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Pharm > Antimicrobials: Cephalosporins > Flashcards

Antimicrobials: Cephalosporins Flashcards

1
Q

Cephalosporins MoA

A

Same as PCNs, they effect the cell wall.

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2
Q

What organism do none of the cephalosporins cover?

A

Enterococcus.

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3
Q

MTT side chains in cephalosporins may result in what (2)

A

prolonged PT/INR (bleeding risk)

disulfiram reaction when combined with alcohol (makes you very sick when you drink, used to be used as a negative reinforcer for alcohol abuse).

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4
Q

which cephalosporin is most likely to prolong PT/INR

A

Cefotetan

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5
Q

Generations of Cephalosporins

A

5 generations. 1st is extremely gram positive. From 1st to 5th, you gain gram negative effects while keeping gram positive effects.

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6
Q

First generation Cephalosporins activity

A

extremely gram positive

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7
Q

fifth generation cephalosporins are indicated in

A

resistant organisms

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8
Q

4th and 5th generation cephalosporins

A

the most broad antibiotics. used a lot as empirics.

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9
Q

Cephalosporin cross sensitivity with PCNs

A

1 - 3%

If they had anaphylaxis or hives to PCNs, avoid cephalosporins.

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10
Q

Absorption of Cephalosporins

A

rapid, thorough

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11
Q

distribution of cephalosporin

A

highly distributed and penetrable

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12
Q

A Cephalosporin metabolized 40% by the liver

A

ceftriaxone

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13
Q

Half life of cephalosporins

A

is mostly short except for ceftriaxone

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14
Q

excretion of cephalosporins

A

unchanged in urine, though some undergo biliary excretion.

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15
Q

ceftriaxone and liver disease

A

not contraindicated, just need to be cautious and monitor.

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16
Q

first generation cephalosporins include (3)

A

cefazolin
cephalexin
cefadroxil

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17
Q

1st generation Cephs are very active against (2)

A

Streptococcal

MSSA

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18
Q

1st generation ceps: weaknesses (3)

A
  • limited activity against gram neg rods
  • no anaerobic cvg
  • poor CSF penetration
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19
Q

1st gen cephs distribution

A

all tissues

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20
Q

1st gen cephs dose reduction

A

If CrCl is <50 mL/min

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21
Q

2nd generation cephalosporins are divided

A

into two groups

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22
Q

2nd generation cephalosporins: group 1 drugs

A

cefuroxime

cefaclor

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23
Q

2nd generation cephalosporins, group 2 AKA

A

the cephamycins

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24
Q

2nd generation cephalosporins, group 2 (cephamycin) drugs

A

cefoxitin
cefotetan
(These have the MTT chains)

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25
Q

Indication of 2nd generation cephalosporins, group 2 (cephamycins)

A

“dirty surgery” ie: GI/GU surgeries

26
Q

2nd generation cephalosporins, group 1, indicated in

A

respiratory infections

head/neck infections

27
Q

risk with cefoxitin or cefotetan

A

bleeding risk

worse in cefotetan

28
Q

Activity of 2nd generation cephalosporins, group 1

4

A
  • active against strep and MSSA
  • some activity against gram neg organisms (head/neck)
  • no activity against gram neg anaerobe bacterioides (b. fragilis)
  • variable CSF levels
29
Q

Activity of 2nd generation cephalosporins, group 2 (cephamycins)
(4)

A
  • inferior against strep and MSSA
  • very good coverage against bacteroides (B fragilis)
  • enhanced activity against gram negatives compared to the 1st generation and 2nd generation group 1s.
  • GI/GU surgeries
30
Q

Distribution of 2nd generation cephalosporins

A 
lung
female GU
kidney
synovial fluid
peritoneal/pericardial fluid
pleural fluid
31
Q

Cefuroxime, a 2nd generation cephalosporin, may be used for

A

meningitis as it penetrates well into the CSF.

32
Q

Dose adjustment for 2nd generation cephalosporins

A

CrCl <50 mL/min

33
Q

3rd generation cephalosporins are divided into

A

anti pseudomonas

and others

34
Q

The only time a patient will be on BID ceftriaxone is in the setting of

A

meningitis

35
Q

3rd generation cephalosporins- anti psuedomonal

A

ceftazidime

36
Q

third generation cephalosporins, “others” (non anti pseudomonas)
(3 for this class)

A

ceftriaxone
cefpodoxime
ceftazidine

37
Q

cefotaxime, a third generation cephalosporins, will be used in the setting of

A

hyperbilirubinemia of newborns, as it will not make the condition worse like ceftriaxone will.

38
Q

cefpodoxime, a 3rd generation cephalosporin, can be thought of as

A

an oral substitute for ceftriaxone.

39
Q

What do you need to keep in mind when prescribing cefpodoxime?

A

it does have an MTT chain, so monitor labs if a patient is also on warfarin

40
Q

dose adjustments for 3rd generation cephs

A

renal: CrCl <50 mL/min

hepatic for ceftriaxone

41
Q

distribution of 3rd generation cephs

A

extensively distributed and penetrates the CSF

42
Q

4th generation cephalosporin drug

A

cefepime

43
Q

what is the broadest of the cephalosporins?

A

cefepime

44
Q

activity of 4th gen cephalosporin, cefepime

A
  • superior gram neg activity, with good activity against pseudomonas
  • staph and strep cvg is comparable to the earlier generations
  • NO activity against MRSA.
45
Q

cefepime as an empiric abc

A

excellent

46
Q

oncologic indication for cefepime

A

febrile neutropenia

47
Q

distribution of 4th gen ceph, cefepime

A

same as 3rd gen.

48
Q

5th generation cephalosporin

A

ceftaroline

49
Q

ceftaroline claim to fame

A

anti MRSA

50
Q

spectrum of activity of 5th generation cephalosporin, ceftaroline

A 
very wide
gram neg
gram pos
aerobic
anaerobic
51
Q

what conditions may you see 5th generation cephalosporin, ceftaroline, used in and what condition will you NOT see it in?
(3, 1)

A

respiratory infections
MRSA
S. pneumo

NOT pseudomonas.

52
Q

why would you give cefepime and Vanco and metronidazole? (empiric)

A

cefepime for the broad spectrum and pseudomonas coverage
Vanco for MRSA
flagyl for anaerobic cvg.

then you’ll de escalate as your cultures come back

53
Q

General monitoring when on cephalosporins

A

c&s
CBC c diff
LFTs
RFTs

54
Q

pregnancy/lactation considerations for cephalosporins (4)

A

category B
cross placenta
may see inc Vd / clearance
crosses breast milk in small amounts

55
Q

Pediatric considerations for cephalosporins

A

longer half lives

*no ceftriaxone in hyper-bilirubinemia infants.

56
Q

Geriatric considerations for cephalosporins

A

dose adjust for renal insufficiency

57
Q

considerations for critically ill patients receiving cephalosporins and example

A

may need higher doses

ie: ceftriaxone dosing for meningitis

58
Q

obesity considerations for cephalosporins

A

may be dose adjusted up

59
Q

when is the only time you’ll see ceftriaxone dosed more than once a day?

A

meningitis

60
Q

cefepime vs ceftaroline

A

cefepime coveres psuedomonas but not MRSA

ceftaroline covers MRSA but not psuedomonas

61
Q

3rd generation cephalosporins: ceftazidime

5

A
  • best for pseudomonas
  • weak against strep and MSSA compared to the others
  • poor activity against gram neg anaerobes (covers <50% b fragilis)
  • excellent CSF levels
  • may see c diff

Pharm (31 decks)

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