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Infection > Erdman ceph > Flashcards

Erdman ceph Flashcards

0
Q

Class generalizations

A

Generally short half life and frequent dosing
Except ceftriaxone which has 8hr half life and a carbapenam.

Eliminated unchanged renally except ceftriaxone, cefoperazone, nafcilin, and oxacillin.

No enterococcus coverage at all

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1
Q

General structure

A

House with garage and basement
Position 7-bacterial activity
Position 3-kinetics activity

6 member ring helps create extra protection against some beta lactamases

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2
Q

Mechanisms of resistance

A

Beta lactamase production

Alteration in PBP (MRSA, PRSP)

Alteration of outer membrane and less drug penetration

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4
Q

1st gen ceph coverage gram positive

A

Group streptococci
Viridans streptococci
Penicillin susceptible s. Pneumoniae
Methicillin susceptible staph aureus (target)
**Best gram + aerobe coverage of all cephs

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5
Q

1st gen ceph coverage gram negative

A

P - proteus mirabilis
E - E. Coli
K - klebsiella pneumoniae

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6
Q

Cefazolin

A

to 1st gen cephalosporin
Used IV
Great for MSSA

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7
Q

Cephalexin

A

1st gen cephalosporin
Used PO
Brand names: Keflex, Keftab, Biocef

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8
Q

Second Gen cephalosporins

A 
Cephalosporins, cephamycins, and carbacephems
Several agents in this class have anaerobic activity(cephamycins)
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9
Q

Second Gen Ceph Gram + coverage

A

Group streptococci
Viridans streptococci
Penicillin susceptible s. Pneumoniae
Methicillin susceptible staph aureus (target)

(same as 1st gen)

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10
Q

Second Gen Ceph gram - coverage

A 
H- H. influenzae
E - Enterobacter spp. (some)
N - neisseria spp
P - proteus mirabilis
E - E. coli
K - K. pneumoniae
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11
Q

ONLY cephalosporins that have activity against anaerobes (class and drugs)

A

Cephamycins (cefotoxin, cefotetan, cefmetazole)

These anaerobes are below the diaphragm and include bacteroides

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12
Q

Cefuroxime

A

2nd gen ceph
Used IV and PO
Brand names:kefurox, Zenacef
Will work on CSF infections but is no longer recommended.

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13
Q

Cefprozil

A

2nd gen ceph
Very common drug (most common 2nd gen)
Brand: Cefzil

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14
Q

Cefoxitin

A

2nd gen ceph
is a cephamycin so has anaerobic coverage!
Brand (Mefoxin)

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15
Q

3rd gen cephalosporin class and positive coverage

A

Some coverage over some Beta lactamase producers

Ceftriaxone has coverage over gram positive aerobes and penicillin-resistant S. pneomoniae (PRSP)

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16
Q

3rd gen cephalosporin gram - coverage

A 
H- H. influenzae
E - Enterobacter spp
N - neisseria spp (including Blactamase N. gonorrhea)
P - proteus mirabilis
E - E. coli
C - Citrobacter sp
K - K. pneumoniae
S - Serrratia marcescens
S - Salmonella sp
S - Shigella sp

Also pseudomonas aeruginosa (target) is covered by ceftazidime and cefoperazone

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17
Q

Ceftriaxone

A

3rd gen ceph
Brand: Rocephin

Elimination is biliary
8hour half life provides allows once daily dosing

**retains gram positive coverage, INCLUDING penicillin-resistant S. pneumoniae (PSRP)

**NO pseudomonas aeruginosa coverage

18
Q

Ceftazidime

A

3rd gen cephalosporin

Brand: Fortaz, Tazicef

19
Q

Cefpodoxime

A

3rd gen ceph
Used PO
Brand: Vantin

20
Q

Fourth gen cephalosporins

A

Gram positive coverage similar to ceftriaxone (good)
Gram negative coverage similar to ceftazidime, including pseudomonas aeruginosa and Beta lactamase producing enterobacter sp.

