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Pharmacology > L23: Cephalosporins > Flashcards

L23: Cephalosporins Flashcards

1
Q

Cefazolin, Cephelexin, and Cefadroxil belong to:
A. First Generation Cephalosporins
B. Second Generation Cephalosporins
C. Third Generation Cephalosporins

A

A. First Generation

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2
Q

Fedoxitin, Cefuroxime, and Cefotetan are:
A. First Generation Cephalosporins
B. Second Generation Cephalosporins
C. Third Generation Cephalosporins

A

B. Second Generation

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3
Q

Ceftriaxone, Ceftazidime, Cefixime, and Ceftazidime + Avibactam belong to which group?
A. 1st gen cephalosporins
B. 2nd gen cephalosporins
C. 3rd gen cephalosporins

A

C. 3rd gen cephalosporins

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4
Q

Cefepime is a ____ generation cephalosporin while Cetaroline fosamil, as well as ceftolozane + tazobactam are ___ a generation cephalosporin

A
  • 4th generation
  • 5th generation
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5
Q

True or False: 4th and 5th generation cephalosporins are only administered via IM

A

False - only administered via IV

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6
Q

Cephalosporins first isolated from ____

A

Acremonium (Cephalosporium)

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7
Q

What is the MOA used by cephalosporins?

A

Bind PBP’s and prevent wall cross-links

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8
Q

None of the cephalosporins have activity against ORSA, except a 5th generation cephalosporin known as….
A. Cefepime
B. Cetaroline fosamil
C. Ceftriaxone
D. Ceftazidime
E. Cefixime

A

B. Cetaroline fosamil

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9
Q

True or False: Gram (-) efficacy decreases in subsequent generations of cephalosporins, often with increasing gram (+) efficacy

A

False – Gram (+) efficacy INCREASES in subsequent generations of cephalosporins, often with DECREASING gram (+) efficacy

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10
Q

True or False: First generation cephalosporins are reserved for serious nosocomial infections

A

False - LATER generations are reserved for serious nosocomial infections

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11
Q

R1 vs. R2???

A

R1: anti-bacterial activity changes
R2: metabolism and PK changes

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12
Q

True or False: The later the generation of cephalosporins, the more gram (-) activity and broad spectrum

A

True

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13
Q

Why are cephalosporin generations 1-4 “LAME”

A

No activity against
- Listeria
- Atypicals
- MRSA
- Enterococci

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14
Q

What feature do cephalosporins share with penicillin? Exception?

A

1) Short 1/2 life

Exception: Ceftriaxone

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15
Q

Cephalosporins have adequate penetration into most tissues, but its penetration into
CNS depends on generation.

Which generations do NOT typically enter CNS, even with
inflamed meninges??

A

1st and 2nd gen

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16
Q

Which 2nd generation cephalosporin enters ocular fluids and CNS?

A

Cefuroxime

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17
Q

Which three 3rd generation cephalosporins enter CNS?

A

Ceftriaxone
Cefotaxime
Ceftazidime

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18
Q

Which 4th generation cephalosporins enter the CNS?

A

Cefepime

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19
Q

True or False: Like penicillins, nearly all of the cephalosporins are cleared by the kidney, so dosing adjustments
may be necessary for patients with renal deficiencies

A

True

3rd generation ceftriaxone

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20
Q

___ extends circulating time of cephalosporins

A

Probenacid

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21
Q

Although there’s only 5-10% frequency of cross-allergy with penicillins, ____ are contraindicated in those with previous serious
reaction to penicillins

A

cephalosporins

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22
Q

____ are a major source of cephalosporin resistance

A

Lactamases

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23
Q

Due to ___ ___, cephalosporins are generally more
resistant to lactamases compared to penicillins

A

steric factors

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24
Q

___ generation cephalosporins are increasingly stable to
lactamases, compared to ___ generations
A. earlier; later
B. later; earlier

A

B. later; earlier

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25
Q

True or False: 3rd generation cephalosporins are less susceptible to Gram (-) lactamases

26
Q

Although 4th generation cephalosporins are even more stable than 3rd, they are still susceptible to
____ and ____

A

KPC (carbapenemase)
metallo-β-lactamases

27
Q

Altered ___ with low affinity for beta lactams is important resistance mode for cephalosporins

28
Q

__ generation cephalosporins are good for routine
infections caused by gram positive cocci
A. First
B. Second
C. Third
D. Fourth
E. Fifth

29
Q

True or False: In gram positive organisms that remain sensitive, 1st gen > 2nd and 3rd gens

30
Q

___ is a first generation cephalosporin that is injectable only – choice for surgery prophylaxis

31
Q

Which four gram (-) enterics can be treated with 1st generation cephalosporins? (Hint: PECK)

A

P. mirabilis
E. coli
Klebsiella pneumoniae

32
Q

_____ is now the only parenteral 1st gen cephalosporin
available in the US

33
Q

Which three 1st generation cephalosporins are orally available?

