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D&D Infectious Disease Midterm > Pharm - Cephalosporins > Flashcards

Pharm - Cephalosporins Flashcards

1
Q

recap - what are the antistaph penicillins

A

methicillin
oxacillin
cloxacillin
nafcillin

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2
Q

differentiate between the structure of penicillins vs cephalosporins

A

both have 4-membered beta lactam ring

however, in penicillins, the fused ring is a 5-membered thiazoline and in cephalosporins it is a 6-membered dihydrothiazine ring

also, penicillins have 1 R substituent and cephalosporins have 2

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3
Q

differentiate between the resistance to B lactamases between penicillins and cephalosporins

A

cephalosporins are MORE RESISTANT to beta lactamases

(but, some strains e coli and klebsiella that have extended spectrum b lactamases can still break cephalosporins)

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4
Q

which have broader spectrum - penicillins or cephalosporins

A

cephalosporins

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5
Q

cephalosporins, tho they have broader spectrum than penicillins, are STILL not active against __ and ____

A

listeria and enterococci

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6
Q

true or false

cephalosporins have similar MOA and resistance mechanisms as penicillins

A

true

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7
Q

how many cephalosporin generations are there??

explain the trends as far as:
-gram positive activity
-gram negative activity
-B lactamase resistance

A

5 generations

-all have similar activity against gram positive

-as you move up the generations (1–>5) there is a broader spectrum and more activity against gram (-)

-as you move up the generations (1–>5) B lactamase resistance increases

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8
Q

name 3 1st gen cephalosporins

A

cephalexin
cefadroxil
cefazolin

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9
Q

how can you remember which cephalosporins are 3rd gen

A

“one”
“ten”
“ime”

and cefdinir

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10
Q

4th gen cephalosporin

A

cefepime

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11
Q

2 5th gen cephalosporins

A

ceftaroline
ceftolozane

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12
Q

cefprozil and cefuroxime - what gen

A

2nd gen

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13
Q

3 mechanisms of cephalosporin resistance

A

-decreased concentration at site of action

-alter TWO PBP’s (1A and 2X)

-hydrolyzed by b lactamases (cephalosporinases)

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14
Q

when the two PBP’s are altered, it makes ____ resistant to ______

A

pneumococci resistant to 3RD GEN CEPHALOSPORINS

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15
Q

First gen cephalosporins have HIGH ACTIVITY against

A

gram positive cocci
(streptococci and staphylococci)

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16
Q

what can 1st gen cephalosporins NOT be used to fight

A

MRSA
pseudomonas
enterobacter, citrobacter

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17
Q

how is cephalexin administered

A

orally

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18
Q

how is cefazolin administered

A

IV infusion only

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19
Q

how are 1st gen cephalosporins eliminated

A

RENALLY - MUST DC DOSE

same issue as penicillins w seizures

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20
Q

same DDI for 1st gen ceph and penicillins

A

probenecid substantially increases serum levels

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21
Q

cephalexin clinical uses

A

PO 1st gen cephalosporin

UTI, staph and strp infections like cellulitis or soft tissue abscess

NOT FOR SERIOUS SYSTEMIC INFECTIONS

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22
Q

at which gen can cephalosporins start being used for respiratory infections including pneumonia

A

2nd gen

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23
Q

2nd gen have high activity against what 2 bacteria

A

Klebsiella and H. influenzae
-cause respiratory infection!!

gram positive cocci

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24
Q

true or false

similar to 1st gen, 2nd gen cephalosporins are not active against enterococci, pseudomonas, or enterobacter infections

A

TRUE

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25
Q

true or false

cefuroxime is a 1st gen cephalosporin

A

FALSE - 2nd gen

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26
Q

how is cefuroxime administered

A

can be oral (cefuroxime axetil) or parenteral by IV (cefuroxime)

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27
Q

how is cefproxil administered and what gen

A

2nd gen oral

28
Q

most cephalosporins are ________ cleared and thus require…..

