Empiric Therapy - _______ spectrum antibioitic - always ________ /c - outcomes will always be better if initial therapy was later found to provide _________ coverage

- BROAD spectrum antibioitic - always START /c - outcomes will always be better if initial therapy was later found to provide ADEQUATE coverage

Directed therapy - use once the organism has been __________ - _________ spectrum when possible - De-___________

- use once the organism has been IDENTIFIED - NARROW spectrum when possible - De-ESCALATING

Choosing the right antimicrobial — Suspected Causative Organism for Site of Infection - May necessitate __________ therapy - Equally important to know normal ________

- May necessitate COMBINATION therapy - Equally important to know normal FLORA

Choosing the right antimicrobial — Host Factors - _________ function, ________ function, a__________, p_________ - recent _________ or __________ exposure - recent hospital exposure requires more _________ antibiotics - _________ function drives appropriate dosing

Choosing the right antimicrobial — Host Factors - RENAL function, LIVER function, ALLERGIES, PREGNANCY - recent ANTIBIOTIC or HOSPITAL exposure - recent hospital exposure requires more AGGRESSIVE antibiotics - RENAL function drives appropriate dosing

Choosing the right antimicrobial — Resistance - MIC (____________________): always want antibiotic ________ MIC level to prevent resistance - Mechanisms of ____________ - Use the _________ --> tells you what bacteria you have in the hospital and what best can tx it - Gram _______ = most problematic bacteria, requires combo therapy - Bacteriostatic = _______; prevents further ________ - Bactericidal = _________; prevents _______

- MIC (MINIMUM INHIBITORY CONCENTRATION): always want antibiotic ABOVE MIC level to prevent resistance - Mechanisms of RESISTANCE - Use the ANTIBIOGRAM --> tells you what bacteria you have in the hospital and what best can tx it - Gram NEGATIVE = most problematic bacteria, requires combo therapy - Bacteriostatic = BAD; prevents further GROWTH - Bactericidal = BETTER; prevents GROWTH

Susceptibility Testing - Tissue, blood, urine, sputum sales sent to lab for pathogen ID undergo a wide array of tests for _______ stain and __________ testing (C/S) - Gram stain takes a few _______ and can be used to ________ therapy or confirm __________ therapy is adequate - Generally takes ______ days to see results - Gram (+) = ______ to treat (ex. = _______ & ________) - Gram (-) = ________ to treat (ex. = ____________ infections & _________)

- Tissue, blood, urine, sputum sales sent to lab for pathogen ID undergo a wide array of tests for GRAM stain and CULTURE/SENSITIVITY testing (C/S) - Gram stain takes a few HOURS and can be used to DIRECT therapy or confirm EMPIRIC therapy is adequate - Generally takes 2 -5 days to see results - Gram (+) = EASIER to treat (ex. = STAPH & STREP) - Gram (-) = DIFFICULT to treat (ex. = HOSPITALIZED infections & PNEUMONIA)

Susceptibility Testing - Final report for bacterial infections will provide pathogen ______ and _________ for various drugs tested against - S = _____________ or __________ (good/goal) - I = __________ (normal road, dicey, may need to push doses) - R = _________

- Final report for bacterial infections will provide pathogen ID and SENSITIVITIES for various drugs tested against - S = SUSCEPTIBLE or SENSITIVE (good/goal) - I = INTERMEDIATE (normal road, dicey, may need to push doses) - R = RESISTANT

Antibiotics: Pharmacodynamics — Concentration Dependent - Efficacy and extent of bacterial killing is directly related to the ________ compared to the MIC - Provided safety is accounted for, "the more the ________" - Need to achieve a certain __________ level to kill bacteria or at least inhibit ________ /c some antimicrobials

- Efficacy and extent of bacterial killing is directly related to the DRUG compared to the MIC - Provided safety is accounted for, "the more the MERRIER" - Need to achieve a certain CONCENTRATION level to kill bacteria or at least inhibit GROWTH /c some antimicrobials

