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Therapeutics Exam 2 - antibiotics:( > Beta Lactams part 2 (cephalosporins) > Flashcards

Beta Lactams part 2 (cephalosporins) Flashcards

1
Q

how many types of cephalosporins are there?

A

5 generations

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2
Q

moa of cephalosporins

A

interferes with cell wall synthesis during active multiplication causing bactericidal activity

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3
Q

what type of killing do cephalosporins display?

A

time-dependent killing

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4
Q

if a patient has a PCN allergy, can you give them a cephalosporin?

A

it depends… if they have anaphylaxis its a no go, but if not a true allergy you can decide to try!

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5
Q

which generation has the most streptococcus activity?

A

5th gen
(activity increases as generation increases, culminating at S pneumoniae coverage)

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6
Q

which generation has best staph (MSSA) coverage?

A

1st gen
(gram positive coverage generally decreases with generation increase)

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7
Q

which generation(s) cover MRSA?

A

5th gen
(ceftaroline)

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8
Q

which generation(s) cover enterococcus gram +?

A

TRICK QUESTION
none of them >:)

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9
Q

which generation(s) have the greatest coverage of gram negatives?

A

5th generations
(gram negative spectrum increases with generation)

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10
Q

what are the first generation cephalosporins? what are their ROA?

A

cephalexin (po)
cefazolin (IV)

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11
Q

main uses of first generation cephalosporins

A
  • good strep activity
  • MSSA
  • some gram neg (PEK): proteus, e. coli, Klebsiella (penumoniae)
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12
Q

avoid use of 1st gen cephs (cephalexin/ cefazolin) in what organisms?

A

this is LAME
- L isteria
- A typical organisms/anaerobes
- M RSA
- E nterococcus

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13
Q

what lab values do you need to check for 1st generation cephalosporins (cefazolin/cephalexin)?

A

CrCl - excreted via urine so renally adjusted

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14
Q

which generation of cephalosporins treats most common organisms for UTI?

A

1st generation (have good body tissue penetration - except CSF)

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15
Q

ADR of 1st generation cephalosporins

A

rash
fever
seizures (renal insufficiency)

. . . so kinda the same as PCN’s

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16
Q

which first generation cephalosporin treats bacteremia and osteomyelitis?

A

cefazolin

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17
Q

which 1st generation cephalosporins are used prior to non-GI surgeries to prevent infection?

A

cefazolin

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18
Q

can you use 1st generation cephalosporins to treat skin and skin structure infections?

A

yes

  • they have good coverage of MSSA and basic streps
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19
Q

which 2nd generation cephalosporins are imposter cephalosporins (not technically cephalosporins)?

A

ceroxitin (IV) and cefotetan (IV)

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20
Q

what are the RoA and names of 2nd generation cephalosporins?

A

cefcalor (po)
cefuroxime (IV, po)
cefprozil (po)

cefoxitin (IV)
cefotetan (IV)

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21
Q

main uses of 2nd gen cephs

A

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)

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22
Q

avoid use of second generation cephs where?

A

this is also very LAME

listeria
atypical
MSSA and MRSA
enterococcus

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23
Q

are second generation cephalosporins used for UTI’s

A

not usually, more 1st gens are common

they still have pretty good body tissue distribution though

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24
Q

ADR’s of second generation cephalosporins

A

diarrhea - cefuroxime and cefoxitin
rash
fever

the imposters (cefoxitin/cefotetan) can cause decreased vitamin K

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25
Q

which second generation cephalosporins increase INR?

A

cefoxitin and cefotetan

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26
Q

most common uses of 2nd gen ORAL cephs

A

UPPER RESPIRATORY INFECTIONS
sinusitis
bronchitis
otitis
pneumonia (increased strep pneumo activity)

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27
Q

which 2nd gen cephalosporins have anaerobe activity and what are they used for

A

cefoxitin and cefotetan

prevent infection during GI surgeries (don’t use 1st generation for this!)

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28
Q

can you use 2nd generation cephs to treat UTI’s

A

kinda

they cover it but aren’t really used

29
Q

what are the 3rd generation cephalosporins and their RoA?

A

ceftriaxone (IV, IM)
cefotaxime (IV, IM)
ceftazidime (IV)
cefdinir (po)
cefpodoxime (po)
cefixime (po)

30
Q

main uses of 3rd gen cephalosporins

A
  • 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
31
Q

which third generation cephs add pseudomonas activity?

