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PT 1 > L23 Cell Wall Inhibitors II > Flashcards

L23 Cell Wall Inhibitors II Flashcards

1
Q

Cephalosporins display variable susceptibility to beta-lactamase enzymes; which generation is most stable?

A

4th generation

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2
Q

First generation cephalosporins work best against ___; they also have good activity against a few ___.

A

Gram positive aerobes; Gram negative aerobes

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3
Q

Which Gram-positive bacteria are susceptible to first generation cephalosporins?

A
  1. Methicillin-susceptible S. aureus
  2. Penicillin-susceptible S. pneumoniae
  3. Group streptococci
  4. Viridans streptococci
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4
Q

Which Gram-negative bacteria are susceptible to first generation cephalosporins?

A
  1. P. mirabilis
  2. E. coli
  3. K. pneumoniae
    PEK
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5
Q

Second generation cephalosporins contain what two types of antibiotic in addition to cephalosporins?

A
  1. Cephamycins

2. Carbacephemas

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6
Q

Second generation cephalosporins are slightly less active against ___, but more active against ___. The cephamycins also have activity against ___.

A

Gram-positive aerobes; Gram-negative aerobes; anaerobes

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7
Q

Which Gram-positive bacteria are susceptible to second generation cephalosporins?

A
  1. Methicillin-susceptible S. aureus
  2. Penicillin-susceptible S. pneumoniae
  3. Group streptococci
  4. Viridans streptococci
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8
Q

Which Gram-negative bacteria are susceptible to second generation cephalosporins?

A
  1. P. mirabilis
  2. E. coli
  3. K. pneumoniae
  4. H. influenzae
  5. Enterobacter spp. (some)
  6. Neisseria spp.
  7. M. catarrhalis

HENPEK

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9
Q

Which type of second generation cephalosporins have activity against anaerobes, and which anaerobes?

A

Cephamycins (cefoxitin, cefotetan, cefmetazole); Bacteroides fragilis

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10
Q

Third generation cephalosporins are less active against ___ aerobes, but have greater activity against ____ aerobes, including some beta-lactamase-producing strains.

A

Gram-positive; Gram-negative

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11
Q

Which third generation cephalosporins retain the best activity against Gram-positive aerobes, including PRSP?

A

Ceftriaxone and cefotaxime

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12
Q

Which Gram-negative bacteria are susceptible to third generation cephalosporins?

A
  1. P. mirabilis
  2. E. coli
  3. K. pneumoniae
  4. H. influenzae
  5. M. catarrhalis
  6. N. gonorrhoeae
  7. N. meningitidis
  8. Citrobacter sp.
  9. Enterobacter sp.
  10. Acinetobacter sp.
  11. Morganella morganii
  12. Serratia marcescens
  13. Providencia
  14. Salmonella sp.
  15. Shigella sp.
  16. Pseudomonas aeruginosa
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13
Q

Which third generation cephalosporins have activity against Pseudomonas aeruginosa?

A

Ceftazidime and cefoperazone

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14
Q

What is beneficial about fourth generation cephalosporins?

A
  1. Extended spectrum of activity (including Pseudomonas aeruginosa and beta-lactamase producing Enterobacter spp.)
  2. Stable against beta-lactamases; poor inducer of extended-spectrum beta-lactamase enzymes
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15
Q

What is the only fourth generation cephalosporin currently available?

A

Cefepime

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16
Q

What is beneficial about fifth generation cephalosporins?

A

Extended activity against respiratory pathogens (H. influenzae, S. pneumoniae, Moraxella, S. aureus) and Gram positive pathogens of SSSI (S. pneumoniae, MRSA)

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17
Q

What is ceftaroline used for?

A
  1. Community acquired bacterial pneumonia

2. SSSI

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18
Q

What is ceftolozane-tazobactam (Zerbaxa) used for?

A

Beta-lactam resistant GNRs including Pseudomonas; complicated intra-abdominal infections and UTI

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19
Q

Overall, cephalosporins are NOT active against which 6 bacteria?

A
  1. MRSA
  2. Enterococcus spp.
  3. Listeria monocytogenes
  4. Stenotrophomonas maltophilia
  5. Clostridium difficile
  6. Atypical bacteria, including Legionella
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20
Q

How are cephalosporins absorbed?

A

Oral cephalosporins are well-absorbed, but achieve lower serum concentrations than parenteral products.

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21
Q

How are cephalosporins distributed?

A

Widely into tissues and fluids; CSF concentrations achieved only with parenteral cefuroxime, 3rd, and 4th generation agents

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22
Q

How are cephalosporins eliminated?

A

Primarily eliminated unchanged by the kidney via glomerular filtration and tubular secretion

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23
Q

Which 2 cephalosporins are not eliminated by the kidney?

A
  1. Ceftriaxone (biliary)

2. Cefoperazone (liver)

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24
Q

Most cephalosporins have short elimination half-lives (< 2 hours), except for ___, which has a half-life of 8 hours.

A

Ceftriaxone

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25
Q

What are first generation cephalosporins used for clinically?

A

Skin and soft tissue infections, septic arthritis, osteomyelitis, endocarditis, surgical prophylaxis, UTIs, bacteremia

26
Q

What are second generation cephalosporins used for clinically?

A

Sinusitis, otitis media, upper and lower respiratory tract infections, polymicrobial infections or surgical prophylaxis for abdominal surgery (cefoxitin, cefotetan)

27
Q

Which second generation cephalosporin is no longer recommended for meningitis?

A

Cefuroxime

28
Q

What are third generation cephalosporins used for clinically?

