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Pharmacology > Beta-Lactams and Monobactams > Flashcards

Beta-Lactams and Monobactams Flashcards

1
Q

What is Empiric therapy?

A

Therapy directed abasing suspected organism before identification of pathogen

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2
Q

Empiric Therapy

  • _______ spectrum antibioitic
  • always ________ /c
  • outcomes will always be better if initial therapy was later found to provide _________ coverage
A
  • 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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3
Q

What is prophylactic therapy?

A

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

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4
Q

Directed therapy

  • use once the organism has been __________
  • _________ spectrum when possible
  • De-___________
A
  • use once the organism has been IDENTIFIED
  • NARROW spectrum when possible
  • De-ESCALATING
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5
Q

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

A
  1. Pharmakokinetics
  2. Suspected causative organism for the site of infection
  3. Host factors
  4. Drug Factors
  5. Resistance
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6
Q

Choosing the right antimicrobial — Pharamacokinetics

- Does the drug target or concentrate in the _____________?

A
  • Does the drug target or concentrate in the RIGHT LOCATION?
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7
Q

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

  • May necessitate __________ therapy
  • Equally important to know normal ________
A
  • May necessitate COMBINATION therapy

- Equally important to know normal FLORA

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8
Q

Choosing the right antimicrobial — Host Factors

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

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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9
Q

Choosing the right antimicrobial — Drug Factors

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

A
  • Mechanism of killing (TIME dependent, CONCENTRATION dependent, BACTERICIDAL, BACTERIOSTATIC)
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10
Q

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 _______
A
  • 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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11
Q

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 & _________)
A
  • 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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12
Q

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 = _________
A
  • 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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13
Q

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
A
  • 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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14
Q

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”
A
  • 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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15
Q

Antibiotics: Pharmacodynamics — Bactericidal vs. Bacteriostatic

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

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

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16
Q

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
A
  • 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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17
Q

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 ________)

A

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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18
Q

What category of penicillins are these?

  • Penicillin G
  • Penicillin Benzathine
  • Penicillin VK
A

Natural Penicillins

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19
Q

Natural Penicillins

  • Spectrum = non- beta-lactamase producing ____________
  • NOT for ________________ since most ________ produce a beta lactamase
  • option when you _______ what bug/bacteria to treat
A
  • 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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20
Q

True or False:

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

A

True; unless you have a beta lactase inhibitor

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21
Q

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
A
  • 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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22
Q

Natural Peniciliins

  • ________ half life; requires several doses
  • only penetration CNS in setting of inflamed ___________
  • _______ eliminated
A
  • SHORT half life; requires several doses
  • only penetration CNS in setting of inflamed MENINGES
  • RENALLY eliminated
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23
Q

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)
A
  • 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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24
Q

What category of penicillins are these?

  • Nafcillin
  • Dicloxacillin
  • Oxacillin
A

Anti-Staphylococcal (aka Penicillinase resistant PCNs)

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25
Q

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
A
  • 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
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26
Q

What category of penicillins are these?

  • Ampicillin
  • Amoxicillin (amoxil)
A

Aminopenicillins

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27
Q

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
A
  • 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
28
Q

Aminopenicillins — Clinical Uses

  • _________ respiratory tract infection
  • Procedural ________ (ex. dental)
  • enterococcal, ________, and endocarditis
  • __________ (in addition to 3rd generation cephalosporin)
A
  • UPPER respiratory tract infection
  • Procedural PROPHYLAXIS (ex. dental)
  • enterococcal, UTI, and endocarditis
  • MENINGITIS (in addition to 3rd generation cephalosporin)
29
Q

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

A
  • 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
30
Q

What category of penicillins are these?

  • Tazobactam
  • Sulbactam
  • Clavulanate
A

Beat lactates inhibitors

31
Q

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 _________
A
  • 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
32
Q

What category of penicillins are these?

  • Piperacillin / tazobactam (Zosyn)
  • Ampicillin / Sulbactam (unasyn)
  • Amoxicillin / Clavulanate (augmentin)
A

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

33
Q

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)

A
  • Adding the beta lactamase inhibitor IMPROVES activity against: H. influenza, E.coli, Proteus mirabillis; S. aureus (MSSA only); Moraxella catarrhalis; anaerobes (namely bactericides)
34
Q

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 _________
A

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
35
Q

What category of penicillins are these?

- Piperacillin

A

Ureidopenicillins

36
Q

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
A

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
37
Q

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
A
  • 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
38
Q

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
A
  • 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
39
Q

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 ________________
A
  • 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
40
Q

Cephalosporins

  • As you move from 1st to 5th generation, the drugs go from coverage gram __________ to covering gram ___________
  • _____ generation is more broad coverage
A
  • 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
41
Q

What generation of Cephalosporins are these?

