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Respiratory 2 > Beta Lactams 2 - Fitzpatrick > Flashcards

Beta Lactams 2 - Fitzpatrick Flashcards

1
Q

1st generation Cephalosporins have high similarity to what Penicillins? So?

Main drugs? (2) Oral or Parenteral?

A

Ampicillin/Amoxicillin + beta-lactamase inhibitor combos
- can enter gram (-) pores OR grapple with gram (+) organisms AND deal with beta-lactamase producing enzymes

Cephalexin (ORAL), Cefazolin (PARENTERAL)

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2
Q

1st generation Cephalosporins are good against what organisms?

A
  • Strep. pyogenes/pneumoniae and Staph. aureus (Penicillin-sensitive strains)
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3
Q

Clinical use for EITHER 1st generation Cephalosporin

A

Surgical prophylaxis

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4
Q

Good use of Cephalexin RATHER THAN Cefazolin

A

ORAL –> pharyngitis (good dosing schedule)

- Strep. pyogenes, etc.

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5
Q

3rd generation Cephalosporins - thing what ADDITIONAL coverages besides those from 1st generation? (2)

A
  • CNS infections (meningitis)

- Pseudomonas

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6
Q

3rd generation Cephalosporin drugs (4)

A
  • Ceftriaxone
  • Cefotaxime
  • Ceftazidime
  • Cefaperazone
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7
Q

***Benefits of Ceftriaxone vs. a 1st generation (6)

A
  • Long 1/2 life
  • Penetrates CSF and bone
  • Treats NEISSERIA (gonorrhea and meningitis)
  • Treats Ampicillin-resistant H. Influenza
  • Treats BORRELIA (LYME DISEASE in CNS or joints)
  • Biliary clearance (easier dosage adjustments)
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8
Q

***Benefit of Cefotaxime vs. a 1st generation

A

Useful for MENINGITIS due to…

  • H. influenza
  • S. pneumoniae
  • N. meningitidis
  • Enteric bacteria
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9
Q

Benefit of Ceftazidime vs. a 1st generation

A

Pseudomonas coverage…

- Strains resistant to anti-pseudomonal Penicillins
- Penicillin allergy
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10
Q

Benefit of Cefaperazone vs. 1st generation

A

Pseudomonas coverage

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11
Q

Patient is on an antibiotic and develops a flushing reaction after drinking alcohol. What drug was she on?

A

Cefaperazone

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12
Q

LIKE 1st GENERATION, 3rd generation is good against what organisms?

A
  • S. aureus
  • S. pneumoniae
  • S. pyogenes
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13
Q

UNLIKE 1st GENERATION, 3rd generation ALSO is good against what organisms?

A
  • Gram (-) rods

- Enteric organisms

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14
Q

ALL 3rd generation drugs are administered how?

A

Parenteral

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15
Q

In SERIOUS Pseudomonas infection, Ceftazidime or Anti-Pseudomonal Penicillin should ALWAYS be administered with what else?

A

An aminoglycoside (Tobramycin)

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16
Q

2nd generation Cephalosporin drugs (4) (+ administration route)

A
  • Cefoxitin - PARENTERAL
  • Cefotetan - PARENTERAL
  • Cefaclor - ORAL
  • Cefuroxime axetil - ORAL
17
Q

2nd generation Cephalosporins are BEST vs. which 2 groups of organisms (compared to 1st generation)?

A
  • Gram (-) – E. coli, Klebsiella (aspiration), H. influenza, Moraxella cattharalis (nose), Proteus
  • Anaerobes (B. fragilis, C. diff., Actinomyces, etc.)
18
Q

Clinical uses of 2nd generation Cephalosporin (2)

A
  • Intra-abdominal or gynecological sepsis

- Intra-abdominal/colorectal surgery

19
Q

Best 2nd generation Cephalosporins for anaerobic bacteria

A

Cefoxitin, Cefotetan (i.e. the parenteral ones)

20
Q

Best 2nd generation Cephalosporin for methicillin-resistant (beta-lactamase producing) organisms

A

Cefuroxime axetil

21
Q

Child patient starts an antibiotic and develops a type 3 hypersensitivity (like serum sickness) reaction in her skin and joints. Drug used?