Antibiotics: Pharmacodynamics — Time Dependent - Efficacy and extent of bacterial killing is directly related to the ______ the drug is greater than MIC - need to dose _________ to keep levels above the MIC. Being late /c doses is _________; allows bacteria to "regroup"

- Efficacy and extent of bacterial killing is directly related to the TIME the drug is greater than MIC - need to dose FREQUENTLY to keep levels above the MIC. Being late /c doses is CRITICAL; allows bacteria to "regroup"

Combination Antibiotics Provide... - ________ = The combination gives greater bactericidal effect than either agent alone - _________ = the combination gives equal bactericidal effect as either agent alone - _________ coverage: poly microbial infections (diabetic foot, gangrene, abdominal) - _________ or __________ resistance - Produces more rapid ____________ effect - potential to __________ doses of more toxic antibiotics - Benefit = better _________ overall and better ________ profile

- SYNERGY = The combination gives greater bactericidal effect than either agent alone - ADDITIVE = the combination gives equal bactericidal effect as either agent alone - BROAD SPECTRUM coverage: poly microbial infections (diabetic foot, gangrene, abdominal) - PREVENT or DECREASE resistance - Produces more rapid BACTERICIDAL effect - potential to DECREASE doses of more toxic antibiotics - Benefit = better KILLING overall and better SIDE EFFECT profile

Natural Penicillins - Spectrum = non- beta-lactamase producing ____________ - NOT for ________________ since most ________ produce a beta lactamase - option when you _______ what bug/bacteria to treat

- Spectrum = non- beta-lactamase producing GRAM POSITIVE COCCI (GPCs) - NOT for STAPHYLOCOCCUS since most STAPH produce a beta lactamase - option when you KNOW what bug/bacteria to treat

Natural Penicillins — Clinical uses - Primarily for __________ caused by S. Pneumonia (including endocarditis) - _______ (PCN G, benzathine PCN) - Prophylactic ________ procedures, oral _________, ________ and delivery - Strep pharyngitis (PCN VK

- Primarily for INFECTIONS caused by S. Pneumonia (including endocarditis) - SYPHILIS (PCN G, benzathine PCN) - Prophylactic DENTAL procedures, oral ANAEROBES, LABOR and delivery - Strep pharyngitis (PCN VK

Natural Peniciliins - ________ half life; requires several doses - only penetration CNS in setting of inflamed ___________ - _______ eliminated

- SHORT half life; requires several doses - only penetration CNS in setting of inflamed MENINGES - RENALLY eliminated

Anti-Staphylococcal Penicillins - Workhorse = ___________ - Spectrum = _____________ resistant (resistant to the enzyme so they are active against the bugs that produce it) - ________ as good against strep as Natural PCNs - Doesn't work against gram ______ (aka no activity)

- Workhorse = NAFCILLIN - Spectrum = PENICILLINASE resistant (resistant to the enzyme so they are active against the bugs that produce it) - NOT AS as good against strep as Natural PCNs - Doesn't work against gram NEGATIVE (aka no activity)

Beta-Lactams and Monobactams Flashcards by Kate Ulrich

What is Empiric therapy?

Therapy directed abasing suspected organism before identification of pathogen

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Empiric Therapy

_______ spectrum antibioitic
always ________ /c
outcomes will always be better if initial therapy was later found to provide _________ coverage

BROAD spectrum antibioitic
always START /c
outcomes will always be better if initial therapy was later found to provide ADEQUATE coverage

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What is prophylactic therapy?

use of antibiotic prior to procedures as a preventative measure (i.e. before dental surgeries)

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Directed therapy

use once the organism has been __________
_________ spectrum when possible
De-___________

use once the organism has been IDENTIFIED
NARROW spectrum when possible
De-ESCALATING

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What 5 factors should be considered when choosing the right Antimicrobial?

Pharmakokinetics
Suspected causative organism for the site of infection
Host factors
Drug Factors
Resistance

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Choosing the right antimicrobial — Pharamacokinetics

- Does the drug target or concentrate in the _____________?

Does the drug target or concentrate in the RIGHT LOCATION?