A

ceftazidime

32
Q

avoid using 3rd generation cephalosporins in what?

A

Listeria
Atypical organisms/ Anaerobes
MSSA/MRSA
Enterococcus

(LAME) (again)

33
Q

which 3rd gen is excreted via biliary excretion

A

ceftriaxone

34
Q

there is a drug interaction between ceftriaxone and what

A

IV calcium
(dont give together!)

35
Q

what 3rd gen ceph is preferred in neonatal patients?

A

cefotaxime

36
Q

ADR’s of 3rd gen cephalosporins

A

painful IM local injection sites
rash
fever
orals cause diarrhea

37
Q

which cephalosporin will likely NOT be the answer on the exam due to inducible resistance issues?

A

ceftazidime

38
Q

which two 3rd generation cephs are almost interchangeable?

A

IV ceftriaxone and ceftazideme

39
Q

which IV cephalosporins can treat CNS infections

A

ceftriaxone, cefotaxime

40
Q

which 3rd generations should not be used to treat bacteremia

A

the oral ones
cefdinir
cefpodoxime
cefixime

41
Q

which 3rd gen doesn’t cover strep pneumo

A

ceftazidime (yet another reason to not use it)

42
Q

which 3rd generation covers pseudomonas

A

ceftazidime (guess it does do something good, still probably not the answer on the exam)

43
Q

oral 3rd gen cephalosporins are used to treat what

A

upper respiratory infections

44
Q

which cephalosporin can cause red stools when given in combo with iron?

A

cefdinir

45
Q

which 3rd generations are useful for skin infections not caused by staph?

A

the oral ones
cefdinir
cefpodoxime
cefixime

46
Q

what is the only 4th generation cephalosporin and its RoA

A

cefepime (IV)

47
Q

main uses of cefepime

A

strep coverage
strep pneumo
MSSA activity
HNPEKM
aeroMACEsss
anti-pseudomonal
*combines 1,2,3 generation activity

48
Q

avoid using cefepime in

A

LAME
+ anaerobes

(can use MSSA this time)

49
Q

ADR of cefepime

A

NEUROTOXICITY***
CNS side effects
seizures
rash
fevers

50
Q

where does cefepime penetrate easily and where does it get good concentrations?

A

good CNS, tissue, penetration
good blood stream, and urinary tract concentration

51
Q

what is the 5th generation cephalosporin

A

ceftaroline (IV)

52
Q

what is the spectrum of ceftaroline

A

MRSA
strep and strep pneumo
MSSA
HNPEKM
aeroMACEsss

53
Q

what bacteria does ceftaroline not cover

A

NO PSEUDOMONAS activity

54
Q

avoid using ceftaroline in which infections?

A

LAE
+ anaerobic

  • covers MRSA so it’s not lame anymore
55
Q

does ceftaroline need to be dose adjusted? why or why not?

A

yes
renal excretion

56
Q

ADR ceftaroline

A

rash
itching
allergic reactions
fever

57
Q

ceftaroline indications

A

CAP and skin infections

58
Q

what generation is cefiderocol

A

trick question
undefined

59
Q

main uses of cefoderocol

A

UTI and lung infections caused by susceptible gram negative organisms

PEK
SPACE
carbapenemase producing organisms

60
Q

avoid using cefoderocol in

A

gram positive organisms
anaerobes

61
Q

ADR cefoderocol

A

diarrhea
neurotoxicity
CDAD

62
Q

indication of cefoderocol

A

UTI and HAP/VAP

63
Q

what are the ceph-BLI combinations

A

ceftazidime + avibactam
ceftolozane + tazobactam

64
Q

what are the main uses of ceph-BLI combinations?

A

mainly target g- infections
pseudomonas
intra-abdominal infections with addition of metronidazole
UTI

65
Q

what can treat infections caused by ESBL’s (extended spectrum beta lactamase producing bugs) aka klebsiella and E. Coli

A

ceftazidime + avibactam
ceftolozane + tazobactam

66
Q

which ceph-BLI has activity against carbapenemase producing organisms

A

ceftazidime = avibactam

67
Q

which ceph-BLI has activity against MDR pseudomonas

A

ceftolozane + avibactam

68
Q

VERY IMPORTANT CONTRAINDICATION OF CARBAPENEMS

A

avoid use in patients taking valproic acid

Therapeutics Exam 2 - antibiotics:( (7 decks)

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