Ch 85: Drugs That Weaken the Bacterial Cell Wall II: Cephalosporins, Carbapenems, Vancomycin, Telavancin, Aztreonam, and Fosfomycin Flashcards

1
Q

The cephalosporins are beta-lactam drugs, but there are 3 exceptions. What are they?

A

Vancomycin, telavancin, and fosfomycin

p. 1025

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2
Q

What are beta-lactamases?

A

Enzymes that cleave the beta-lactam ring, rendering the drug inactive.

(p. 1025)

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3
Q

Which 5th generation cephalosporin has demonstrated activity against MRSA?

A

Ceftaroline (Teflaro)

p. 1025

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4
Q

What is the only 4th generation cephalosporin?

A

cefepime (Maxipime)

p. 1026

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5
Q

Cefepime is highly _________ to ____-__________, has a very _____ _____________ ________, and penetration to the ___ is ____.

A

Resistant to beta-lactamases
Broad antibacterial spectrum
CSF is good

(p. 1026)

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6
Q

Practically all cephalosporins are eliminated by…

One notable exception is…

A

…the kidneys.
…ceftriaxone (Rocephin).

(p. 1027)

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7
Q

Which two cephalosporins can cause bleeding tendencies?

By what mechanism do they do this?

A

Cefotetan and ceftriaxone
reduction of prothrombin levels through interference with vitamin K metabolism

(p. 1027)

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8
Q

What serious immune-mediated reaction can be induced by cephalosporins?

A

hemolytic anemia

p. 1027

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9
Q

Just as with penicillins, probenecid delays…

A

…renal excretion of some cephalosporins, prolonging their effects.

(p. 1027)

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10
Q

What combination of drugs can form a potentially fatal precipitate?

A

ceftriaxone (Rocephin) and IV calcium

p. 1027

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11
Q

What are the 2 prime rules of antimicrobial therapy?

A

Match the drug with the bug, and use a drug whose spectrum is no broader than required.

(p. 1028)

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12
Q

What 4 carbapenems are available?

A

imipenem, meropenem, ertapenem, and doripenem

p. 1029

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13
Q

Are any of the carbapenems active against MRSA?

A

No

p. 1029

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14
Q

What interaction occurs between imipenem and valproate?

A

Imipenem can reduce blood levels of valproate.

p. 1030

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15
Q

In general, how would you describe the class of carbapenems?

A

Carbapenems are beta-lactam antibiotics with a very broad antimicrobial spectrum.

(p. 1029)

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16
Q

Resistant organisms have emerged when P. aeruginosa is treated with imipenem alone, so it should be…

A

…combined with another antipseudomonal drug when used against this microbe.

(p. 1030)

17
Q

What kind of microbe is Pseudomonas aeruginosa?

What should you know about it?

A

It’s an aerobic gram-negative rod
Most healthy people don’t get infected by this bug bc it has weak invasive abilities. In immunocompromised patients, it is a common cause of pneumonia.

(p. 81 of Clinical Microbiology Made Ridiculously Simple)

18
Q

What mnemonic should you remember for Pseudomonas aeruginosa?

A

C BE PSEUDO
(corneal infections, burns, endocarditis, pneumonia, sepsis, external malignant otitis media, UTI, diabetic osteomyelitis)

(p. 82 of Clinical Microbiology Made Ridiculously Simple)

19
Q

What kind of microbe is Clostridium difficile?

A

gram-positive, spore-forming, anaerobic bacillus

p. 1031

20
Q

What is virulence?

A

the ability of an organism to cause disease

21
Q

What is NAP1/BI/027?

A

A particularly virulent strain of C. diff.

p. 1031

22
Q

Intensive use of ________________, such as ____________ [_____] and ____________ [________], is believed responsible for the rapid spread of the NAP1/BI/027 strain.

A

fluoroquinolones,
Ciprofloxacin [Cipro] and levofloxacin [Levaquin]

(p. 1031)

23
Q

Vancomycin is active only against…

A

…gram-positive bacteria.

p. 1031

24
Q

What is the cause of red man syndrome associated with rapid infusion of vancomycin and what are possible symptoms?

A

They result from histamine release.
Flushing, rash, pruritus, urticaria, tachycardia, and hypotension.

(p. 1033)