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Choosing the right antimicrobial — Suspected Causative Organism for Site of Infection

May necessitate __________ therapy
Equally important to know normal ________

May necessitate COMBINATION therapy

- Equally important to know normal FLORA

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Choosing the right antimicrobial — Host Factors

_________ function, ________ function, a__________, p_________
recent _________ or __________ exposure
recent hospital exposure requires more _________ antibiotics
_________ function drives appropriate dosing

Choosing the right antimicrobial — Host Factors

RENAL function, LIVER function, ALLERGIES, PREGNANCY
recent ANTIBIOTIC or HOSPITAL exposure
recent hospital exposure requires more AGGRESSIVE antibiotics
RENAL function drives appropriate dosing

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Choosing the right antimicrobial — Drug Factors

- Mechanism of killing (_______ dependent, _________ dependent, bacteri_______, bacterio________)

Mechanism of killing (TIME dependent, CONCENTRATION dependent, BACTERICIDAL, BACTERIOSTATIC)

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Choosing the right antimicrobial — Resistance

MIC (____________________): always want antibiotic ________ MIC level to prevent resistance
Mechanisms of ____________
Use the _________ –> tells you what bacteria you have in the hospital and what best can tx it
Gram _______ = most problematic bacteria, requires combo therapy
Bacteriostatic = _______; prevents further ________
Bactericidal = _________; prevents _______

MIC (MINIMUM INHIBITORY CONCENTRATION): always want antibiotic ABOVE MIC level to prevent resistance
Mechanisms of RESISTANCE
Use the ANTIBIOGRAM –> tells you what bacteria you have in the hospital and what best can tx it
Gram NEGATIVE = most problematic bacteria, requires combo therapy
Bacteriostatic = BAD; prevents further GROWTH
Bactericidal = BETTER; prevents GROWTH

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Susceptibility Testing

Tissue, blood, urine, sputum sales sent to lab for pathogen ID undergo a wide array of tests for _______ stain and __________ testing (C/S)
Gram stain takes a few _______ and can be used to ________ therapy or confirm __________ therapy is adequate
Generally takes ______ days to see results
Gram (+) = ______ to treat (ex. = _______ & ________)
Gram (-) = ________ to treat (ex. = ____________ infections & _________)

Tissue, blood, urine, sputum sales sent to lab for pathogen ID undergo a wide array of tests for GRAM stain and CULTURE/SENSITIVITY testing (C/S)
Gram stain takes a few HOURS and can be used to DIRECT therapy or confirm EMPIRIC therapy is adequate
Generally takes 2 -5 days to see results
Gram (+) = EASIER to treat (ex. = STAPH & STREP)
Gram (-) = DIFFICULT to treat (ex. = HOSPITALIZED infections & PNEUMONIA)

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Susceptibility Testing

Final report for bacterial infections will provide pathogen ______ and _________ for various drugs tested against
S = _____________ or __________ (good/goal)
I = __________ (normal road, dicey, may need to push doses)
R = _________

Final report for bacterial infections will provide pathogen ID and SENSITIVITIES for various drugs tested against
S = SUSCEPTIBLE or SENSITIVE (good/goal)
I = INTERMEDIATE (normal road, dicey, may need to push doses)
R = RESISTANT

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Antibiotics: Pharmacodynamics — Concentration Dependent

Efficacy and extent of bacterial killing is directly related to the ________ compared to the MIC
Provided safety is accounted for, “the more the ________”
Need to achieve a certain __________ level to kill bacteria or at least inhibit ________ /c some antimicrobials

Efficacy and extent of bacterial killing is directly related to the DRUG compared to the MIC
Provided safety is accounted for, “the more the MERRIER”
Need to achieve a certain CONCENTRATION level to kill bacteria or at least inhibit GROWTH /c some antimicrobials

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Antibiotics: Pharmacodynamics — Time Dependent

Efficacy and extent of bacterial killing is directly related to the ______ the drug is greater than MIC
need to dose _________ to keep levels above the MIC. Being late /c doses is _________; allows bacteria to “regroup”

