosporins have short half lives EXCEPT CefTriaxone = 8 hours

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2
Q

What are the 4 [B-Lactams]

A

B-Lactams:

  1. Penicillins (House + Garage)
  2. Cephalosporins (Garage +[6-membered structure])
  3. Monobactams (Garage)
  4. CarBaPenems (TWO Garages)
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3
Q

CEPHALOSPORIN

A: Cephalosporin MOA

B: Bacteriostatic vs. BacteriCIDAL

C: How are Cephalosporins DeActivated?

C2: Explain its relationship with SPICE Bacteria

D: Cephalosporin can also be useless when _____ or _______ have altered their [penicillin binding protein] or ______ membrane permeability

A

A: Cephalosporins INHIBIT [Penicillin-Binding Proteins] in the [Cell Wall]—> Inhibits FINAL transpeptidation step

B: BacteriCIDAL

C: Cephalosporin can be DeActivated when [B- Lactamase enzymes] hydrolyze [B-Lactam Ring]. They also can INDUCE the production of these [B-Lactamase enzymes] = (SPICE BACTERIA)

D: Cephalosporin can also be useless when [MRSA or PRSP] have altered their [penicillin binding protein] or outer membrane permeability

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4
Q

Cephalosporins have 5 Generations

A: 1st Generation Cephalosporins are best for ______ and some ________

B: Name the 4 Gram Positives Bacteria that [1st Gen Cephalosporin] treats?

A

A: 1st Generation Cephalosporins are best for [Gram POSITIVE Aerobes] and some [gram negative aerobes]

B: Gram Positives:

  • MssA
  • [PssP]
  • [Group Strep]
  • [Viridans Strep]

“Many Pts Get Violent when taking [1st and 2nd Cephalosporins] “

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5
Q

Cephalosporins have 5 Generations

A: 1st Generation Cephalosporins are best for ______ and some ________

B: Name the 3 [Gram negative Bacteria] that [1st Gen Cephalosporin] treats?

A

A: 1st Generation Cephalosporins are best for [Gram POSITIVE Aerobes] and some [gram negative aerobes]

B: Gram negatives =

1º PEK

  • [Proteus Mirabilis]
  • [E. Coli]
  • [Klebsiella]
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6
Q

3 [1st Generation Cephalosporins] (Generic and Brand Name)

A
  1. [Cefazolin - Ancef]
  2. [Cephalexin - Keflex]
  3. [Cefadroxil - Duricef]
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7
Q

A: 2nd Generations are more active against ______ and, specifically, [2nd generation - ______] acts on AnAerobes such as ____

B: Which Gram Positive bacteria do [2nd generation cephalosporins] treat? (4)

A

A: 2nd Generations are more active against [gram negative aerobes] and [CEPHAMYCIN 2º Ceph] acts on AnAerobes such as [Bacteroides Fragilis]

B: Gram Positives:

  • MssA
  • [PssP]
  • [Group Strep]
  • [Viridans Strep]

“Many Pts Get Violent when taking [1st and 2nd Cephalosporins] “

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8
Q

A: 2nd Generations are more active against ______ and, specifically, [2nd generation - ______] acts on AnAerobes such as ____

B: Which Gram negative bacteria do they treat? (6)

A

A: 2nd Generations are more active against [gram negative aerobes] and [CEPHAMYCIN 2º Ceph] acts on AnAerobes such as [Bacteroides Fragilis]

B: Gram negatives [2nd generation Cephalosporins Treat] =

2º HENPEK

  1. Haemophilus Influenzae
  2. E.Coli
  3. Neisseria
  4. Proteus Mirabilis
  5. Enterobacter
  6. Klebsiella
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9
Q

4 [2nd Generation Cephalosporins] (Generic only)

A

[2nd Generation Cephalosporins]

  1. Cefuroxime
  2. Cefprozil
  3. [CefoXitin Cephamycin]
  4. [CefoTetan Cephamycin]
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10
Q

A1: [3rd Generation Cephalosporins] are BEST at ______ (even ones that produce [______].