**stable against Beta lactamases and are weak inducers of AmpC

**only current agent is Cefepime

21
Q

Cefepime

A

4th gen cephalosporin

Only agent currently available in this class

22
Q

Anti-MRSA cephalosporins

A

Gram + coverage similar to ceftriaxone, but also has activity against MRSA.**
Gram - coverage similar to ceftriaxone (does NOT cover pseudomonas aeruginosa)**
**Only ceftaroline is available

23
Q

ceftaroline

A

Only available anti-MRSA cephalosporin

**Does NOT cover pseudomonas aeruginosa

24
Q

Cephalosporin Beta Lactamase Inhibitor Combination

A

Ceftolozane -Tazobactam
Gram + coverage is streptococcus
Gram - coverage is similar to cefepime(4th gen), incuding resistant pseudomonas aeruginosa

**Approved 12/2014, only current agent

25
Q

General cephalosporin guidelines of activity

A 
NOT good against:
MRSA (except ceftaroline)
Enterococcus spp
Listeria
C. diff
Atypical like legionella
stenotrophomonas maltophilia (except ceftazidime)
26
Q

Synergy against Viridans strep

A

Ceftriaxone with gentamicin

27
Q

Synergy against staph aureus

A

cefazolin plus gentamicin

28
Q

Synergy against gram negative aerobes

A

ceftriaxone, ceftazidime, or cefepime plus gentamicin, tobraymycin, or amikacin

29
Q

Treating CSF conditions (meningitis)

A

will ONLY work with parenteral cefuroxime, most 3rd and 4th gen agents at max doses will

  • *NO FIRST GENS!**
  • *Cefuroxime is no longer recommended for meningitis**
30
Q

Cephalosporin elimination

A

Most are eliminated unchanged by the kidneys, so most require renal adjustment. General T1/2 is 2 hrs

  • *Ceftriaxone is biliary, 8 hr half life
  • *Cefoperazone is liver
31
Q

Uses of 1st gen ceph

A

Especially good for endocarditis and bacteremia due to MSSA

Surgical prophylaxis

32
Q

Uses of 3rd gen cephs

A

Ceftazidime is good if pseudomonas is suspected or documented

Ceftriaxone is good for uncomplicated gonorrhea (one IM dose), community aquired pneumonia, (CAP), PRSP, viridans strp endocarditis

33
Q

Uses of 4th gen cephs

A

Cefepime is especially good for pseudomonas

34
Q

Hypersensitivity

A

IgM or IgG - responsible for rash and itching, can try a cephalosporin

IgE - responsible for septic shock, avoid any cephalosporins, PCN, etc in these patients

5-15% cross reactivity with penicillin

35
Q

Adverse effects due to MTT side chain

A

Cefamandole, cefotetan, cefmetazole, cefoperazone, moxalactam
Hypothrombinemia - reduction in vit. K producing bacteria in GI leads to low levels

Ethanol intolerance - disulfuram like reaction for about 24 hrs

36
Q

IV interactions

A

IV calcium and ceftriaxone precipitates (wait 24hrs)

Cefepime and ceftazodine can cause non-convulsive status epilepticus if pt. has renal insufficiency (delirium, mental status change)

37
Q

GI effects

A

common to cause C. diff and increase in bilirubin from ceftriaxone

38
Q

Agents not renally eliminated

A

Nafcilin, oxacillin, ceftriaxone, cefoperazone

39
Q

MTT side chain

A

Cefamandole, cefotetan, cefmetazole, cefoperazone, moxalactam

Cause disulfiram like reaction and hypoprothrombinemia due to decrease in it K producing bacteria in the Gi tract.

40
Q

Ceftriaxone same line incompatibilities

A

Do not use with IV calcium. If giving calcium, must wait 24 hours after giving antibiotic.

41
Q

Agents that are associated with nonconvulsive status epilepticus

A

Cefepime and ceftazidime

Infection (7 decks)

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