  • Cefadroxil (Duracef)
  • Cefazolin (Kefzol)
  • Cephalexin (keflex)
A

1st Gen

42
Q

What generation of Cephalosporins are these?

  • Cefaclor (ceclor)
  • Cefotetan (Cefotan)
  • Cefuroxime (Kefurox, Zinacef, Ceftin)
  • Cefoxitin (Ceftin, Mefoxin)
A

2nd Gen

43
Q

What generation of Cephalosporins are these?

  • Cefotaxime (claforan)
  • Ceftriaxone (Rocephin)
  • Ceftazidime (Fortaz)
  • Ceftazidime / Avibactam (avycaz)
  • Cefpodoxime (Vantin)
  • Cefdinir (Omnicef)
A

3rd Gen

44
Q

What generation of Cephalosporins are these?

- Cefeprime (Maxipime)

A

4th Gen

45
Q

What generation of Cephalosporins are these?

  • Ceftaroline (Teflaro)
  • Ceftolazane / Tazobactam (Zerbaxa)
A

5th Gen

46
Q

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

A

MOA: inhibit cell wall SYNTHESIS by binding to PBP’s

  • TIME dependent
  • BACTERICIDAL (rapid)
47
Q

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
A
  • 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
48
Q

1st Generation

  • Cefazolin (Ancef/Kefzol) & Cephalexin (Keflex) = used a lot for ________ or ________ infections
  • Cefadroxil (Duricef) = used __________ for orthopedic surgeries
A
  • Cefazolin (Ancef/Kefzol) & Cephalexin (Keflex) = used a lot for PEDIATRIC or DENTAL infections
  • Cefadroxil (Duricef) = used PROPHYLACTICALLY for orthopedic surgeries
49
Q

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 ___________
A
  • 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
50
Q

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
A
  • 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
51
Q

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
A
  • 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
52
Q

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: _______________
A
  • 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
53
Q

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
A
  • 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
54
Q

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
A
  • 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
55
Q

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 ________
A
  • 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
56
Q

4th Gen — Clinical Uses

  • Febrile _____________ (first line drug - penetrates CNS)
  • Post-_________ infections
  • Nosocomial _____________
  • SSTI
  • UTI
A
  • Febrile NEUTROPENIA (first line drug - penetrates CNS)
  • Post-NEUROSURGICAL infections
  • Nosocomial PNEUMONIA
  • SSTI
  • UTI
57
Q

5th Generation — Ceftaroline (Teflaro)

  • for patients resistant to other ________ antibiotics
  • Gram __________ activity similar to Ceftriazone
  • ________ resistant
  • Not reliable for pseudomonas or ____________
  • __________ = vancomycin + ceftriazone
A
  • for patients resistant to other MRSA antibiotics
  • Gram NEGATIVE activity similar to Ceftriazone
  • PENICILLIN resistant
  • Not reliable for pseudomonas or ANAEROBES
  • CEFTAROLINE = vancomycin + ceftriazone
58
Q

5th Generation — Ceftolozane / Tazobactam (Zerbaxa)

  • Indicated for ___________ infections and complicated ______
  • Spectrum of activity: _________ spectrum, including activity against pathogens known to be ______
A
  • Indicated for INTRA-ABDOMINAL infections and complicated UTI
  • Spectrum of activity: BROAD spectrum, including activity against pathogens known to be MDR
59
Q

Cephalosporins — Adverse Drug Reactions

- What are 3 ADRs of cephalosporins?

A
  1. Allergies (rash, hives, anaphylaxis)
  2. NVD
  3. Hematologic
60
Q

Carbapenems

- What are carbapenems used for?

A

The nastiest infections

61
Q

What drug class are are these in?

  • imipenem / cilastatin (primaxin)
  • meropenem (merrem)
  • ertapenem (invanz)
  • doripenem (doribax)
A

Carbapenems

62
Q

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
A
  • 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
63
Q

Carbapenems — spectrum

  • Great _________ activity
  • Does NOT cover: ________
A
  • Great ANAEROBIC activity

- Does NOT cover: MRSA

64
Q

Carbapenems — ADRs

- What are the 2 main ADRs?

A
  1. neurotoxicity

2. Seizures

65
Q

Carbapenems — Clinical Uses

  • Reserved for resistant ________ infections
  • LRTIs — ________ pneumonia
  • CNS infections — meropenem __________ best
  • ____________ infections
  • _______ neutrophenia
  • Bacteremia
  • _________ fibrosis
  • SSTIs
A
  • Reserved for resistant BACTERIAL infections
  • LRTIs — NOSOCOMIAL pneumonia
  • CNS infections — meropenem PENETRATES best
  • INTRAABODMINAL infections
  • FEBRILE neutrophenia
  • Bacteremia
  • CYSTIC fibrosis
  • SSTIs

Pharmacology (10 decks)

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