A2: [______ - 3º Ceph] and [______ - 3º Ceph] are the BEST 3rd generation against [Gram Positive Aerobes] INCLUDING [Penicillin RESISTANT ______ ______]

A

A1: [3rd Generation Cephalosporins] are BEST at [Gram negative aerobes] (even ones that produce [B-lactamase].

A2: [CefTriaxone - 3º Ceph] and [CefoTaxime - 3º Ceph] are the best 3rd generation against [Gram POSITIVE Aerobes] INCLUDING [PRSA]

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11
Q

What Gram Negative Aerobes do [3rd Generation Cephalosporins] Treat? (9)

A

[3rd Generation Cephalosporin] Gram negative Aerobes:

B: Gram negatives [3rd generation Cephalosporins Treat] =

3º HENPEKSSS

  1. Haemophilus Influenzae
  2. E.Coli
  3. Neisseria
  4. Proteus Mirabilis
  5. Enterobacter
  6. Klebsiella
  7. Salmonella
  8. Serratia
  9. Shigella
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12
Q

What 2 [3rd Generation Cephalosporins] can you give to treat [Pseudomonas Aeruginosa]

A
  1. [CefTazidime - 3º Ceph]
  2. [CefoPerazone - 3º Ceph]

“Out of the 3º Cephs, only a Pure Tazmaninan Devil can defeat Mona”

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13
Q

4 [3rd Generation Cephalosporins] (Generic and Brand)

A

[3rd Generation Cephalosporins]

  1. [Ceftriaxone - Rocephin]
  2. [CefTazidime - Fortaz]
  3. [Cefpodoxime - Vantin]
  4. [CefoPerazone - Cefobid]
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14
Q

[4th Generation Cephalosporin]

A: Name 3 Reasons we need this

B: What’s the name of the ONLY [4th Generation Cephalosporin] available?

C: 2 [Gram negative bacteria] it treats

A

[4th Generation Cephalosporin]

  1. Extended spectrum of activity
  2. Stable against [B-Lactamase enzymes]
  3. poor inducer of [B-Lactamase enzyme]

B: [CefePIME - 4º Ceph] is the only Rx available

C:

  • Pseudomonas Aeruginosa
  • Enterobacter producing [B-lactamase]
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15
Q

[5th Generation Cephalosporin]

A: Has Extended Activity against … (4)

B: Name the only Rx available

A

[5th Generation Cephalosporin]

A: Extended Activity against

  • Respiratory Pathogens
  • Strep Pneumoniae (can treat [CA-bacterial PNA] )
  • MRSA
  • Skin Infections

“The 5th Generation will [Recognize S.M.S.] text”

B: [CeFTaROline - 5º Ceph] is only available

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16
Q

Which generation Cephalosporin is used for [Surgical Prophylaxis]?

A

[1st Generation Cephalosporin]

17
Q

What 4 indications are [CefTriaxone - 3º Ceph] mostly for?

A
  1. [Viridans Strep]
  2. CA-PNA
  3. Uncomplicated Gonorrhea (single IM dose)
  4. PRSP and PRSA

“What do we even need CefTriaxone for? V-CUP!”

18
Q

Adverse Effects of Cephalosporins

  1. Hypersensitivity (2)
  2. [MTT side chain] = can cause inhibition of Vitamin ___ metabolism or _______ —> what 2 conditions?
A

Adverse Effects of Cephalosporins

  1. Hypersensitivity = Rash and [IgE-mediated rxn]
  2. [MTT side chain] = can cause inhibition of Vitamin K metabolism or [DEC in Vitamin K GI bacteria] —>

♦ [hypO-prothrombinemia]

♦Ethanol intolerance

19
Q

A: List 4 Main Carbapenems

B: Structure allows for __________ and [____ stability] —> __________

C: Carbapenems are _______[bacteriostatic/bactericidal] that works by ________ and inhibiting [_____]