Efficacy and extent of bacterial killing is directly related to the TIME the drug is greater than MIC
need to dose FREQUENTLY to keep levels above the MIC. Being late /c doses is CRITICAL; allows bacteria to “regroup”

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Antibiotics: Pharmacodynamics — Bactericidal vs. Bacteriostatic

____________ = kills
___________ = slows ________; holds the bacteria “__________” while functioning immune system fights infection

BACTERICIDAL = kills

- BACTERIOSTATIC = slows GROWTH; holds the bacteria “IN CHECK” while functioning immune system fights infection

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Combination Antibiotics Provide…

________ = The combination gives greater bactericidal effect than either agent alone
_________ = the combination gives equal bactericidal effect as either agent alone
_________ coverage: poly microbial infections (diabetic foot, gangrene, abdominal)
_________ or __________ resistance
Produces more rapid ____________ effect
potential to __________ doses of more toxic antibiotics
Benefit = better _________ overall and better ________ profile

SYNERGY = The combination gives greater bactericidal effect than either agent alone
ADDITIVE = the combination gives equal bactericidal effect as either agent alone
BROAD SPECTRUM coverage: poly microbial infections (diabetic foot, gangrene, abdominal)
PREVENT or DECREASE resistance
Produces more rapid BACTERICIDAL effect
potential to DECREASE doses of more toxic antibiotics
Benefit = better KILLING overall and better SIDE EFFECT profile

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Penicillin
MOA: inhibition of bacterial cell wall ________ by binding to and inactivating _________ binding proteins (PBPs)
- ___________ (rapid)
- _______ dependent (2-3x/day)
- it is the ______________ that accounts for antimicrobial activity
- Variations in side chains account or differences in spectrum (more chains = more ________)

MOA: inhibition of bacterial cell wall SYNTHESIS by binding to and inactivating PENICILLIN binding proteins (PBPs)

BACTERICIDAL (rapid)
TIME dependent (2-3x/day)
it is the BETA-LACTAM that accounts for antimicrobial activity
Variations in side chains account or differences in spectrum (more chains = more SELECTIVE)

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What category of penicillins are these?

Penicillin G
Penicillin Benzathine
Penicillin VK

Natural Penicillins

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Natural Penicillins

Spectrum = non- beta-lactamase producing ____________
NOT for ________________ since most ________ produce a beta lactamase
option when you _______ what bug/bacteria to treat

Spectrum = non- beta-lactamase producing GRAM POSITIVE COCCI (GPCs)
NOT for STAPHYLOCOCCUS since most STAPH produce a beta lactamase
option when you KNOW what bug/bacteria to treat

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True or False:

Microbes that produce beta lactates are resistant to a lot of penicillins

True; unless you have a beta lactase inhibitor

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Natural Penicillins — Clinical uses

Primarily for __________ caused by S. Pneumonia (including endocarditis)
_______ (PCN G, benzathine PCN)
Prophylactic ________ procedures, oral _________, ________ and delivery
Strep pharyngitis (PCN VK

Primarily for INFECTIONS caused by S. Pneumonia (including endocarditis)
SYPHILIS (PCN G, benzathine PCN)
Prophylactic DENTAL procedures, oral ANAEROBES, LABOR and delivery
Strep pharyngitis (PCN VK

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Natural Peniciliins

________ half life; requires several doses
only penetration CNS in setting of inflamed ___________
_______ eliminated

SHORT half life; requires several doses
only penetration CNS in setting of inflamed MENINGES
RENALLY eliminated

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Anti-Staphylococcal Penicillins

Workhorse = ___________
Spectrum = _____________ resistant (resistant to the enzyme so they are active against the bugs that produce it)
________ as good against strep as Natural PCNs
Doesn’t work against gram ______ (aka no activity)

Workhorse = NAFCILLIN
Spectrum = PENICILLINASE resistant (resistant to the enzyme so they are active against the bugs that produce it)
NOT AS as good against strep as Natural PCNs
Doesn’t work against gram NEGATIVE (aka no activity)

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What category of penicillins are these?

