EXAM 2 cephalosporins, carbapenems, monobactams

Question 1

Cephalosporins MOA

Answer 1

interfere w/ PBPs on bacterial cell walls
bactericidal

Question 2

cephalosporins MOR

Answer 2

Production of b-lactamase enzymes
Alterations in PBPs leading to decreased binding affinity (MRSA, PSRP)
Several have activity against PRSP; one is active against MRSA(ceftaroline)
Alteration of outer membrane leading to decreased penetration

Question 3

cephalosporin spectrum

Answer 3

Lose gram (+) activity w/ increase gram (-) activity as you go 1st -> 2nd -> 3rd -> 4th
Greater b-lactamase stability as you go from 1st -> 2nd -> 3rd -> 4th

Question 4

1st gen cephalosporins

Answer 4

cefazolin (parenteral)
cephalexin (oral)

Question 5

1st gen cephalosporin spectrum

Answer 5

MSSA (cefazolin drug of choice)

Question 6

2nd gen cephalosporins

Answer 6

cefuroxime
cefprozil
cefoxitin

Question 7

2nd gen cephalosporin spectrum

Answer 7

MSSA
BDA (cefoxitin)

Question 8

3rd generation cephalosporins

Answer 8

ceftriaxone
ceftazidime
cefpodoxime

Question 9

3rd gen cephalosporin spectrum

Answer 9

PRSP (ceftriaxone)
pseudomonas (ceftazidime)

Question 10

4th generation cephalosporin

Answer 10

cefepime

Question 11

cefepime spectrum

Answer 11

PRSP
MSSA
Pseudomonas

Question 12

anti-MRSA cephalosporin

Answer 12

Ceftaroline

Question 13

ceftaroline spectrum

Answer 13

PRSP
skin and soft tissue MRSA
MSSA

Question 14

cefiderocol spectrum

Answer 14

Fetroja

ESBLs, AMPCs

Question 15

cephalosporin b-lacatamase inhibitor combos

Answer 15

Ceftolozane-tazobactam (zerbaxa)
Ceftazidime-avibactam (avycaz)

Question 16

Ceftolozane-tazobactam (zerbaxa)
Ceftazidime-avibactam (avycaz)
spectrum

Answer 16

pseudomonas aeruginosa

Question 17

Which cephalosporin is considered potential drug of choice for MSSA infections?
Ceftazidime
Cefotetan
Cefazolin
Ceftolozane-Tazobactam
Cefnoicid

Answer 17

Cefazolin

Question 18

Which cephalosporin does NOT have activity against Pseudomonas aeruginosa?
Ceftriaxone
Ceftazidime
Cefepime
Ceftolozane-Tazobactam
Ceftazidime-Avibactam

Answer 18

Ceftriaxone

Question 19

Cephalosporin pharmacology

Answer 19

Time>MIC is PD parameter

Question 20

cephalosporin distribution

Answer 20

Widely distributed
CSF concentrations ONLY achieved with PARENTAL cefuroxime, 3rd gen and 4th gen agents

Question 21

Cephalosporin elimination

Answer 21

Most are primarily eliminated unchanged by kidney
Ceftriaxone (biliary) + Cefoperazone (liver) are NOT eliminated by kidneys

Question 22

what is the half life of cephalosporins?

Answer 22

most have <2 hrs t 1/2
ceftriaxone has 8 hr t1/2 –> can give it QD

Question 23

adverse effects of cephalosporins

Answer 23

Hypersensitivity
MTT side chain –> hypoprothrombinemia and ethanol intolerance
IV calcium and ceftriaxone precipitates –> nonconvulsice status epilepticus

Question 24

T/F: a patient who developed anaphylaxis to penicillin requiring ICU admission can safety receive any cephalosporin

Answer 24

FALSE

Question 25

what are the available carbapenems?

Answer 25

imipenem meropenem ertapenem doripenem New agents: meropenem/vaborbactam and imipenem/relebactam

Question 26

carbapenems MOA

Answer 26

inhibit cell wall synthesis by binding to PBP primary target is PBP-2 bactericidal

Question 27

carbapenems MOR

Answer 27

b-lactamase production - highly stable against b-lactamse so drug of choice for AMPc and ESBLs decrease permeability alteration in PBPs

Question 28

carbapenems spectrum

Answer 28

most broad spectrum agents (liquid jesus or gorilla cillin) MSSA pseudomonas (except erta) BDA (bacteroides)

Question 29

T/F carbapenems are highly stable against b-lactamase enzymes are considered DoC for serious infections due to ESBL and AmpC bugs

Answer 29

TRUE

Question 30

T/F Meropenem/vaborbactam and imipenem/relabactam were developed to provide activity against KPC producing enterobacterales

Answer 30

TRUE

Question 31

carbapenems pharmacology

Answer 31

Time>MIC like all b-lactams clinically useful synergy with AMG

Question 32

carbapenems distribution

Answer 32

widely distributed in body tissues and fluids CSF penetration --> meropenem is the only one that gets enough penetration

Question 33

carbapenems elimination

Answer 33

all are primarily eliminated unchanged kidneys --> need dose adjustments short elimination, but ertapenem has t1/2 4 hrs so can give QD dosing

Question 34

imipenem metabolism

Answer 34

undergoes hydrolysis by DHP which forms nephrotoxic metabolite given with cilastatin a DHP inhibitor

Question 35

carbapenem adverse effects

Answer 35

hypersensitivity higher CNS: confusion, dizzy, hallucination, seizures risk factors: seizures, CNS disorders, high dose, renal insufficiency

Question 36

which carbapenem is co-formulated with cilastatin to prevent DHP degradation in the renal brush border and subsequent nephrotoxicity? Doripenem Meropenem Ertapenem Imipenem All carbapenems are co-formulated with cilastatin

Answer 36

Imipenem

Question 37

Monobactam spectrum

Answer 37

psuedomonas aeruginosa

Question 38

aztrenoam distribution

Answer 38

wide distribution in body tissues and fluids penetrates CSF in pressence of inflamed meniges

Question 39

Which of the following antibiotics can be used in a patient who developed angioedema, hives, and hypotension requiring ICU admission after an IM injection of penicillin? Ampicillin Meropenem Ceftaroline Aztreonam None of the above

Answer 39

Aztreonam