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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
which second generation cephalosporins increase INR?
cefoxitin and cefotetan
26
most common uses of 2nd gen ORAL cephs
UPPER RESPIRATORY INFECTIONS sinusitis bronchitis otitis pneumonia (increased strep pneumo activity)
27
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!)
28
can you use 2nd generation cephs to treat UTI's
kinda they cover it but aren't really used
29
what are the 3rd generation cephalosporins and their RoA?
ceftriaxone (IV, IM) cefotaxime (IV, IM) ceftazidime (IV) cefdinir (po) cefpodoxime (po) cefixime (po)
30
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
31
which third generation cephs add pseudomonas activity?
ceftazidime
32
avoid using 3rd generation cephalosporins in what?
Listeria Atypical organisms/ Anaerobes MSSA/MRSA Enterococcus (LAME) (again)
33
which 3rd gen is excreted via biliary excretion
ceftriaxone
34
there is a drug interaction between ceftriaxone and what
IV calcium (dont give together!)
35
what 3rd gen ceph is preferred in neonatal patients?
cefotaxime
36
ADR's of 3rd gen cephalosporins
painful IM local injection sites rash fever orals cause diarrhea
37
which cephalosporin will likely NOT be the answer on the exam due to inducible resistance issues?
ceftazidime
38
which two 3rd generation cephs are almost interchangeable?
IV ceftriaxone and ceftazideme
39
which IV cephalosporins can treat CNS infections
ceftriaxone, cefotaxime
40
which 3rd generations should not be used to treat bacteremia
the oral ones cefdinir cefpodoxime cefixime
41
which 3rd gen doesn't cover strep pneumo
ceftazidime (yet another reason to not use it)
42
which 3rd generation covers pseudomonas
ceftazidime (guess it does do something good, still probably not the answer on the exam)
43
oral 3rd gen cephalosporins are used to treat what
upper respiratory infections
44
which cephalosporin can cause red stools when given in combo with iron?
cefdinir
45
which 3rd generations are useful for skin infections not caused by staph?
the oral ones cefdinir cefpodoxime cefixime
46
what is the only 4th generation cephalosporin and its RoA
cefepime (IV)
47
main uses of cefepime
strep coverage strep pneumo MSSA activity HNPEKM aeroMACEsss anti-pseudomonal *combines 1,2,3 generation activity
48
avoid using cefepime in
LAME + anaerobes (can use MSSA this time)
49
ADR of cefepime
NEUROTOXICITY*** CNS side effects seizures rash fevers
50
where does cefepime penetrate easily and where does it get good concentrations?
good CNS, tissue, penetration good blood stream, and urinary tract concentration
51
what is the 5th generation cephalosporin
ceftaroline (IV)
52
what is the spectrum of ceftaroline
*MRSA* strep and strep pneumo MSSA HNPEKM aeroMACEsss
53
what bacteria does ceftaroline not cover
NO PSEUDOMONAS activity
54
avoid using ceftaroline in which infections?
LAE + anaerobic * covers MRSA so it's not lame anymore
55
does ceftaroline need to be dose adjusted? why or why not?
yes renal excretion
56
ADR ceftaroline
rash itching allergic reactions fever
57
ceftaroline indications
CAP and skin infections
58
what generation is cefiderocol
trick question undefined
59
main uses of cefoderocol
UTI and lung infections caused by susceptible gram negative organisms PEK SPACE carbapenemase producing organisms
60
avoid using cefoderocol in
gram positive organisms anaerobes
61
ADR cefoderocol
diarrhea neurotoxicity CDAD
62
indication of cefoderocol
UTI and HAP/VAP
63
what are the ceph-BLI combinations
ceftazidime + avibactam ceftolozane + tazobactam
64
what are the main uses of ceph-BLI combinations?
mainly target g- infections pseudomonas intra-abdominal infections with addition of metronidazole UTI
65
what can treat infections caused by ESBL's (extended spectrum beta lactamase producing bugs) aka klebsiella and E. Coli
ceftazidime + avibactam ceftolozane + tazobactam
66
which ceph-BLI has activity against carbapenemase producing organisms
ceftazidime = avibactam
67
which ceph-BLI has activity against MDR pseudomonas
ceftolozane + avibactam
68
VERY IMPORTANT CONTRAINDICATION OF CARBAPENEMS
avoid use in patients taking valproic acid

Therapeutics Exam 2 - antibiotics:( (7 decks)

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