A

Bacteremia, pneumonia, complicated UTI, peritonitis, intra-abdominal infections, skin and soft tissue infections, bone and joint infections, meningiti

29
Q

What is ceftriaxone used for?

A

Uncomplicated gonorrhea, CAP, PRSP, viridans strep endocarditis

30
Q

What are fourth generation cephalosporins used for clinically?

A

Pneumonia, bacteremia, UTIs, skin and soft tissue infections, intra-abdominal infections, Gram-negative meningitis, febrile neutropenia

31
Q

Which generations of cephalosporins cover Pseudomonas?

A

Third, fourth

32
Q

What are fifth generation cephalosporins used for clinically?

A

Community acquired bacterial pneumonia, SSSIs

33
Q

What is the incidence of hypersensitivity for cephalosporins; what is the cross-reactivity with penicillins?

A

5%; 5-15%

34
Q

When can cephalosporins be used/not used with respect to allergy?

A

Okay to use if the reaction is rash or itching; do not use if there is an IgE-mediated reaction

35
Q

Certain cephalosporins (cefamandole, cefotetan, cefmetazole, cefoperazone, moxalactam) have an MTT side chain, which can cause what 2 adverse effects?

A
  1. Hypoprothrombinemia (due to enzyme inhibition of vitamin K metabolism or reduction in vitamin K-producing bacteria in the GI tract
  2. Ethanol intolerance
36
Q

What are the hematologic side effects of cephalosporins?

A

Leukopenia and thrombocytopenia

37
Q

What are the GI side effects of cephalosporins?

A

Increased bili and C. diff. colitis

38
Q

What are the 4 carbapenems currently available?

A
  1. Imipenem
  2. Meropenem
  3. Ertapenem
  4. Doripenem
39
Q

What is the primary target of carbapenems?

A

PBP-2

40
Q

What are the most broad spectrum agents available?

A

Carbapenems

41
Q

Which bacteria are not covered by carbapenems?

A
  1. MRSA
  2. PRSP
  3. VRE
  4. Coag-negative staph.
  5. C. difficile
  6. Atypical bacteria
  7. S. maltophilia
42
Q

Which carbapenems are best for treating Gram-positive aerobes?

A

Imipenem and doripenem

43
Q

Which Gram-positive bacteria are susceptible to carbapenems?

A
  1. Methicillin-susceptible S. aureus
  2. Penicillin-susceptible S. pneumoniae
  3. Group streptococci
  4. Viridans streptococci
  5. Enterococcus faecalis
44
Q

Which Gram-negative bacteria are susceptible to carbapenems?

A
  1. P. mirabilis
  2. E. coli
  3. K. pneumoniae
  4. H. influenzae
  5. M. catarrhalis
  6. N. gonorrhoeae
  7. N. meningitidis
  8. Citrobacter spp.
  9. Enterobacter spp.
  10. Acinetobacter spp.
  11. Morganella morganii
  12. Serratia marcescens
  13. Providencia
  14. Salmonella spp.
  15. Shigella spp.
  16. Pseudomonas aeruginosa
45
Q

Which carbapenems are best for treating Gram-negative aerobes?

A

Meropenem and doripenem

46
Q

Which carbapenem does not treat Pseudomonas aeruginosa?

A

Ertapenem

47
Q

Which Gram-positive anaerobes are susceptible to carbapenems?

A
  1. Peptococcus spp.
  2. Peptostreptococcus spp.
  3. Veillonella
  4. Clostridiium spp. (not C. diff.)
48
Q

Which Gram-negative anaerobes are susceptible to carbapenems?

A
  1. Bacteroides spp.
  2. Fusobacterium
  3. Prevotella spp.
49
Q

How are carbapenems distributed?

A

Widely into body tissues and fluids

50
Q

Which carbapenem penetrates the CSF best?

A

Meropenem

51
Q

How are carbapenems eliminated?

A

Primarily by the kidney

52
Q

Why can imipenem be nephrotoxic and what can be co-administered to help?

A

It undergoes hydrolysis by a dihydropeptidase enzyme in the renal brush border to a nephrotoxic metabolite; it is co-marketed with cilastin, a DHP inhibitor

53
Q

What are the clinical uses of carbapenems?

A

Empiric therapy for hospital acquired infections such as respiratory tract infections, septicemia, intra-abdominal infections, skin and soft tissue infections, bone and joint infections, polymicrobial infections, infections due to beta-lactamase-producing organisms, febrile neutropenia (imip and mero), meningitis (meropenem)

54
Q

What is the incidence of hypersensitivity of carbapenems?

A

3%

55
Q

What are the CNS adverse effects associated with carbapenems?

A

Confusion, dizziness, hallucinations, seizures

56
Q

What are risk factors for seizures when taking carbapenems?

A

Pre-existing CNS disorder, high doses, and renal insufficiency

57
Q

What is the only monobactam currently available?

A

Aztreonam

58
Q

What is the preferred binding site of monobactams when inhibiting cell wall synthesis?

A

PBP-3 of gram-negative aerobes

59
Q

Which Gram-negative bacteria are susceptible to monobactams?

A
  1. E. coli
  2. K. pneumoniae
  3. P. mirabilis
  4. S. marcescens
  5. H. influenzae
  6. M. catarrhalis
  7. Enterobacter
  8. Citrobacter
  9. Providencia
  10. Morganella
  11. Salmonella
  12. Shigella
  13. Pseudomonas aeruginosa
60
Q

What are the clinical uses of aztreonam?

A

UTIs, respiratory tract infections, meningitis, bacteremia, skin and soft tissue infections, and intra-abdominal infections due to susceptible gram-negative aerobes

PT 1 (34 decks)

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