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PHRM 865 - exam 2 > Cephalosporins > Flashcards

Cephalosporins Flashcards

1
Q

Cephalosporins chemistry

A

Great stability against some b-lactamase enzymes

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2
Q

MOA

A

Bactericidal
interfere with cell wall synthesis by binding to PBP located in the bacterial cell wall which leads to inhibition of final transpeptidation step of peptidoglycan synthesis

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3
Q

Mechanism of resistance

A
  1. Production of B-lactamase enzymes
  2. alteration in the PBP leading to decreased affinity (MRSA, PRSP)
  3. Alteration of outer membrane leading to decreased penetration to the PBP
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4
Q

Classification of cephalosporins

A

grouped in 4 generations
based on structure/ antimicrobial activity and resistance to B-lactamase enzymes

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5
Q

Generalization of spectrum of activity

A

Lose gram positive activity with an increase gram negative as you go from 1 to 2 to 3 to 4

Greater b-lactamase stability as you go from 1 to 2 to 3 to 4

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6
Q

Cefazolin and Cephalexin

A

First generation Cephalosporins

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7
Q

First generation cephalosporin activity

A

Best with gram positive

Gram positive:
Group steptococci
Viridans streptococci
Pen-susc S. Pneumoniae
Meth-susc S. Aureus

Gram Negative (PEK)
Pseudomonas Mirabilis
E. Coli
Klebsiella Pneumoniae

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8
Q

Cefuroxime and Cefprozil and Cefoxitin

A

Second generation Cephalosporins

Cefoxitin is a cephamycin but grouped with second generation due to activity

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9
Q

Second generation Cephalosporins

A

Cefuroxime, Cefproxil, Cefoxitin

Gram positive:
Group Streptococci
Viridans Streptococci
PSSP
MSSA

Gram Negative (HENPEK)
Pseudomonas Mirabilis
E. Coli
Klebsiella Pneumoniae
H. Influenzae (BL -)
Enterobacter Spp. (some)
Neisseria spp.
M.Catarrhalis

Aerobes (ONLY CEFOXITIN)
bacteroides Fragilis
Bacteroides fragilis group

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10
Q

Ceftriaxone, Ceftazidime, Cefpodoxime

A

Third Generation Cephalosporins

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11
Q

Third generation Cephalosporins Coverage

A

Ceftriaxone, Ceftazidime, Cefpodoxime

CEFTRIAXONE IS ONLY ONE THAT COVERS GRAM POSITIVE AEROBES - PEN-RESISTANT S. PNEUMONIAE

Gram negative aerobes: (HENPEK-CSSS)
H. Influenziae
Enterobacter spp
Niessiria gonorrhoeae
Pseudomonas mirabilis
E. Coli
Klebsiella
Citrobacter spp.
Salmonella
Shigella
Serratia marcescens
Pseudomonas aeruginosa (ONLY CEFTAZIDIME) -EXAM Q

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12
Q

Cefepime

A

Fourth generation Cephalosporin

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13
Q

Fourth generation Cephalosporin coverage

A

Cefepime
Gram positive:
PEN-RESISTANT S. PNEUMONIAE

Gram negative: (HENPEK-CSSS)
H. Influenziae
Enterobacter spp (BL+)
Niessira
psuedomonas mirabilis
E. Coli (BL+)
Klebsiella
Citrobacter
Shigella
Salmonella
Serratia
Psuedomonas Aeurginosa

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14
Q

Ceftaroline

A

Anti-MRSA cephalosporin

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15
Q

Anti-MRSA Cephalosporin

A

Ceftaroline

Gram positive: pen-resistant s. pseumoniae, meth-resistant s. aeureus

Gram negative aerobes: (HENPEK-CSSS)
H. Influenziae
Enterobacter spp
Niessiria gonorrhoeae
Pseudomonas mirabilis
E. Coli
Klebsiella
Citrobacter spp.
Salmonella
Shigella
Serratia marcescens

