Beta Lactams part 2 (cephalosporins) Flashcards
how many types of cephalosporins are there?
5 generations
moa of cephalosporins
interferes with cell wall synthesis during active multiplication causing bactericidal activity
what type of killing do cephalosporins display?
time-dependent killing
if a patient has a PCN allergy, can you give them a cephalosporin?
it depends… if they have anaphylaxis its a no go, but if not a true allergy you can decide to try!
which generation has the most streptococcus activity?
5th gen
(activity increases as generation increases, culminating at S pneumoniae coverage)
which generation has best staph (MSSA) coverage?
1st gen
(gram positive coverage generally decreases with generation increase)
which generation(s) cover MRSA?
5th gen
(ceftaroline)
which generation(s) cover enterococcus gram +?
TRICK QUESTION
none of them >:)
which generation(s) have the greatest coverage of gram negatives?
5th generations
(gram negative spectrum increases with generation)
what are the first generation cephalosporins? what are their ROA?
cephalexin (po)
cefazolin (IV)
main uses of first generation cephalosporins
- good strep activity
- MSSA
- some gram neg (PEK): proteus, e. coli, Klebsiella (penumoniae)
avoid use of 1st gen cephs (cephalexin/ cefazolin) in what organisms?
this is LAME
- L isteria
- A typical organisms/anaerobes
- M RSA
- E nterococcus
what lab values do you need to check for 1st generation cephalosporins (cefazolin/cephalexin)?
CrCl - excreted via urine so renally adjusted
which generation of cephalosporins treats most common organisms for UTI?
1st generation (have good body tissue penetration - except CSF)
ADR of 1st generation cephalosporins
rash
fever
seizures (renal insufficiency)
. . . so kinda the same as PCN’s
which first generation cephalosporin treats bacteremia and osteomyelitis?
cefazolin
which 1st generation cephalosporins are used prior to non-GI surgeries to prevent infection?
cefazolin
can you use 1st generation cephalosporins to treat skin and skin structure infections?
yes
- they have good coverage of MSSA and basic streps
which 2nd generation cephalosporins are imposter cephalosporins (not technically cephalosporins)?
ceroxitin (IV) and cefotetan (IV)
what are the RoA and names of 2nd generation cephalosporins?
cefcalor (po)
cefuroxime (IV, po)
cefprozil (po)
cefoxitin (IV)
cefotetan (IV)
main uses of 2nd gen cephs
good strep coverage
- strep pneumo
HNPEKM - h. influenzae, moraxella catarrhalis, neisseria, proteus, E coli, klebsiella
the imposter cephalosporins (cefoxitin/cefotetan) cover GUT ANAEROBIC ACTIVITY (b. fragilis)
avoid use of second generation cephs where?
this is also very LAME
listeria
atypical
MSSA and MRSA
enterococcus
are second generation cephalosporins used for UTI’s
not usually, more 1st gens are common
they still have pretty good body tissue distribution though
ADR’s of second generation cephalosporins
diarrhea - cefuroxime and cefoxitin
rash
fever
the imposters (cefoxitin/cefotetan) can cause decreased vitamin K
which second generation cephalosporins increase INR?
cefoxitin and cefotetan
most common uses of 2nd gen ORAL cephs
UPPER RESPIRATORY INFECTIONS
sinusitis
bronchitis
otitis
pneumonia (increased strep pneumo activity)
which 2nd gen cephalosporins have anaerobe activity and what are they used for
cefoxitin and cefotetan
prevent infection during GI surgeries (don’t use 1st generation for this!)
can you use 2nd generation cephs to treat UTI’s
kinda
they cover it but aren’t really used
what are the 3rd generation cephalosporins and their RoA?
ceftriaxone (IV, IM)
cefotaxime (IV, IM)
ceftazidime (IV)
cefdinir (po)
cefpodoxime (po)
cefixime (po)
main uses of 3rd gen cephalosporins
- strep activity and GREAT strep pneumo
- HNPEKM - h. infleunzae, moraxella catarrhalis, neisseria, proteus, E. coli, klebsiella
- more gram neg - aeroMACESss
Morganella
Acinetobacter
Citrobacter
Enterobacter
Serratia, (klebsiella AEROgenes)
Shigella
Salmonella
which third generation cephs add pseudomonas activity?
ceftazidime
avoid using 3rd generation cephalosporins in what?
