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Pharmacology > Cephalosporins, Carbapenems and monobactams > Flashcards

Cephalosporins, Carbapenems and monobactams Flashcards

1
Q

1st generation options

A

Cefadroxil (Duracef), Cefazolin (Kefzol), Cephalexin (Keflex)

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2
Q

2nd generation options

A

Cefaclor (Ceclor), Cefotetan (Cefotan), Cefuroxime (Kefurox, Zinacef), Cefoxitin (Ceftin)

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3
Q

3rd generation options

A

Cefotaxime (Claforan), Ceftriaxone (Rocephin), Ceftazidime (Fortaz), Ceftazidime/Avibactam (Avycaz), Cefpodoxime (vantin), Cefdinir (Omnicef)

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4
Q

4th generation options

A

Cefepime (Macipime)

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5
Q

5th generation options

A

Ceftaroline (Teflaro), Ceftolazane/Tazobactam (Zerbaxa)

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6
Q

MOA of cephalosporins

A

inhibit cell wall synthesis by binding to PBPs, time dependent, bactericidal (rapid)

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7
Q

What is the spectrum of cephalosporins

A

No cephalosporin has enterococcal or listeria activity, inc gram - coverage as go from 1st-> 3rd generation and lose some gram + coverage, 4th and 5th regain staph

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8
Q

Dose of 1st generations

A

Cefazolin (Ancef) 1gm IV Q8hrs, Cephalexin (Keflex)- 500 mg PO QID

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9
Q

Spectrum of 1st generations

A

strep, staph MSSA only, most oral anaerobes

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10
Q

What do 1st generations not cover?

A

strep. pneu, limited gram -

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11
Q

Clinical use of 1st generation

A

skin, skin structures, UTI (but resistance now), IV for definitive bacteremia/endocarditis, osteomyelitis, surgical prophylaxis

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12
Q

What is the DOC for surgery prophylaxis?

A

1st generation

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13
Q

2nd generation dosage

A

Cefuroxime (Zinacef)- 1.5gm IV q6h, Cefoxitin (Mefoxin)- 2gm IV q 12 h

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14
Q

Spectrum of 2nd generation

A

increased aerobic gram-, h. influenzae, neisseria, proteus, e coli, klebsiella, moraxella catarrhalis, staph aureus

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15
Q

Subcategory of 2nd generation

A

Cephamycins- cefoxitin, cefotetan- introduce anaerobic coverage (Bacteroides), less gram + than others, important for abd surgeries

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16
Q

Clinical use of 2nd generations

A

URI, CAP, Neisseria, UTI, SSTI, cefoxitin, cefotetan-abd surg prophylaxis, cardiothoracic surg prophylaxis- cefuroxime

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17
Q

3rd generation dosage

A

rocephin- 1gm IV daily, ceftazidime (Fortaz)- 1 gm IV TID, Cefpodoxime (Vantin)- 200 mg PO BID, Cefdinir (Omnicef)- 300 mg PO BID

18
Q

Spectrum of 3rd gen

A

enhanced gram -, enterobacteriaceae, serratia, citrobacter, enterobacter, morganella, salmonella, shigella, strep, ceftazidime- pseudo

19
Q

3rd gen not good for?

20
Q

Clinical use of 3rd generation

A

IV- CNS, C/HAP, gonorrhea (ceftriaxone), endocarditis, pyelonephritis, oral- URI, skin, terrible [blood] no pseudo coverage

21
Q

What is the first cephalosporin available with a beta lactamase inhibitor?

A

Ceftazidime/avibactam (Avycaz)- broad spectru,, good for chronically ill with abd infxn, UTi

22
Q

4th gen spectrum

A

enhance gram +, MSSA, S pneu, better enterobacter, citrobacter and serratia, pseudo,

23
Q

4th gen does not cover

A

anaerobics, enterococcal, MRSA

24
Q

Clinical use of 4th gen

A

febrile neutropenia, post neurosurg infxn, nosocomial pneu, SSTI, UTI

25
Q

5th gen spectrum

A

penicillin resistant s pneu, MRSA, gram - similar to ceftriaxone

26
Q

5th gen not used for

A

pseudo or anaerobes

27
Q

Clinical use of 5th gen

A

pneumonia, SSTI

28
Q

New IV 5th gen

A

ceftolozane/tazobactam (Zerbaxa)- indicated for intra-abdominal infxn, UTI, broad spectrum

29
Q

ADRs of cephalosporins

A

allergy, if anaphylaxis w/ penicillin do not give!, NVD, abx colitis?, hematologic

30
Q

Carbapenems

A

Imipenem/cilistatin (Primaxin), Meropenem (Merrem), Ertapenem (Invanz), Doripenem (Doribax)

31
Q

MOA of carbapenems

A

inhibit cell wall synthesis by binding to PBPs, bind to wider variety of PBPs, bactericidal, time dependent, highly stable

32
Q

Spectrum of carbapenems

A

great anaerobic, very broad spectrum

33
Q

What do carbapenems not cover?

A

MRSA, vanc resistant enterococcus, stenotrophomonas maltophilia, burkholderia cepacia, ertapenem- pseudo

34
Q

ADRs of carbapenems

A

neurotoxicity/seizures (greatest with imipenem/cilistatin, similar to B-lactams if start to accumulate

35
Q

Clinical use of carbapenems

A

reserved for resistant bacterial infxn, LRTI (nosocomial pneu), CNS infxn, intra abd infxn, febrile neutropenia, bacteremia, cystic fibrosis, ssti’s

36
Q

Monobactam option

A

aztreonam (Azactam) IV only

37
Q

MOA of monobactam

A

inhibit cell wall synthesis by binding to PBPs

38
Q

Spectrum of monobactam

A

gram neg only, including enterobacteriaceae and pseudomonas

39
Q

What does monobactam not cover?

A

no anaerobic activity

40
Q

Clinical use of monobactam

A

penicillin (anaphylaxis) pts with gram - infxn

Pharmacology (61 decks)

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