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16
Q

Cefiderocol

A

Does not cover gram positive

Gram negative aerobes: (HENPEK-CSSS)
H. Influenziae
Enterobacter spp
Niessiria gonorrhoeae
Pseudomonas mirabilis
E. Coli
Klebsiella
Citrobacter spp.
Salmonella
Shigella
Serratia marcescens
Pseudomonas Aeruginosa

Covers ESBLs, AmpC, CREs, KPCs, NDMs, VIM, OXA-48

17
Q

Ceftolozane-Tazobactam (Zerbaxa)

A

Cephalosporin-b-lactamase inhibitor

18
Q

Cephalosporin-b-lactamase inhibitor

A

Ceftolozane-Tazobactam (Zerbaxa)
Ceftazidime-Avibactam (avycaz)

Gram positive: streptococcus

Gram negative aerobes: (HENPEK-CSSS)
H. Influenziae
Enterobacter spp
Niessiria gonorrhoeae
Pseudomonas mirabilis
E. Coli
Klebsiella
Citrobacter spp.
Salmonella
Shigella
Serratia marcescens
Pseudomonas Aeruginosa

Zerbaxa Includes ESBLs and AmpC
Avycaz includes ESBLs, AmpC, KPCs, OXA

19
Q

Which cephalosporin is considered a potential drug of choice for infections due to MSSA?

A. Ceftazidime
B. Cefotetan
C. Cefazolin
D. Ceftolozane-Tazobactam
E. Cefonicid

A

Cefazolin - first generation Cephalosporin

20
Q

Which cephalosporin does NOT have activity against Pseudomonas aeruginosa?

A. Ceftriaxone
B. Ceftazidime
C. Cefepime
D. Ceftolozane-Tazobactam
E. Ceftazidime-Avibactam

A

A. Ceftriaxone - 3rd gen cephalosporin

21
Q

Pharmacology

A

Time dependent
clinical efficacy is Time above MIC (T>MIC)

22
Q

Absorption

A

Oral cephalosporins are well absorbed but have lower concentration than parental products - food can decrease absorption

23
Q

Distribution

A

Widely distributed through out the tissues and fluids

CSF concentration acheived only with Parental Cefuroxime, Cefepime, Ceftiaxone, Ceftazidime

24
Q

Elimination

A

Most eliminated unchanged by the kidney

Ceftriaxone biliary
Cefoperazone through liver

Short elimination half lives around 2 hours

ceftriaxone has half life of 8 hours

25
First generation Clinical use
MSSA Streptococci skin and soft tissue infections Surgical prophylaxis
26
Second generation clinical use
Cefuroxime and Cefprozil and Cefoxitin No longer recomended for treatment of meningitis Bacteroides fragilis - Cefoxitine Polymycrobial infections
27
Third generation clinical use
Ceftazidime if Pseudomonas suspected infection Ceftriaxone is used for uncomplicated gonorrhea (One IM dose), PRSP
28
Fourth generation clinical use
Cefepime - Antipseudomonal activity
29
Anti-MRSA cephalosporin clinical use
Ceftaroline - Skin and soft tissue infection including those cause by MRSA
30
Adverse effects
1. Hypersenitivity reaction - Patients who had severe reaction to penicillin needed ICU admission should avoid ALL Cephelosporins those with other reaction and NO ICU admission should avoid Cephalopsorins with similar R1 chain 2. Hematologic - Anemia, Leukopenia, Thrombocytopenia 3. Gastrointestinal- increased bili (ceftriaxone), C. diff 4. other - IV calcium and ceftriaxone orecipitation(never mix the two), Nonconvulsive status epilepticus (can happen in those with renal insufficiency)
31
Adverse reaction specific to Cefamandole, Cefotetan, Cefmetazole, Cefoperazone, Moxalactam
Due to MTT side chain (Nitromethylthiotetrazole) Causes -hypoprothrombinemia due to reaction in Vitamin K producing bacteria in GI - Ethanol intolerance - pts should not drink while on these drugs
32
True/False: A patient who developed anaphylaxis to penicillin requiring ICU admission can safely receive any cephalosporin.
FALSE All beta-lactams (including all cephalosporins) should be avoided in a patient who developed anaphylaxis to penicillin requiring ICU admission

PHRM 865 - exam 2 (23 decks)

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