Nafcillin
Dicloxacillin
Oxacillin

Anti-Staphylococcal (aka Penicillinase resistant PCNs)

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Anti-Staphylococcal Penicillins — Clinical uses - Any infection where _______ is confirmed - Ex: ______ and _______ structure infections, bacteremia, __________ (PNA), osteoarthritis, __________ arthritis - Locally, 60% of tap aureus is MRSA so you should not use these drugs __________ - ________ half life

- Any infection where MSSA is confirmed - Ex: SKIN and SKIN structure infections, bacteremia, PNEUMONIA (PNA), osteoarthritis, SPETIC arthritis - Locally, 60% of tap aureus is MRSA so you should not use these drugs EMPIRICALLY - SHORT half life

What category of penicillins are these? - Ampicillin - Amoxicillin (amoxil)

Aminopenicillins

Aminopenicillins — Spectrum - Gram ________ spectrum; very similar to natural PCNs - does not cover _______ or ________ (S. aureus) alone - Drug of Choice for susceptible ___________ and _________ (often isolated in neonates) - Adds gram _________ coverage not seen /c natural PCNs

- Gram POSITIVE spectrum; very similar to natural PCNs - does not cover MSSA or MRSA (S. aureus) alone - Drug of Choice for susceptible ENTEROCOCCI and LISTERIA (often isolated in neonates) - Adds gram NEGATIVE coverage not seen /c natural PCNs

Aminopenicillins — Clinical Uses - _________ respiratory tract infection - Procedural ________ (ex. dental) - enterococcal, ________, and endocarditis - __________ (in addition to 3rd generation cephalosporin)

- UPPER respiratory tract infection - Procedural PROPHYLAXIS (ex. dental) - enterococcal, UTI, and endocarditis - MENINGITIS (in addition to 3rd generation cephalosporin)

Aminopenicillins - Decrease effectiveness of _____________ Amoxicillin better absorbed than __________, so higher doses of ________ are required which has a harsher ADR profile - __________ penetrates inflamed meninges

- Decrease effectiveness of BIRTH CONTROL PILLS Amoxicillin better absorbed than AMPICILLIN, so higher doses of AMPICILLIN are required which has a harsher ADR profile - AMPICILLIN penetrates inflamed meninges

What category of penicillins are these? - Tazobactam - Sulbactam - Clavulanate

Beat lactates inhibitors

Beta - Lactamase Inhibitors - Initially created as ________ but they alone do not have ___________ activity - Acts as "__________" — takes the damage and lets another drug do the repairs - Gives ________ to the base drug (PCN) - provides additional activity against ___________ - Increases incidence of antibiotic associated ________ (eat yogurt to help restore flora) - Prevents _________ & enhances activity of other _________

- Initially created as ANTIBIOTIC but they alone do not have ANTIMICROBIAL activity - Acts as "SUICIDE BOMB" — takes the damage and lets another drug do the repairs - Gives STABILITY to the base drug (PCN) - provides additional activity against ANAEROBES - Increases incidence of antibiotic associated DIARRHEA (eat yogurt to help restore flora) - Prevents RESISTANCE & enhances activity of other ANTIBIOTICS

What category of penicillins are these? - Piperacillin / tazobactam (Zosyn) - Ampicillin / Sulbactam (unasyn) - Amoxicillin / Clavulanate (augmentin)

Beta lactam / beta lactase inhibitor combos (aka aminopenicillin + beta lactamase inhibitor)

Aminopenicillin + Beta Lactamase Inhibitor: Spectrum - Adding the beta lactamase inhibitor __________ activity against: H. influenza, E.coli, Proteus mirabillis; S. aureus (MSSA only); Moraxella catarrhalis; anaerobes (namely bactericides)

- Adding the beta lactamase inhibitor IMPROVES activity against: H. influenza, E.coli, Proteus mirabillis; S. aureus (MSSA only); Moraxella catarrhalis; anaerobes (namely bactericides)

