Cephalosporins, Carbapenems, Monobactam

Question 1

Name the Ceph-gen 1 drugs (2)

Answer 1

Cefalozin

Cephalexin

Question 2

Cephalosporin Gen 1: Spectrum of Activity

Answer 2

Gram + aerobes:
MSSA

Gram - aerobes: PEK
Proteus Mirabilis
E. Coli
Kleb Pneumo

Question 3

Cephalosporin Gen 1: Clinical Use

Answer 3

Surgical prophylaxis

SSSI
Septic Arthritis
Osteomyelitis
Endocarditis
UTIs
Bacteremia

Question 4

Cephalosporin Gen 2 Drugs Classes (3)

Answer 4

Cephalosporins
Cephamycin
Carbecephems

Question 5

Cephalosporin Gen 2: Spectrum of Activity

Answer 5

Gram + aerobes:
MSSA

Gram - aerobes:
HENPEK + M
H. influ
Enterobacter group
Neisseria group
Proteus Mirabilis
E. Coli
Kleb pneumo

M. cattrhalis

gram - anaerobe
bacteroide fragilis

Question 6

Cephalosporin Gen 2: clinical use

Answer 6

** surgical prophylaxis for abdominal surgery**
Sinusitis
Otitis Media
Upper and lower respiratory tract

Question 7

What is special about generation 2 of cephalosporins?

Answer 7

Cephamycin and carbcephems have ANAEROBIC activity

Question 8

Cephalosporin gen 3 drugs

Answer 8

Ceftriaxone
ceftazidime
cefpodoxime

Question 9

Cephalosporin gen 3: spectrum of activity

Answer 9

gram + aerobes

inc gram - aerobes:
HENPECKSSS + MP

INCLUDES PSEUDOMONAS ACTIVITY (ceftaz, cefpodo)

Question 10

Cephalosporin gen 3: clinical uses

Answer 10

• Complicated UTI*
• Meningitis esp if PSEUDO is suspected **
• Uncomplicated gonorrhea*
• CA-penumo*
• Endocarditis (S. viridian)

Question 11

Cephalosporin gen 3 downfall??

Answer 11

Induces B-lactamase producing bacteria (Neisseria)

Question 12

Ceph gen 4 drugs:

Answer 12

Cefepime

Question 13

Ceph gen 4 spectrum of activity:

Answer 13

gram + aerobes

Gram - aerobes:
HENPECKSSS + MP
INC PSEUDO coverage

Question 14

ceph gen 4 clinical use:

Answer 14

GRAM NEG meningitis
Febrile neutropenia
**PSEUDO INFECTIONS **

Question 15

Good thing about ceph gen 4:

Answer 15

More stable against resistance
includes coverage for B-lactamase producing enterobacter
LESS likely to induce extended spectrum B-lactamase (ESBL)

Question 16

Ceph Gen 5 drug:

Answer 16

ceftaroline

Question 17

Ceph Gen 5: spectrum of activity

Answer 17

gram + aerobes:
MRSA
PSSP

Gram - aerobes:
increased H. influ and M. catarrhalis activity

Question 18

Ceph Gen 5: clinical use

Answer 18

CA- Bacterial Pneumo

SSSI

Question 19

Improvement of Ceph with Gen 5?

Answer 19

Increase activity against respiratory infections
increase activity agasint SSSI
MRSA activity!!

Question 20

Cephalosporins do not cover against??

Answer 20

LAME infections!!
Listeria
Atypicals - mycoplasma, chlamydia, legionella, S. Malt, Cdiff
MRSA (except gen 5 ceftaroline!)
Enterococcus spp

Question 21

Which Cephs are able to penetrate the CSF, if any?

Answer 21

THREE AND FOUR
parenteral cefuoxime (gen 2)

Question 22

How are cephs eliminated?

Answer 22

RENALLY

**EXCEPT: Ceftriaxone (billiary) and Cefoperazone (hepatic)

Question 23

What is the half life ?

Answer 23

Short, increase dose req.

EXCEPT: Ceftriaxone - 8 hours

Question 24

Can I drink some alchy-hol if I’m taking Cephs??

Answer 24

NO!

Ethanol-intolerance is one of the side effects of those drugs containing MTT side chains

Question 25

What are some AEs of cehalosporins?

Answer 25

Hypersensitivity (if IgE mediated, cannot desen!!)

MTT side chain reactions:

• Hypoprothrombinemia
• Ethanol intolerance

Hematologic side effects
GI - C.diff ?
Ceftriaxone + Ca2+ interaction –> preceipates