Topic 9-Cephalosporins

Question 1

Mechanism of action

Answer 1

Inhibits transpeptidase by binding PBP

Question 2

First generation cephalosporin parenteral drugs

Answer 2

cefazoline cefalotin

Question 3

First generation cephalosporin oral drugs

Answer 3

cefalexin cefadroxil

Question 4

First generation spectrum and indication

Answer 4

Gram positive bacteria, strong effect Strong effect for staphylococcus Used in clinic as prophylaxis, pre-aspiration meds to avoid gram + infections Used in respiratory/skin infections (maybe UTI)

Question 5

Second generation cephalosporin parenteral drugs

Answer 5

cefuroxime cefamandole cefoxitin

Question 6

Second generation cephalosporin oral drugs

Answer 6

cefuroxime-axetil cefaclor

Question 7

Second generation cephalosporin spectrum and indications

Answer 7

good effects against Gram -/+ (better against gram -) With cephalosporin 1 drugs, has best effects against staph H. influenzae, Neisseria, and Serratia Indications include mild UTI airway infection

Question 8

What bacteria is cefuroxime good against

Answer 8

H. influenzae

Question 9

What is cefoxitine good for

Answer 9

mild/moderate/severe poly-infection and bacillus fragilis Good effect against oral cavity anaerobes

Question 10

Third generation cephalosporin parenteral drugs

Answer 10

ceftriaxone cefotaxime cefoperazone ceftazidime

Question 11

Third generation cephalosporin oral drugs

Answer 11

ceftibuten cefixime

Question 12

Third generation cephalosporin spectrum

Answer 12

Gram - best effect with 4th and 5th generation cephalosporins Worst effect for Gram +

Question 13

Third generation cephalosporin indications

Answer 13

-Reserve ABX -Used in pneumococcus ABX resistance -oral-used in UTI -Pyelonephritis, 1st choice compound since fluroquinolones are now resistant -CNS, 1st choice treatment of meningitis -pseudomonas aeruginosa

Question 14

Which bacteria is Ceftazidime used for

Answer 14

pseudomonas

Question 15

Which bacteria is cefoperazone used for

Answer 15

pseudomonas

Question 16

Fourth generation cephalosporins parenteral drug

Answer 16

cefepime

Question 17

What is the spectrum of fourth generation cephalosporins

Answer 17

Effective against Gram - like third and fifth generation and some MRSA effect/Gram + effect

Question 18

What is cefepime used for

Answer 18

pseudomonas

Question 19

What are the fifth generation cephalosporin parenteral drugs

Answer 19

ceftolozane ceftaroline

Question 20

What are the spectrum of fifth generation cephalosporins

Answer 20

Effective against Gram - like third and fourth generation and strong MRSA effect/Gram + effect

Question 21

What is ceftolozane used for?

Answer 21

pseudomonas, acetobacter, Gram - pneumonia, UTI, and abdominal infections

Question 22

What is ceftaroline used for?

Answer 22

Gram -, MRSA, and community acquired skin infections

Question 23

Cephalosporin pharmacokinetics (5 major points)

Answer 23

No oral absorption Bad distribution Good penetration 3rd generation has excellent penetration (therapeutic levels reached in gallbladder) 3rd generation has good therapeutic levels for meningitis

Question 24

Cephalosporin administration

Answer 24

8-12 hours given

Question 25

How often is cefotaxime given

Answer 25

3-4 times a day (taxis are fast so has faster degradation)

Question 26

What antibiotics are given once a day

Answer 26

ceftriaxone, ceftibuten, and cefixime

Question 27

Where is cephalosporins metabolized

Answer 27

kidneys

Question 28

Besides the kidney’s where is ceftriaxone and cefoperazone eliminated

Answer 28

the bile (40-50% of the time)

Question 29

Side effects of cephalosporins

Answer 29

Non-toxic ABX Allergy (cross allergy with penicillin so if you have a penicillin allergy, high chance of being allergic to cephalosporins) High serum levels causes epileptic serizures Hemolytic anemia/thrombocytopenia GI effect=diarrhea, biliary tract alcohol intolerance Disulfiram like effect

Question 30

Which two drugs cause alcohol interolerance?

Answer 30

cefoperazone and cefamandol (Think music cause of opera and mandolin)

Question 31

Disulfiram like effect is

Answer 31

inhibited aldehyde dehydrogenase causes acetyl aldehyde build up leading to nausea, vomiting, high blood presure, and flushing