Cephalosporins, Carbapenems and monobactams

Question 1

1st generation options

Answer 1

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

Question 2

2nd generation options

Answer 2

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

Question 3

3rd generation options

Answer 3

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

Question 4

4th generation options

Answer 4

Cefepime (Macipime)

Question 5

5th generation options

Answer 5

Ceftaroline (Teflaro), Ceftolazane/Tazobactam (Zerbaxa)

Question 6

MOA of cephalosporins

Answer 6

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

Question 7

What is the spectrum of cephalosporins

Answer 7

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

Question 8

Dose of 1st generations

Answer 8

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

Question 9

Spectrum of 1st generations

Answer 9

strep, staph MSSA only, most oral anaerobes

Question 10

What do 1st generations not cover?

Answer 10

strep. pneu, limited gram -

Question 11

Clinical use of 1st generation

Answer 11

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

Question 12

What is the DOC for surgery prophylaxis?

Answer 12

1st generation

Question 13

2nd generation dosage

Answer 13

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

Question 14

Spectrum of 2nd generation

Answer 14

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

Question 15

Subcategory of 2nd generation

Answer 15

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

Question 16

Clinical use of 2nd generations

Answer 16

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

Question 17

3rd generation dosage

Answer 17

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

Question 18

Spectrum of 3rd gen

Answer 18

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

Question 19

3rd gen not good for?

Answer 19

staph

Question 20

Clinical use of 3rd generation

Answer 20

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

Question 21

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

Answer 21

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

Question 22

4th gen spectrum

Answer 22

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

Question 23

4th gen does not cover

Answer 23

anaerobics, enterococcal, MRSA

Question 24

Clinical use of 4th gen

Answer 24

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

Question 25

5th gen spectrum

Answer 25

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

Question 26

5th gen not used for

Answer 26

pseudo or anaerobes

Question 27

Clinical use of 5th gen

Answer 27

pneumonia, SSTI

Question 28

New IV 5th gen

Answer 28

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

Question 29

ADRs of cephalosporins

Answer 29

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

Question 30

Carbapenems

Answer 30

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

Question 31

MOA of carbapenems

Answer 31

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

Question 32

Spectrum of carbapenems

Answer 32

great anaerobic, very broad spectrum

Question 33

What do carbapenems not cover?

Answer 33

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

Question 34

ADRs of carbapenems

Answer 34

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

Question 35

Clinical use of carbapenems

Answer 35

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

Question 36

Monobactam option

Answer 36

aztreonam (Azactam) IV only

Question 37

MOA of monobactam

Answer 37

inhibit cell wall synthesis by binding to PBPs

Question 38

Spectrum of monobactam

Answer 38

gram neg only, including enterobacteriaceae and pseudomonas

Question 39

What does monobactam not cover?

Answer 39

no anaerobic activity

Question 40

Clinical use of monobactam

Answer 40

penicillin (anaphylaxis) pts with gram - infxn