Aminopenicillin + Beta Lactamase Inhibitor: Clinical Uses Polymicrobial infections - _________ infections (anaerobes, gram negative, enterococcus) - Amoxicillin / Clavulanate (Augmentin) = otitis media, sinusitis, chronic ________, skin and soft tissue, _______ respiratory tract infections, human or animal _______ - Ampicillin / Sulbactam (Unasyn) = same as Augmentin, but better for _________

Polymicrobial infections - ABDOMINAL infections (anaerobes, gram negative, enterococcus) - Amoxicillin / Clavulanate (Augmentin) = otitis media, sinusitis, chronic BRONCHITIS, skin and soft tissue, LOWER respiratory tract infections, human or animal BITES - Ampicillin / Sulbactam (Unasyn) = same as Augmentin, but better for ENTEROCCI

What category of penicillins are these? | - Piperacillin

Ureidopenicillins

Ureidopenicillins Piperacillin / Tazobactam (zosyn) - only used in _________ - Used when doctor ________ what's going on (broad spectrum) - Used for really bad ________; near critical condition - most _______ PCN against Pseudomonas aeruginosa - Active against: Staph aureus (________), anaerobes

Piperacillin / Tazobactam (zosyn) - only used in HOSPITALS - Used when doctor DOESN'T KNOW what's going on (broad spectrum) - Used for really bad INFECTIONS; near critical condition - most ACTIVE PCN against Pseudomonas aeruginosa - Active against: Staph aureus (MSSA), anaerobes

Ureidopenicillins — Clinical Uses - Multi drug resistant (MDR) gram _________ organisms (ex. pneumonia, sepsis, febrile __________, __________ infections, pyelonephritis, cystic ________) - Only available ______ - Drug of Choice for ________ therapy of any/all severe infections

- Multi drug resistant (MDR) gram NEGATIVE organisms (ex. pneumonia, sepsis, febrile NEUTROPENIA, NOSOCOMIAL infections, pyelonephritis, cystic FIBROSIS) - Only available IV - Drug of Choice for EMPIRIC therapy of any/all severe infections

Penicillins — Adverse Drug Reactions - ________/__________/___________ - very common - ________ — more common - __________ reactions (most common SE, but minimally severe) - Hematologic effects (ex. ___________ & inhibition of _________ aggregation) - **___________ = most occur /c large doses or adjustments not made in the setting of renal insufficiency

- NAUSEA/VOMITING/DIARRHEA - very common - RASH — more common - ALLERGIC reactions (most common SE, but minimally severe) - Hematologic effects (ex. NEUTROPENIA & inhibition of PLATELET aggregation) - **SEZIURES = most occur /c large doses or adjustments not made in the setting of renal insufficiency

Antibiotics induce Nausea/vomiting/Diarrhea - All antibiotics cause _____ upset by disrupting normal GI flora - What are the 2 approaches to replenish GI flora? Efficacy controversial - Latest = effecting in __________ antibiotic induced diarrhea but not for treating it - Should be avoided in ________________

- All antibiotics cause GI upset by disrupting normal GI flora - (1) EAT YOGURT REGULARLY, & (2) TAKE PROBIOTICS Efficacy controversial - Latest = effecting in PREVENTING antibiotic induced diarrhea but not for treating it - Should be avoided in IMMUNOCOMPROMISED

Cephalosporins - As you move from 1st to 5th generation, the drugs go from coverage gram __________ to covering gram ___________ - _____ generation is more broad coverage

- As you move from 1st to 5th generation, the drugs go from coverage gram POSITIVE to covering gram NEGATIVE - 5TH generation is more broad coverage

What generation of Cephalosporins are these? - Cefadroxil (Duracef) - Cefazolin (Kefzol) - Cephalexin (keflex)

1st Gen

What generation of Cephalosporins are these? - Cefaclor (ceclor) - Cefotetan (Cefotan) - Cefuroxime (Kefurox, Zinacef, Ceftin) - Cefoxitin (Ceftin, Mefoxin)

2nd Gen

What generation of Cephalosporins are these? - Cefotaxime (claforan) - Ceftriaxone (Rocephin) - Ceftazidime (Fortaz) - Ceftazidime / Avibactam (avycaz) - Cefpodoxime (Vantin) - Cefdinir (Omnicef)