A

Cephalexin, cefadroxil, or cephradine

34
Q

Uses for 1st gen cephalosporins?

A
  • Mild ear infection
  • UTI
  • Pneumonia
  • Endocarditis
  • Throat infection
  • Cellulitis, abscess, (polymicrobial infections)
35
Q

Orally available 1st generation cephalosporins are poorly active against penicillin-resistant
pneumococci, such as ____

A

P. aeruginosa

36
Q

How do 2nd generation cephalosporins compare to 1st gen?

A

2nd generations are better against Gram (-)
organisms (e.g. H. influenzae, Moraxella
catarrhalis), but sacrifices some Gram (+) efficacy

37
Q

Which two 2nd generation cephalosporins are effective against anaerobes, including
B. fragilis?

A

1) Cefoxitin
2) Cefotetan

38
Q

___ is a 2nd generation cephalosporin that has oral availability

A

Cefuroxime

39
Q

Unlike most 2nd gen, _____ has good CNS penetration, but inferior to 3rd generation for meningitis

A

Cefuroxime

40
Q

Clinical uses of Cefuroxime?

A
  • Sinusitis
  • Otitis media
  • Community acquired
    pneumonia
41
Q

Which pathogens does Cefuroxime (oral 2nd gen cephalosporin) have activity against?

A

S. pneumoniae
H. influenzae
M. catarrhalis
P. pyogenes
K. pneumoniae

42
Q

True or False: Cephamycins are notable for activity against Bacteroides anaerobes

43
Q

Which two 2nd gen cephalosporins are injectable only and used for anaerobic infections?

A

Cefoxitin
Cefotetan

44
Q

____, a 2nd gen cephalosporin, is the choice for prophylaxis in surgery of abdominal and pelvic cavities
A. Cefoxitin
B. Cefotetan

A

A. Cefoxitin

45
Q

True or False: For infections outside of the abdominal and pelvic areas, cephamycins have MANY advantages over the
1st generation cephalosporins

A

False - for infections outside of the abdominal and pelvic areas, cephamycins have NO advantages over the
1st generation cephalosporins

46
Q

True or False: 2nd gen cephalosporins are better than 3rd generation for treating gram (-) pathogens

A

False - 3rd generation cephalosporins are better than 2nd generations for treating gram negative infections

47
Q

True or False: 3rd gen cephalosporins are stable
to the beta-lactamases produced by Neisseria, H.
influenzae, but are ineffective against gram-positives

48
Q

Which two 3rd gen cephalosporins can get into the CNS easily, thereby treat meningitis?

A

Ceftriaxone
Ceftazidime

49
Q

____ is a good 3rd generation cephalosporin that is good for treating penicillin-resistant Strep
Pneumoniae
A. Ceftriaxone
B. Ceftazidime

A

A. Ceftriaxone

50
Q

True or False: Enterobacter becomes resistant to 3rd gen cephs

51
Q

Sepsis, UTI, infections of respiratory tract, skin, bone/joints can be best treated with which generation of cephalosporins?
A. First
B. Second
C. Third
D. Fourth

52
Q

3rd Generation Ceftazidime is particularly useful
against _____
A. E. coli
B. P. aeruginosa
C. S. aureus
D. S. pneumo

A

B. P. aeruginosa

53
Q

Which generation cephalosporin is stable to the beta-lactamases produced by Pseudomonas aeruginosa strains resistant to the anti-pseudomonal penicillins?
A. First generation
B. Second generation
C. Third generation
D. Fourth generation

A

C. Third generation

54
Q

Ceftazidime (3rd gen cephalosporin) is good for meningitis due to pseudomonas, but it is ineffective against _____
A. Gram (+)
B. Gram (-)

A

A. Gram (+)

55
Q

Cefoperazone is similar to ceftazidime, but inferior. Why?

A

Greater vulnerability to lactamases, and adverse effects including anticoagulation

56
Q

Properties of Ceftriaxone?

A
  1. Extensive billary clearance (no dose adjustments for renal insufficiency)
  2. Resistant to some B-lactamases – but vulnerable to ESBL’s
  3. Good at penetrating CSF/peipheral fluids
57
Q

What is the recommended therapy for Neisseria
gonorrhoeae, even penicillin-resistant forms?

A

Ceftriaxone IM

58
Q

True or False: Oral cefixime also effective for N. gonorrheae

59
Q

What are 3 conditions that can be treated with Ceftraxione?

A
  1. N. gonorrhoeae (even penicillin resistant forms!)
  2. S. pneumo
  3. Neuro complications from Lyme (B. burgdorferi)
60
Q

Limitations of Ceftriaxone?

A
  1. Poor activity against P. aeruginosa
  2. No activity against ORSA (LAME)
  3. Not effective against Enterobacter
  4. Precipitation toxicities

Pharmacology (53 decks)

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