Listeria
Atypical organisms/ Anaerobes
MSSA/MRSA
Enterococcus
(LAME) (again)
which 3rd gen is excreted via biliary excretion
ceftriaxone
there is a drug interaction between ceftriaxone and what
IV calcium
(dont give together!)
what 3rd gen ceph is preferred in neonatal patients?
cefotaxime
ADR’s of 3rd gen cephalosporins
painful IM local injection sites
rash
fever
orals cause diarrhea
which cephalosporin will likely NOT be the answer on the exam due to inducible resistance issues?
ceftazidime
which two 3rd generation cephs are almost interchangeable?
IV ceftriaxone and ceftazideme
which IV cephalosporins can treat CNS infections
ceftriaxone, cefotaxime
which 3rd generations should not be used to treat bacteremia
the oral ones
cefdinir
cefpodoxime
cefixime
which 3rd gen doesn’t cover strep pneumo
ceftazidime (yet another reason to not use it)
which 3rd generation covers pseudomonas
ceftazidime (guess it does do something good, still probably not the answer on the exam)
oral 3rd gen cephalosporins are used to treat what
upper respiratory infections
which cephalosporin can cause red stools when given in combo with iron?
cefdinir
which 3rd generations are useful for skin infections not caused by staph?
the oral ones
cefdinir
cefpodoxime
cefixime
what is the only 4th generation cephalosporin and its RoA
cefepime (IV)
main uses of cefepime
strep coverage
strep pneumo
MSSA activity
HNPEKM
aeroMACEsss
anti-pseudomonal
*combines 1,2,3 generation activity
avoid using cefepime in
LAME
+ anaerobes
(can use MSSA this time)
ADR of cefepime
NEUROTOXICITY***
CNS side effects
seizures
rash
fevers
where does cefepime penetrate easily and where does it get good concentrations?
good CNS, tissue, penetration
good blood stream, and urinary tract concentration
what is the 5th generation cephalosporin
ceftaroline (IV)
what is the spectrum of ceftaroline
MRSA
strep and strep pneumo
MSSA
HNPEKM
aeroMACEsss
what bacteria does ceftaroline not cover
NO PSEUDOMONAS activity
avoid using ceftaroline in which infections?
LAE
+ anaerobic
- covers MRSA so it’s not lame anymore
does ceftaroline need to be dose adjusted? why or why not?
yes
renal excretion
ADR ceftaroline
rash
itching
allergic reactions
fever
ceftaroline indications
CAP and skin infections
what generation is cefiderocol
trick question
undefined
main uses of cefoderocol
UTI and lung infections caused by susceptible gram negative organisms
PEK
SPACE
carbapenemase producing organisms
avoid using cefoderocol in
gram positive organisms
anaerobes
ADR cefoderocol
diarrhea
neurotoxicity
CDAD
indication of cefoderocol
UTI and HAP/VAP
what are the ceph-BLI combinations
ceftazidime + avibactam
ceftolozane + tazobactam
what are the main uses of ceph-BLI combinations?
mainly target g- infections
pseudomonas
intra-abdominal infections with addition of metronidazole
UTI
what can treat infections caused by ESBL’s (extended spectrum beta lactamase producing bugs) aka klebsiella and E. Coli
ceftazidime + avibactam
ceftolozane + tazobactam
which ceph-BLI has activity against carbapenemase producing organisms
ceftazidime = avibactam
which ceph-BLI has activity against MDR pseudomonas
ceftolozane + avibactam
VERY IMPORTANT CONTRAINDICATION OF CARBAPENEMS
avoid use in patients taking valproic acid