A

Cefaclor (2nd generation Cephalosporin)

22
Q

4th generation Cephalosporin drug

Has actions comparable (a little better) to a combo of which other 2 generations?

A

Cefepime

1st generation (gram (+) w/ beta-lactimase insensitivity) + 3rd generation (gram (-), pseudomonas)

23
Q

A patient had a Pseudomonas infection and was taking Ceftazidime, but the drug started to wear off. Other option?

A

Cefepime (4th gen.) - active against Ceftazidime-resistant strains of Pseudomonas

24
Q

2 potential adverse effects of Cephalosporins

A
  • Hypersensitivity (type 1 anaphylaxis or type 4 rash)

- Disulfiram-like reaction (nausea, flushing, HA w/ alcohol consumption)

25
Q

A patient had a recent severe hypersensitivity reaction to a Penicillin. Should you give a Cephalosporin instead?

A

NO

26
Q

The disulfiram-like reaction seen as an adverse effect to Cephalosporins results from an inhibition of what enzyme? Which causes a build-up of what?

A

Aldehyde dehydrogenase

Acetaldehyde

27
Q

A patient is on Warfarin (or has coagulation issues) and develops an independent bacterial infection. You consider administering a Cephalosporin. Which TWO should you be CAUTIOUS of?

Why?

A
  • Cefotetan (2nd gen.)
  • Cefaperazone (3rd gen.)

Cause reduced vitamin-K production by GI bacteria –> deficient prothrombin –> BLEEDING potential

28
Q

Monobactam - drug name (1)

A

Aztreonam

29
Q

Aztreonam is effective against which organisms?

A

Gram (-) rods (Klebsiella, Pseudomonas, Serratia, etc.)

30
Q

Aztreonam - MoA

Is it active against Gram (+) organisms? Why or why not?

A

Inhibition of PBP3

NO - the PBP3 is only on gram (-) rods

31
Q

Is Aztreonam a 1st line therapy? Solo empiric therapy?

When/how is it used generally?

A

NO and NO

  • SUBSTITUTE for Ampicillin/Amoxicillin or Gen 3/4 Cephalosporins IF hypersensitive to these
32
Q

How is Aztreonam administered?

A

Parenteral

33
Q

A severely ill hospitalized patient needs empirical antibiotic therapy for several bacteria, including Gram (+) and Gram (-), as well as Methicillin-sensitive (beta-lactamase) organisms. Good potential option (class)?

A

Carbapenems

34
Q

Adverse effects of Carbapenems

A
  • Nephrotoxicity
  • CNS toxicity (seizures, confusion)
  • Hypersensitivity and rash (caution w/ penicillin allergy)
35
Q

Imipenem/Cilastatin combo - explain

A

Imipenem (Carbapenem) is metabolized to a NEPHROTOXIC metabolite via DIPEPTIDASE enzyme.

Cilastatin is a DIPEPTIDASE INHIBITOR, thus preventing the nephrotoxicity and prolonging the effects of Imipenem

36
Q

Meropenem - benefits over Imipenem (2)

A
  • NOT nephrotoxic OR CNS toxic (less seizure risk)

- Better for bacterial meningitis and intra-abdominal infection

37
Q

TO REVIEW: Vancomycin is used for which 2 things?

A
  1. Penicillin hypersensitivity

2. MRSA or PRSP (penicillin-resistant strep. pneumoniae)

38
Q

How does Erythromycin differ from Vancomycin? (2)

A
  • MSSA, NOT MRSA or PRSP

- Oral (outpatient) rather than IV Vancomycin (inpatient)

39
Q

***Use of Clindamycin

A

WITH Beta Lactam drug - to decrease production of necrotizing/toxic metabolites by certain strep/staph infections that would otherwise cause toxic shock or necrotizing fasciitis (“skin-eating bacteria”)

Respiratory 2 (15 decks)

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