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Anti-Infectives Exam 2 > Lecture 2 - Diagnosing infection, Cephalosporins, Carbapenems, & Monobactam > Flashcards

Lecture 2 - Diagnosing infection, Cephalosporins, Carbapenems, & Monobactam Flashcards

1
Q

Signs & Symptoms of Infection: General

A

Fever = > 100.4
1F Rectal > oral > 1F axillary
Inc WBC, HR, BP

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2
Q

Signs & Symptoms of Infection: Site Specific

A

Local signs of pain and inflammation
Swelling, erythema, tenderness, purulent drainage
Imaging

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3
Q

Signs & Symptoms of Infection: Labs + Tests

A

ESR

CRP

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4
Q

Cephalosporins MOA

A
  1. Bind to PBPs

2. Inhibit cross-linking of peptidoglycan in the cell wall

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5
Q

1st Gen Cephalosporins

A

Cefazolin (IV)
Cephalexin (PO)
Cefadroxil (PO)

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6
Q

2nd Gen Cephalosporins

A 
Cefuroxime (IV/PO)
Cefprozil (PO)
Cefaclor (PO)
Cefotetan (IV)
Cefoxitin (IV)
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7
Q

3rd Gen Cephalosporins

A 
Ceftriaxone (IV)
Cefotaxime (IV)
Ceftazidime (IV)
Cefdinir (PO)
Cefditoren (PO)
Cefixime (PO)
Cefpodoxime (PO)
Ceftibuten (PO)
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8
Q

4th Gen Cephalosporins

A

Cefepime

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9
Q

5th Gen Cephalosporins

A

Ceftaroline

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10
Q

Advanced Gen Cephalosporins

A

Cefiderocol
Ceftazidime-avibactam
Ceftolozane-tazobactam

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11
Q

1st & 2nd Gen Cephalosporins Spectrum of Activity Gram +

A

No enterococcal activity
1st gen Cefazolin = txm of choice for MSSA…maybe better than nafcillin

Not effective against MRSA
Great activity against all Strep spp.

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12
Q

3rd & 4th Gen Cephalosporins Spectrum of Activity Gram +

A

Less active than 1st/2nd gen in general
no enterococcus activity

Limited activity against MSSA
Not active against MRSA

Great activity against all Strep spp.

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13
Q

Ceftriaxone treatment of choice against….

A

Invasive Streptococcal infections (Penicillin-I or -R)

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14
Q

Ceftriaxone exception…

A

used in combo with Ampicillin for synergy in E.faecalis endocarditis

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15
Q

5th gen Cephalosporins Spectrum of activity Gram +

A

Best gram + of all gen

no Enterococcus activity

** Great against Step Aureus, MSSA, MRSA **
Great activity against all Strep spp.

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16
Q

Which Cephalosporins are used as Salvage therapy in combo with vanc or dapto for synergy?

A

5th gen

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17
Q

Advanced Gen Cephalosporins Spectrum of activity

A

Designed for Gram -

Gram + isn’t as good

No activity against S. aureus or Enterococcus

Ceftolozane-tazobactam + Ceftazidime-avibactam active against Streptococcus spp.

Cefiderocol has some activity against Streptococcus, less than other beta-lactams

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18
Q

1st & 2nd Gen Cephalosporins Spectrum of Activity Gram -

A

No activity against non-fermenters

Limited Gram - activity overall

Active against susceptible E.Coli, K pneumoniae, P.mirabilis

2nd gene more activity than 1st

2nd gen activty agisnst H.influenzae + M. catarrhalis (used in CAP for children)

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19
Q

3rd + 4th Gen Cephalosporins Spectrum of Activity Gram -

A

3rd gen (Ceftriaxone) txm of choice for E.coli, K.pneum, H.influenzae

3rd gen don’t have activity against non fermenters

4th gen have broader activity against Gram -

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20
Q

Which 3rd gen Cephalosporin has activity against non-fermenters?

A

Ceftazidime

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21
Q

Pseudomonas aeruginosa 4th gen Cephalosporin that is drug of choice?

A

Cefepime

3rd gen would be Ceftazidime

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22
Q

5th Gen Cephalosporins Spectrum of Activity Gram -

A

Limited Gram - activity similar to 2nd gene

No activity against non-fermenters

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23
Q

Advanced Gen Cephalosporins Spectrum of activity Gram -

A

Very broad Gram - coverage

Expanded coverage against multi-drug resistant organisms

24
Q

Ceftazidime-avibactam is active against…..

A

carbapenemase-producing organisms (commonly via KPC enzyme)

25
Q

Ceftolozane-tazobactam has expanded coverage against…

A

MDR P. aeruginosa

26
Q

Cefiderocol has activity against….