A

Carbapenems: = DIME

1) DOripenem ** –> best for Gram Positive AND Gram negative Aerobes
2) i​mipenem ** –> best for Gram Positive Aerobes
3) Meropenem xx –> best for gram neg aerobes
4) Ertapenem xx –> best for gram neg aerobes (but not Pseudomonas Aeruginosa) ———————————————————————————- ———————————————————————————-

B: Structure allows for [Extended Spectrum of activity] and [B-lactamase stability] —> [MOST BROAD SPECTRUM ABX]

C: Carbapenems are BacteriCIDALs that works by EFFICIENTLY penetrating cell wall and inhibiting [PBP2]

20
Q

Bacteria NOT Covered by Carbapenems (7)

A

Bacteria NOT Covered by Carbapenems

  1. MRSA
  2. [Atypical Bacteria]
  3. C.Diff
  4. Maltophilia
  5. VRE
  6. PRSP
  7. [Coag neg Staph]

“MAC, an MVP rejects Carbapenems”

21
Q

A: What are the 5 [Gram Positive Aerobes] covered by Carbapenems?

B: Which one does it transition into a Bacteriostatic for?

A

List the [Gram POSITIVE Aerobes] that Carbapenems Cover

  1. PssP
  2. Virdans Strep
  3. Group Strep
  4. Enterococcus= ACTS AS BACTERIOSTATIC
  5. MssA

“A Positive Carbapenem is a Vibrant GeM”

22
Q

Gram negative aerobes covered by Carbapenems (4)

A

Gram negative aerobes covered by Carbapenems -

  • ALL [Bacteroides species]
  • Fusobacterium
  • [Proteus Mirabilis]
  • NEISSERIA
23
Q

Carbapenem Elimination

A: All primarily eliminated by ______

B: Imipenem undergoes hydrolysis by a ______ enzyme in the ______ to a ______ metabolite; comarketed with ______, a DHP inhibitor.

C: Carbapenems have ______ half-lives (i.e. Ertapenem = __ hours)

A

Carbapenem Elimination

A: All primarily eliminated by Kidney

B: Imipenem undergoes hydrolysis by a dihydropeptidase enzyme in the renal brush border into a nephrotoxic metabolite; comarketed with cilastatin, a DHP inhibitor

C: Carbapenems have Short half-lives (i.e. Ertapenem = 4 hours)

24
Q

4 CLINICAL USES FOR Carbapenems

A
  1. Polymicrobial Infections
  2. Infections 2º to [B-lactamase producing organisms] like SPICE/SPACE
  3. Pseudomonas (CAN’T USE ERTAPENEM)
  4. Empiric therapy for [Nosocomial Infections]

P.I.P.E

“DIMEs are for PIPEs “

25
Q

Carbapenem Adverse Effects (3)

B: What are risk factors for Seizure-induced Side Effect (3)

A
  1. CNS = Seizures / Confusion / Dizziness

B: Risk Factors for Seizures:

  • High doses
  • Renal Insufficiency
  • CNS disorder
26
Q

What’s the only MONOBACTAM currently available

B: Mechanism

C: Time or Concentration Dependent

D: Main Organism targeted

A

[AZTREONAM Monobactam]

B: BINDS TO [PBP3] of [gram NEGATIVE AEROBES ONLY]

C: [Time Dependent BacteriCIDAL]

D: -Pseudomonas Aeruginosa

27
Q

Can [AZTREONAM-monobactam] be used in a pt allergic to Penicillin? Why or why not?

A

[AZTREONAM-monobactam] has NO [cross-reactivity] with Penicillins and thus, CAN BE USED in [Penicillin allergic pts]

28
Q

Which bacteria are Cephalosporins NOT active against as a family?

A

“Cephalosporins can’t fight CAMELS”

(x) C. Diff
(x) [Atypical bacteria like Legionella]
(x) MRSA
(x) Enteroccocus
(x) Listeria
(x) [Stenotrophomonas maltophilia]

🄼 💊M2 PHARM EXAM 3 Rx (8 decks)

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