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Pharmacology > Cephalosporin (Anti-Biotics) > Flashcards

Cephalosporin (Anti-Biotics) Flashcards

1
Q

How are cephalosporins administered?

A

IV or IM, and also oral for those that are acid stable.

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2
Q

Whats special to note about Cephalosporin distibution into body compartments?

A

CSF penetration is bad even if the meninges is inflammed for first and second gen (with the exception of Cefuroxime). Some 3rd and 4th gen however can tx meningitis.

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3
Q

Whats special about the chemistry of the 5th gen cephalosporins?

A

They are prodrugs, and are converted in the serum to the active drug.

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4
Q

How are cephalosporins excreted?

A

Glomerular filtration and excretion of unchanged drug.

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5
Q

General t(1/2) of cephalosporins?

A

1-8 hrs.

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6
Q

What is the activity of the first gen cephalosporins?

A

Gram + even those that elaborate Beta lactamases, as well as specific gram neg (PEcK M), Proteus, E. Coli, Klebsiella. Also Moraxella.

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7
Q

How does the 2nd generation cephalosporins compare to the first?

A

It has the same first gen activity but expanded second gen activity. However, resistance began to creep up. A subset of 2nd gen has activity against B. Fragilis, but 2nd gen has less activity to staph and strep than 1st gen.

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8
Q

General activity of 3rd gen cephalosporins?

A

Broad spectrum gram + and -, some cross the BBB. Poor B. Fragilis activity, but a subset has activity against P. Aeruginosa.

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9
Q

General activity of 4th gen cephalosporins?

A

Broad spectrum + pseudomonas. Greater activity against bacteria with beta lactamases but not vs ESBL’s.

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10
Q

Why would we use the 5th gen cephalosporins?

A

They are used for anti-MRSA. This is the only beta lactam that has activity against MRSA.

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11
Q

Of all the gram + activity of cephalosporins, which gram + are resistant to basically all cephalosporins?

A

Penicillin resistant S. Pneumoniae, MRSA (5th gen does work though), MSSE, and other coagulase neg staph.
Enterococcus, Listeria, and C. Diff.

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12
Q

Which gram neg are resistant to Cephalosporins?

A

KPC producing Enterobacteriae like K. Pneumoniae, C. Jejuni, Stenotrophomonas Maltophilia, Acinetobacter spp.

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13
Q

Which “atypicals” are inherently resistant to cephalosporins?

A

Mycoplasma, Legionella pneumophila, chlamydia.

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14
Q

What is the most common mode of resistance to cephalosporins?

A

Beta lactamase hydrolysis.

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15
Q

Activity of cephalosporins and B. Fragilis?

A

Fragilis is resistant to all EXCEPT Cephamycins, which include cefoxitin and cefotetan.

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16
Q

What is special about cephamycins? What drugs are in this class?

A

They work against B. fragilis, and their class includes Cefoxitin and Cefotetan.

17
Q

What are ESBL’s? Which bacteria has them? Cephalosporin activity against these?

A

Extended spectrum beta lactamases. E. Coli, Klebsiella, and other enterobactericeae. All penicillin’s do not work against organisms with ESBLs, cefotaxime, ceftriaxone and ceftazidime also do not work (these are 3rd gen cephalosporins). Must use beta lactamase inhibitors to work

18
Q

Which are the bacteria that expresses the AmpC Beta lactamases and whats special about this class?

A

Even with the use of beta lactamase inhibitor these organisms will be resistant to cephalosporins. “Cephalosporins May Prove Sub-Effacacious After Peeing” standing for Citrobacter, Morganella, Providencia, Serratia Enterobactor, Acinetobacter and Pseudomonas.

19
Q

When would we want to use 1st gen cephalosporins?

A

Skin and soft tissue infections caused by S. Pyo and MSSA. URI’s, uncomplicated GU infections, endocarditis px for activity against viridens strep.

20
Q

What are the 3 first gen cephalosporins?

A

Cefazolin. Cephalexin and Cefadroxil.

21
Q

When would you take Cefazolin?

A

It is parenteral only and used for Surgical Px of skin flora infections.

22
Q

When would you take Cefalexin and Cefadroxil?

A

Oral mild to moderate infections (so you can take it at home), Cephalexin take every 6 hrs Cephadroxil every 12.

23
Q

What is the key thing to remember about 2nd gen cephalosporins?

A

They offer no advantages over other Beta Lactams, so rather pointless. Generally they can be used for the same things as the 1st gen.

24
Q

What 2nd gen cephalosporin can be used for surgical Px?

A

Cefuroxime. Cefuroxime sodium is what is used parenteral, but there is also Cefuroxime axetil and that is oral.

25
Q

What is vital to recall about the drug Cefoxitin (and to a lesser extent, Cefotetan)?

A

Great against gram neg anarobic gut bugs, like B. fragilis specially.

26
Q

What drug is administered pre-surgery Px against B. fragilis and other gram neg anarobic bacteria?

A

Cefoxitin

27
Q

What are the 3 3rd gen cephalosporins?

A

Ceftriaxone (tri for 3rd gen) and Cefotaxime (these two drugs are very similar except cefotaxime is x3 administration whereas Ceftriaxone is 1-2x daily admin). Ceftazimide.

28
Q

How are Ceftriaxone and Cefataxime administered?

A

IM or IV only as they are meant only for serious infections.

29
Q

What are the uses for Ceftriaxone and Cefotaxime?

A

Bacterial meningitis, URI and LRI, intra abdominal infections, skin and skin structure infections, Lyme, Gonorrhea, PID and bacterial septicemia.

30
Q

What is Ceftazidime’s claim to fame?

A

Only cephalosporin that can tx P. Aeruginosa which the other 2 3rd gen’s cannot. Also tx serratia and enterobactericeae. Poor gram +, better gram neg.

31
Q

What is the only drug in the 4th gen cephalosporins?

A

Cefepime.

32
Q

When would we use Cefepime?

A

This 4th gen drug is reserved for use against nosocomial pneumonia, and infections against other multidrug resistant bugs. Hits gram + (not MRSA) and gram neg (including P. aeruginosa to an extent but not as well as Ceftazidime).

33
Q

What organisms are resistant to cefepime?

A

MRSA, B. fragilis, E. Coli and Klebsiella that have ESBL or KPC class A beta lactamases.

34
Q

Which is the only 5th gen cephalosporin that is approved in the US for use?

A

Ceftaroline.

35
Q

What are the bugs that Ceftaroline is reserved for to tx?

A

Complicated bacterial skin infections caused by MRSA or Strep, E coli and Klebsiella. Also CA pneumonia.

36
Q

What bugs are resistant to 5th gen cephalosporins, which is basically Ceftaroline in the U.S.?

A

ESBL’s, serine carbapenamases, metallo beta lactamases, and B fragilis.

37
Q

What are the two rare but serious AE’s noted by cephalosporins in general?

A

Bone marrow suppression and renal tubular necrosis.

38
Q

What are the 3 unique AE’s noted with Ceftriaxone?

A

Cholestatic hepatitis/gall bladder disease, hyperbilirubinemia in neonates (resulting in kernicterus), precipitation of Ca containing solutions.

39
Q

What are the unique AE’s of Cefotetan?

A

Hypoprothrombomenia by inhibiting vit K activation, disulfuram (ant-abuse) like reactions.

Pharmacology (33 decks)

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