3rd Gen

What generation of Cephalosporins are these? | - Cefeprime (Maxipime)

4th Gen

What generation of Cephalosporins are these? - Ceftaroline (Teflaro) - Ceftolazane / Tazobactam (Zerbaxa)

5th Gen

Cephalosporins MOA: inhibit cell wall ________ by binding to PBP's - ________ dependent - ___________ (rapid)

MOA: inhibit cell wall SYNTHESIS by binding to PBP's - TIME dependent - BACTERICIDAL (rapid)

Cephalosporins — Spectrum - Increase gram __________ coverage as you go from 1st to 3rd generation and loss some gram __________ coverage (mostly staph) - 4th and 5th generation drugs regain _______ activity

- Increase gram NEGATIVE coverage as you go from 1st to 3rd generation and loss some gram POSITIVE coverage (mostly staph) - 4th and 5th generation drugs regain STAPH activity

1st Generation - Cefazolin (Ancef/Kefzol) & Cephalexin (Keflex) = used a lot for ________ or ________ infections - Cefadroxil (Duricef) = used __________ for orthopedic surgeries

- Cefazolin (Ancef/Kefzol) & Cephalexin (Keflex) = used a lot for PEDIATRIC or DENTAL infections - Cefadroxil (Duricef) = used PROPHYLACTICALLY for orthopedic surgeries

1st Generation — Spectrum - Streptococci and Staphylococci (_____ only) - Not reliable for Strep. Pneumonia d/t development of _________ resistant S. Pneumo - Limited gram _________ activity (P. mirabilis, E. coli and Klebsiella pneumonia) - Active against most oral ___________

- Streptococci and Staphylococci (MSSA only) - Not reliable for Strep. Pneumonia d/t development of PENICILLIN resistant S. Pneumo - Limited gram NEGATIVE activity (P. mirabilis, E. coli and Klebsiella pneumonia) - Active against most oral ANAEROBES

1st Generation — Clinical Uses - Skin and skin structure ___________ - ______ (not best option anymore d/t resistance) - IV use for ________ therapy (not empiric) —> bacteremia/endocarditis, osteomyelitis - Surgical _________ (not colonic surgery) - Generally a ________ half life than PCNs

- Skin and skin structure INFECTIONS - UTI (not best option anymore d/t resistance) - IV use for DEFINITIVE therapy (not empiric) —> bacteremia/endocarditis, osteomyelitis - Surgical PROPHYLAXIS (not colonic surgery) - Generally a LONGER half life than PCNs

2nd Generation — Spectrum - used in ________ - Increased aerobic gram _________ coverage over 1st generation - Increased activity against _____________ - Introduces ___________ coverage (bactericides) for use in abdominal surgeries - Less gram __________ than other 2nd gens

- used in SURGERIES - Increased aerobic gram NEGATIVE coverage over 1st generation - Increased activity against STAPH AUREUS - Introduces ANAEROBIC coverage (bactericides) for use in abdominal surgeries - Less gram POSITIVE than other 2nd gens

2nd Generation — Clinical Uses - ________ respiratory tract infections (sinusitis, bronchitis, otitis media) - ____________ pneumonia (CAP) - Neisseria spp (STDs, neisseria meningitis) - _________ tract infections - SSTIs - Surgical prophylaxis: ___________ - Surgical prophylaxis: _______________

- UPPER respiratory tract infections (sinusitis, bronchitis, otitis media) - COMMUNITY-ACQUIRED pneumonia (CAP) - Neisseria spp (STDs, neisseria meningitis) - URINARY tract infections - SSTIs - Surgical prophylaxis: ABDOMINAL - Surgical prophylaxis: CARDIOTHORACIC

3rd Generation — Spectrum - Enhanced gram __________ coverage compared to 1st and 2nd gen. - More stable to __________ than 1st and 2nd generation - _______ active vs staphylococci than 1st and 2nd gen

- Enhanced gram NEGATIVE coverage compared to 1st and 2nd gen. - More stable to RESISTANCE than 1st and 2nd generation - LESS active vs staphylococci than 1st and 2nd gen

