Antimicrobials 2 Flashcards
What are the cell wall synthesis inhibitors?
fosfomycin, beta lactams, bacitracin, daptomycin, vancomycin
cephalosporins MOA?
cephalosporins are beta lactams
- binds to PBP
- activate autolytic enzymes
cephalosporins spectrum?
generation 1 –> 3
increasing activity against gram negative
decreasing activity against gram positive
generation 4 = broad
generation 5 = similar to gen 3 plus effective against MRSA
IMPORTANT: INACTIVE against CLAME
chlamydia, listeria, legionella, actinobacter, mycoplasma, enterococci
cephalosporins vs penicillins? (beta lactamase resistant? bacteriocidal?
more resistant to beta lactamases
ie. next step
beta lactams so yes bacteriocidal
cephalosporins resistance mech?
modify PBPs
1st gen cephalosporins? used for?
cephalexin, cefazolin
Used as a penicillin G subsitute because they are still effective against organisms with penicillinase (a beta lactamase) ie. s. aureus
Cefazolin DOC
surgical prophylaxis
1st gen cephalosporins used to treat?
gram positive
E coli
Klebsiella pneumoniae
P. mirabilis (proteus)
2nd gen cephalosporins? what are they? active against what organisms?
more gram negatives, less gram positives
H. influenza
Enterobacter
Neisseria
2nd gen:
aman is eating a dole cup and suddenly he HEARS something and he thinks it’s an OX coming IN, but no sadly its just an ACTOR
cefamandole
cefotetan
cefoxitin
cefaclor
which 2nd generations treat abd and pelvic cavity infections?
Cefotetan
Cefoxitin
both ones with Os
O looks like a belly
what are the 3rd generation cephalosporins? what are they active against?
cef-triaxone cef-operazone -cef-otaxime -cef-tazidime -cef-fixime
active against same 2nd gen (HEN) -
H. influenza
Enterobacter
Neisseria
active against more gram negatives, and less gram postiives
Which cephalosporins are active against pneumococci?
3rd generation: all the T ones
cef triaxone
cefo taximine
cef tazidime
*recall penicillin G also active against pneumococci
Which cephalosporins are active against pseudomonas?
3rd gen: cefoperazone and ceftazidime
also active against pseudomonas: antipseudomal penicilins
4th generation cephalosporins?
cefipime
parenteral only
wide spectrum:
Hemophilus, enterobacter, neisseria (HEN), (2nd and 3rd)
E Coli, P mirabilis (1st)
Pseudomonas aeruginosa (3rd: operazone, tazidime)
Pneumococcus: (3rd: Ts: triaxone, taxidime, taximime)
cefipime treats?
4th gen
mixed infections - broad spec
complicated UTIs
complicated intra abd infections
febrile neutropenia
5th gen cephalosporin?
ceftaroline
Parenteral only
MRSA!!!!!!!!
similar spectrum to generation 3
cephalosporins admin?
most = paraenteral
except
cephalexin, ceflacor, cefixime
do cephalosporins get to CSF?
only 3rd gen
cephalosporins elimination?
kidneys
EXCEPTION: bile: ceftriazone and cefoperazone
which beta lactams cause disulfiram like side effects? what other side effect is caused by these drugs ?
cephalosporins:
cefamandole
cefotetan
cefoperazone
*also cause low prothrombin
If allergic to penicillin, can you prescribe cephalosporins?
minor allergy: go tru
severe: no
What are some AE of cephalosporins?
kernicterus: ceftriaxone binds albumin
allergic reactions
pain at infection site
SUPERINFECTIONS - CLOSTRIDIUM DIFICILE
Carbapenems? Beta lactamase resisitent? MRSA resistant?
Yes. resistant against beta lacatmase (so are monobactams) (as you go down the list of beta lactams, more resistant)
Not MRSA resistant
Carbapenems ?
doripenem
ertapenem
imipenem (AMY in sketchy)
meropenem
Carbapenems spectrum?
very broad spectrum
gram pos
gram neg
aerobes
anaerobes
Pseudomonas aeruginosa (except ertapenem) remember em rata is skinny ie less broad
Carbapenem AE?
partial cross sensitivity with penicilins
High IMIPENEM: seizures
Which carbapenem has to be given with something else in order to prevent it’s degradation?
imipenem
cilastatin (keep it lastin with cilastin)
cilastin : dehydropeptidase inhibitor
if not, imipenem is degraded by
dehydropeptidase 1
When are carbapenems prescribed?
usually restricted to avoid resistance
only given for LIFE THREATENING infections that req beta lactamase activity
Monobactams? names? resistant to beta lactamases?
aztreonam
yes resistant
can you give monobactam to patients with penicillin allergies?
yes.
monobactam is the most structurally different one of the Beta lactams - little cross hypersensitivity
monobactam spectrum?
narrow
only give to
aerobic, gram negative rods
pseudomonas
*weird because most drugs treat gram postive
monobactams active against pseudomonas?
yes
when are monobactams prescribed?
gram negative infections (already hard to treat) in patients allerfic to penicillin
UTIs, intraabdominal, gynceological infections, etc
monobactams rote of admin?
IV, IM, can even be inhaled for cystic fibrosis patients
monobactam penetrate CSF? excretion?
yes, when inflamed
excreted via urine