A

renally cleared and thus require dose adjustment in renal failure

29
Q

major gen of cephalosporins used for meningitis

A

3rd gen

30
Q

which particular 2nd gen is used in CAP

A

cefuroxime

31
Q

ORAL cephalosporins 2nd gen clinical uses

A

lower resp tract infections
sinusitis
otitis

32
Q

true or false

3rd gen cephalosporins CANNOT be used in enterobacter infections

A

TRUE

4th gen can

33
Q

main clinical uses 3rd gen cephalosporins

A

meningitis
sepsis
serious infections

34
Q

3rd gen cephalosporins have high activity against which 2 bacteria

A

haemophilus
neisseria

(both can cause meningitis)

35
Q

true or false

2nd gen cephalosporins can be used for CAP

A

true – specifically cefuroxime

36
Q

true or false

3rd gen have high activity against citrobacter

A

true

37
Q

which 3rd gen cephalosporin is NOT renally eliminated and thus does NOT require a dosage adjustment in renal failure

A

ceftriaxone
removed by liver (biliary tract)

38
Q

intramuscular __ + ___ is used to treat gonorrhea

A

ceftriaxone + azithro

39
Q

true or false

2nd gen cephalosporins can be used for the treatment of sepsis

A

FALSE

3rd gen

40
Q

ceftazidime generation

A

3rd gen (one/ime/ten)

41
Q

_____ + _______ is used to treat neutropenic and febrile immunocompromised patients

A

ceftazidime + avibactam (b lactamase inhibitor

ceftazidime = 3rd gen cephalosporin - used for serious infections!

42
Q

name 2 cephamycins and what generation are they

A

part of 2nd gen

cefoxitin and cefotetan

43
Q

the ORAL 2nd gen cephalosporins are active against __ and ___

A

b lactamase producing H. influenzae or moraxella catarrhalis

44
Q

3rd gen cephalosporins have moderate activity against _____

specifically which 3rd gen

A

pseudomonas aeruginoisa

only ceftazidime

45
Q

3rd gen cephalosporins distribute well in the ____, aside from _____

A

well in CSF, aside from ORAL 3rd gen cephalosporins

46
Q

___ and ___ are approved for meningitis including meningitis caused be pneumococci, meningococci, H. influenzae, and susceptible enteric gram negative rods

A

ceftriaxone and cefotaxime

(3rd gen)

47
Q

can 4th gen, like 3rd, also be used for febrile neutropenia empiric therapy?

A

yes

48
Q

name 4 bacteria that cefepime has good activity against

A

pseudomonas
enterobacteriaceae
staph aureus (NOT MRSA)
streptococccal pneumonia

4TH GEN

49
Q

true or false

cefepime is only given by IV route

A

true

50
Q

2 main clinical uses of cefepime

A

enterobacter infections
empiric therapy of febrile neutropenia

good for nosocomial infections!

51
Q

how is it that 4th gen cephalosporin like cefepime has good activity against enterobacter

A

it’s more resistant to the beta lactamases produced by them

52
Q

TRUE OR FALSE

ceftaroline fosamil is not active against MRSA

A

FALSE - it is

53
Q

2 major clinical uses ceftaroline fosamil

A

CAP
SSTI (MRSA)

54
Q

ceftaroline fosamil is NOT active against —

A

extended spectrum b lactamase producing organisms or ampc

55
Q

true or false

ceftaroline fosamil is a prodrug

A

true

metabolized to ceftaroline

56
Q

TRUE OR FALSE

ceftaroline fosamil retains binding to PBP2a

A

TRUE - ACTIVE AGAINST MRSA!

57
Q

true or false

ceftaroline fosamil is susceptible to chromosomal b lactamases

A

true

58
Q

name 2 cephalosporins that can be combined with a b lactamase inhibitor

also name their class

A

ceftazidime (3rd gen) + avibactam

ceftolozane (5th gen) + taxobactam
could also add metronidazole to that

59
Q

with is the clinical use of ceftolozane + tazobactam + potential metronidazole

A

for hospital acquired pneumonia
complicated UTI
abdominal infections

60
Q

true or false

ceftolozane is not renally excreted

A

false - it is - need dose adjustment

61
Q

what is approximate chance of cross reactivity that someone allergic to penicillin will also be allergic to cephalosporins?

which gens is this most likely for?

A

~1%

more likely with 1st and 2nd gen cephalosporins

62
Q

main toxicity of cephalosporins

A

RENAL toxicity - interstitial nephritis and tubular necrosis

63
Q

which group can cause bleeding issues and what molecule is it on

what is done to resolve

A

MTT - methylthiotetrazole on cefotetan (2nd gen cephamycin)

given with vitamin K
gives severe disulfuram like reactions and hypoprothombinemia and bleeding disorders

64
Q

true or false

cephalosporins can cause c diff diarrhea

A

true - bc kills normal flora and c diff can overgrow

65
Q

cephalosporins can cause ___ penia and ______penia

A

leukopenia and thrombocytopenia

decreased blood cell count

66
Q

*what generation of cephalosporins are recommended for the treatment of bacterial meningitis

A

3rd gen

67
Q
A

D&D Infectious Disease Midterm (26 decks)

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