A

MDR Acinetobacter, MBL producing Enterobacterales, along with all the other stuff

27
Q

Cephalosporins Anaerobes Spectrum of activity

A

overall not that great

Most have activity against Peptostreptococcus

** Cefoxitin + Cefotetan ** have best activity

28
Q

Cephalosporins Spectrum of activity for Atypical?

A

none

29
Q

Cephalosporins M & E

A

Few are extensively metabolized

Oral prep stable in Acid/ GI tract

None of the oral achieve therapeutic conc in CSF

Most excreted in kidney, 1/2 life 1-2hrs, some up to 3-8hrs allowing for 12-24hr dosing intervals (ceftriaxone)

30
Q

Cephalosporins ADR

A

GI - Obstructive biliary toxicity (ceftriaxone)
Hepatic
CNS - Encephalopathy, seizures (cefepime)
Hypersensitivity = less than penicillins

31
Q

Cephalosporins Drug Interactions

A

Interact w/ warfarin and increase inhibition of Vit K reductase, increased risk of bleeding

Probenecid = inc plasma lvls of cephalosporins

32
Q

Using Ceftriaxone in MSSA?

A

nah, not preferred because MICs can be intermediate and treatment failure can be seen

33
Q

Non-Pseudomonal Carbapenem

A

Ertapenem

34
Q

Pseudomonal Carbapenems

A

Imipenem

Meropenem

35
Q

Carbapenem + Beta-lactamase inhibitor

A

Meropenem-vaborbactam

Imipenem-relebactam

36
Q

Carbapenems Spectrum of Activity Gram +

A

Limited Enterococcal activity

Active against MSSA but not MRSA

Active against all Strep spp.

37
Q

Imipenem considered active against E.faecalis if…

A

its a Penicillin-susceptible one

38
Q

Carbapenems Spectrum of Activity Gram -

A

Broad Gram - activity

No activity against Stenotrophomonas maltophilia

39
Q

Ertapenem will not cover against which gram -

A

non-fermentors

40
Q

Carbapenems active against Pseudomonas aeruginosa…..

A

Meropenem and Imipenem

41
Q

Carbapenems are often used for….

A

ESBL producing strains

42
Q

Carbapenems + Beta-lactamase inhibitor combo spectrum of activity is…

A

extended against carbapenemase-producing organisms (commonly via KPC enzyme)

active but not as helpful against MDR Acinetobacter or Pseudomonas

no activity against Stenotrophomonas maltophilia

Reserved for MDR gram - usually

43
Q

Carbapenems Spectrum of activity for Anaerobes

A

Great activity against both Gram -/+ anaerobes

Used for polymicrobial infections that include anaerobes

44
Q

Carbapenems Spectrum of activity for Atypicals

A

none

45
Q

Carbapenems DI

A

Valproic acid = avoid combo

Probenecid = avoided, increase plasma levels

46
Q

Carbapenems ADR

A 
GI = N,V,D
CNS = Seizures ( Imipenem>meropenem>ertapenem)
Hypersensitivity = low cross reactivity w/ penicillin < 1%
47
Q

Carbapenems M & E

A

Imipenem subject to degradation by DHP-1, made w/ something to prevent its breakdown

all distribute well, CNS too

Imi/Mero dosed every 6-8hr (1hr 1/life)
erta dosed every 24hrs (4hr 1/2life

all have renal elim, so need dose adjustment

48
Q

Aztreonam MOA

A

Binding ot PBPs, specifically high affinity for PBP3

Inhibit cross-linking of peptidoglycan in cell wall

49
Q

Aztreonam Spectrum of activity

A

Gram + = 0
Anaerobes = 0
Atypical = 0

50
Q

Aztreonam Spectrum of Activity Gram -

A

Active against E.Coli, K. Pneumoniae, P. mirabilis

Not active against ESBL or KPC organisms
Active against MBLs

No activity against other nonfermentors (only P.aeruginosa)

51
Q

Aztreonam is considered treatment of choice against….

A

Pseudomonas aeruginosa,

in patients who are beta-lactam intolerant/allergic

52
Q

Aztreonam M & E

A

not extensively metabolized and not absorbed in GI tract

Distributes well into tissues + fluids, CNS too

1.7hrs 1/2life, prolonged in renal dysfunction

53
Q

Monobactam drug

A

Aztreonam

54
Q

Aztreonam ADR

A 
GI = N,V,D
Derm = rash
55
Q

Aztreonam DI

A

no significant DI

Anti-Infectives Exam 2 (8 decks)

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