3rd Generation — Ceftazidime / Avibactam (Avycaz) - __________ agent - indicated for __________ infections and complicated _______ - Spectrum of activity: _______ spectrum, including activity abasing pathogens known to be ______ - The first available /c a ___________ inhibitor

- NEWER agent - indicated for INTRA-ABDOMINAL infections and complicated UTI - Spectrum of activity: BROAD spectrum, including activity abasing pathogens known to be MDR - The first available /c a BETA LACTAMASE inhibitor

4th Gen — Spectrum - Enhanced gram __________ activity: MSSA and S. pneumonia - Similar gram ________ to 3rd generation - More __________ than 3rd generation agents for enterobacter sp,. Citrobacter sp., Serratia sp., - _____________ aeruginosa - no _________ activity (bad), no enterococcal activity and no ________

- Enhanced gram POSITIVE activity: MSSA and S. pneumonia - Similar gram NEGATIVE to 3rd generation - More STABLE than 3rd generation agents for enterobacter sp,. Citrobacter sp., Serratia sp., - PSEUDOMONAS aeruginosa - no ANAEROBIC activity (bad), no enterococcal activity and no MRSA

4th Gen — Clinical Uses - Febrile _____________ (first line drug - penetrates CNS) - Post-_________ infections - Nosocomial _____________ - SSTI - UTI

- Febrile NEUTROPENIA (first line drug - penetrates CNS) - Post-NEUROSURGICAL infections - Nosocomial PNEUMONIA - SSTI - UTI

5th Generation — Ceftaroline (Teflaro) - for patients resistant to other ________ antibiotics - Gram __________ activity similar to Ceftriazone - ________ resistant - Not reliable for pseudomonas or ____________ - __________ = vancomycin + ceftriazone

- for patients resistant to other MRSA antibiotics - Gram NEGATIVE activity similar to Ceftriazone - PENICILLIN resistant - Not reliable for pseudomonas or ANAEROBES - CEFTAROLINE = vancomycin + ceftriazone

5th Generation — Ceftolozane / Tazobactam (Zerbaxa) - Indicated for ___________ infections and complicated ______ - Spectrum of activity: _________ spectrum, including activity against pathogens known to be ______

- Indicated for INTRA-ABDOMINAL infections and complicated UTI - Spectrum of activity: BROAD spectrum, including activity against pathogens known to be MDR

Cephalosporins — Adverse Drug Reactions | - What are 3 ADRs of cephalosporins?

1. Allergies (rash, hives, anaphylaxis) 2. NVD 3. Hematologic

Carbapenems | - What are carbapenems used for?

The nastiest infections

What drug class are are these in? - imipenem / cilastatin (primaxin) - meropenem (merrem) - ertapenem (invanz) - doripenem (doribax)

Carbapenems

MOA of Carbapenems - inhibit cell wall ________ by binding to PBPs - They bind to a wide variety of PBPs, making them ________ spectrum agents - bacteri______ - ______ dependent killers - ________ stable to beta lactamases

- inhibit cell wall SYNTHESIS by binding to PBPs - They bind to a wide variety of PBPs, making them BROADER spectrum agents - BACTERICIDAL - TIME dependent killers - HIGHLY stable to beta lactamases

Carbapenems — spectrum - Great _________ activity - Does NOT cover: ________

- Great ANAEROBIC activity | - Does NOT cover: MRSA

Carbapenems — ADRs | - What are the 2 main ADRs?

1. neurotoxicity | 2. Seizures

Carbapenems — Clinical Uses - Reserved for resistant ________ infections - LRTIs — ________ pneumonia - CNS infections — meropenem __________ best - ____________ infections - _______ neutrophenia - Bacteremia - _________ fibrosis - SSTIs

- Reserved for resistant BACTERIAL infections - LRTIs — NOSOCOMIAL pneumonia - CNS infections — meropenem PENETRATES best - INTRAABODMINAL infections - FEBRILE neutrophenia - Bacteremia - CYSTIC fibrosis - SSTIs