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Pharm > Cephalosporins, Carbapenems, and Monobactams > Flashcards

Cephalosporins, Carbapenems, and Monobactams Flashcards

1
Q

List the organisms that 1st gen cephalosporins are effective against. Which is target?

A

Gram-pos: - MSSA (*target) - PCN-susc. Strep pneumo - Group streptococci - Viridians streptococci Grem-neg: (PEK) = - Proteus mirabilis - E. coli - Klebsiella pneumoniae

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2
Q

List the organisms that 2nd gen cephalosporins are effective against. *Which group is unique to this gen?

A

Gram-pos: (slightly less active than 1st gen) - MSSA (*target), PCN-susc. Strep pneumo, Group streptococci, Viridians streptococci. Gram-neg: (HENPEK) = - H. influenzae - Enterobacter spp. - Neisseria spp. - Proteus mirabilis - E. coli - Klebsiella pneumoniae (+ M. catarrhalis). Anaerobes: Bacteroides fragilis /group

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3
Q

List the organisms that 3rd gen cephalosporins are effective against. *Which is target?

A

Gram-neg (HENPECKSSS P) = - H. influenzae - Enterobacter spp. - Neisseria gonorrhoeae - Proteus mirabalis - E. coli - Citrobacter spp. - Klebsiella pneumoniae - Serretia marcescens - Salmonella spp. - Shigella spp.; *Pseudomonas aeruginosa (target) (still have gram-pos activity but less active than earlier gens)

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4
Q

Which 3rd gen. cephalosporin does NOT target pseudomonas, unlike the others? Which would you use instead?

A

Ceftriaxone - Ceftazidime

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5
Q

How does the activity of 4th gen cephalosporins change compared to 3rd gen?

A

Gram-pos: similar to ceftriaxone. Gram-neg: Similar to ceftriaxone but also adds: - Pseudomonas aeruginosa - Beta-lactamse-producing enterobacter spp.

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6
Q

List the categories/organisms that 5th gen cephalosporins are effective against. *Which is unique to this gen?

A

Resp pathogens - H. influenzae - strep. Pneumoniae - Moraxella - Staph aureus. Gram-pos + SSSI: - Strep pneumonia *MRSA*

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7
Q

*What important organisms are cephalosporins NOT active against? (6)

A

SMACLE - Stenotrophomonas maltophilia - MRSA (*except for the 5th gen) - Atypical bacteria (eg Legionella; cuz no cell wall) - C-diff - Listeria - Enterococcus spp.

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8
Q

All cephalosporins are eliminated via the ___________ except for ___________ and ___________ (how are each eliminated?)

A
  • Kidney - Ceftriaxone (bile) - Cefoperazone (liver)
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9
Q

Which gens of cephalosporins are used for surgical prophylaxis?

A

1st and 2nd (2nd for more intense surgeries?)

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10
Q

What are some of the uses of ceftriaxone? (4 orgs)

A
  • Uncomplicated gonorrhea (single IM dose) - CAP - PRSP - Viridans strep endocarditis
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11
Q

What’s the most important organisms that 4th gen cephalosporins cover (that ceftriaxone doesn’t)?

A

Pseudomonas

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12
Q

What are the major adverse effects of all gen cephalosporins? (2)

A
  1. Hypersensitivity 2. C-diff
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13
Q
  • Are Carbapenems broad or narrow spectrum? - What major groups are they effective against? - What are their target organisms?
A
  • Most broad-spectrum available - Many gram-pos and gram-neg aerobes, as well as gram-pos/neg anaerobes. - Targets: MSSA, bacteroides.
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14
Q

*What organisms are carbapenems NOT effective against? (7)

A

*NOT effective against: MRSA, PRSP, VRE, coag-neg staph, c-dif, atypical bacteria, S. maltophila

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15
Q

-______________, a carbapenem, undergoes hydrolysis by a dihydropeptidase enzyme in the ________________ to a toxic metabolite. - Therefore, it’s comarketed with _________, a DHP inhibitor (to prevents this)

A
  • Imipenem - Renal brush border (hepatotoxic) - Cilastatin (not on test, but USMLE)
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16
Q

What major drug category do cephalosporins fall under? Carbapenems?

A
  • Beta-lactams - Beta-lactams
17
Q

What are carbapenem’s mech of action? - Baciocidal or static? - Time or conc-dependent?

A

Inhibitors of cell wall synthesis by binding to and inhibiting PBPs; primary target is PBP-2 - Bacteriocidal - Time-dependent

18
Q

Name the major carbapenems. - Which 2 are the “best”?

A

DIME - Doripenem (best) - Imipenem (best) - Meropenem - Ertapenem

19
Q

What are the mechs of resistance for cephalosporins? (which is most important?)

A
  • Beta-lactamase enzymes (most important) - PBP alteration - Decreased membrane penetration
20
Q

Beta-lactams are all cross-allergenic except for which one?

A

Aztreonam

21
Q

Are cephalosporins bacteriocidal or bacteriostatic?

A

Bactericidal

22
Q

Which subset of the cephalosporins are the only ones that have activity against anaerobes? - Which generation is it in?

A

Cephamycins - 2nd gen

23
Q

*What gen. cephalosporin is used for the treatment of meningitis?

A

3rd gen

24
Q

When treating meningitis w/3rd gen cephalosporins, if pseudomonas is suspected or present, what specific drug would you use?

A

Ceftazidime

25
Q

What is the main thing that 5th gen cephalosporins are used for?

A

Drug-resistant organisms

26
Q

Why were cephalosporins developed?

A

Beta lactams that are less susceptable to beta-lactamase enzymes.

27
Q

Why were carbapenems developed?

A
  • Extended spectrum of activity - Further beta-lactamase stability
28
Q

What are the clinical uses of carbapenems?

A
  • Empiric therapy for HA-infections - Polymicrobial infections - Infections due to β-lactamase-producing organisms (SPICE, SPACE, others)
29
Q

*If pseudomonas is suspected, which carbapenem would you avoid?

A

*Avoid ertapenem if pseudomonas suspected

30
Q

What are the main adverse effects of carbapenems?

A
  • CNS (e.g. seizures) - GI - Hypersensitivity
31
Q

Do carbapenems have hypersensitivity/cross-reactivity w/PCNs like cephalosporins do?

A

Yes

32
Q

What category of drug is a monobactam? - How can it be administered?

A

Synthetic monocyclic beta-lactam - IV

33
Q

Monobactams are beta-lactams. What specific part of the cell wall do they target? - What is the main class of organisms they target?

A

PBP-3 - of gram-negative aerobes

34
Q

Recall: what class of organisms do monobactams inhibit? - What’s its main target?

A

Gram-neg aerobes * Pseduomonas

35
Q

Recall: what is the class of drugs that aztreonam is a member of? Since aztreonam is the only beta-lactam that does have cross-allergencitiy, what clinical implications does this have?

A
  • Monobactams - Can be used in PCN-allergic pts
36
Q

What are the major adverse effects of monobactams?

A

N/D

37
Q

What are the major adverse effects for 2nd gen cephalosporins, besides hypersensitivity and c-diff?

A
  • Hypoprothrombinemia - Ethanol intolerance due to disulfiram-like rxn
38
Q

Which gen’s of cephalosporins inhibit pseudomonas?

A
  • 3rd (except ceftriaxone) - 4th
39
Q

Which gen of cephalosporins are effective against anaerobes like bacteroides?

A

2nd gen only

Pharm (32 decks)

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