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Antimicrobials: Cephalosporins Flashcards

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1
Q

Cephalosporins MoA

A

Same as PCNs, they effect the cell wall.

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2
Q

What organism do none of the cephalosporins cover?

A

Enterococcus.

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3
Q

MTT side chains in cephalosporins may result in what (2)

A

prolonged PT/INR (bleeding risk)

disulfiram reaction when combined with alcohol (makes you very sick when you drink, used to be used as a negative reinforcer for alcohol abuse).

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4
Q

which cephalosporin is most likely to prolong PT/INR

A

Cefotetan

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5
Q

Generations of Cephalosporins

A

5 generations. 1st is extremely gram positive. From 1st to 5th, you gain gram negative effects while keeping gram positive effects.

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6
Q

First generation Cephalosporins activity

A

extremely gram positive

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7
Q

fifth generation cephalosporins are indicated in

A

resistant organisms

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8
Q

4th and 5th generation cephalosporins

A

the most broad antibiotics. used a lot as empirics.

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9
Q

Cephalosporin cross sensitivity with PCNs

A

1 - 3%

If they had anaphylaxis or hives to PCNs, avoid cephalosporins.

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10
Q

Absorption of Cephalosporins

A

rapid, thorough

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11
Q

distribution of cephalosporin

A

highly distributed and penetrable

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12
Q

A Cephalosporin metabolized 40% by the liver

A

ceftriaxone

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13
Q

Half life of cephalosporins

A

is mostly short except for ceftriaxone

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14
Q

excretion of cephalosporins

A

unchanged in urine, though some undergo biliary excretion.

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15
Q

ceftriaxone and liver disease

A

not contraindicated, just need to be cautious and monitor.

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16
Q

first generation cephalosporins include (3)

A

cefazolin
cephalexin
cefadroxil

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17
Q

1st generation Cephs are very active against (2)

A

Streptococcal

MSSA

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18
Q

1st generation ceps: weaknesses (3)

A
  • limited activity against gram neg rods
  • no anaerobic cvg
  • poor CSF penetration
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19
Q

1st gen cephs distribution

A

all tissues

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20
Q

1st gen cephs dose reduction

A

If CrCl is <50 mL/min

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21
Q

2nd generation cephalosporins are divided

A

into two groups

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22
Q

2nd generation cephalosporins: group 1 drugs

A

cefuroxime

cefaclor

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23
Q

2nd generation cephalosporins, group 2 AKA

A

the cephamycins

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24
Q

2nd generation cephalosporins, group 2 (cephamycin) drugs

A

cefoxitin
cefotetan
(These have the MTT chains)

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25
Indication of 2nd generation cephalosporins, group 2 (cephamycins)
"dirty surgery" ie: GI/GU surgeries
26
2nd generation cephalosporins, group 1, indicated in
respiratory infections | head/neck infections
27
risk with cefoxitin or cefotetan
bleeding risk | worse in cefotetan
28
Activity of 2nd generation cephalosporins, group 1 | 4
- active against strep and MSSA - some activity against gram neg organisms (head/neck) - no activity against gram neg anaerobe bacterioides (b. fragilis) - variable CSF levels
29
Activity of 2nd generation cephalosporins, group 2 (cephamycins) (4)
- inferior against strep and MSSA - very good coverage against bacteroides (B fragilis) - enhanced activity against gram negatives compared to the 1st generation and 2nd generation group 1s. - GI/GU surgeries
30
Distribution of 2nd generation cephalosporins
``` lung female GU kidney synovial fluid peritoneal/pericardial fluid pleural fluid ```
31
Cefuroxime, a 2nd generation cephalosporin, may be used for
meningitis as it penetrates well into the CSF.
32
Dose adjustment for 2nd generation cephalosporins
CrCl <50 mL/min
33
3rd generation cephalosporins are divided into
anti pseudomonas | and others
34
The only time a patient will be on BID ceftriaxone is in the setting of
meningitis
35
3rd generation cephalosporins- anti psuedomonal
ceftazidime
36
third generation cephalosporins, "others" (non anti pseudomonas) (3 for this class)
ceftriaxone cefpodoxime ceftazidine
37
cefotaxime, a third generation cephalosporins, will be used in the setting of
hyperbilirubinemia of newborns, as it will not make the condition worse like ceftriaxone will.
38
cefpodoxime, a 3rd generation cephalosporin, can be thought of as
an oral substitute for ceftriaxone.
39
What do you need to keep in mind when prescribing cefpodoxime?
it does have an MTT chain, so monitor labs if a patient is also on warfarin
40
dose adjustments for 3rd generation cephs
renal: CrCl <50 mL/min | hepatic for ceftriaxone
41
distribution of 3rd generation cephs
extensively distributed and penetrates the CSF
42
4th generation cephalosporin drug
cefepime
43
what is the broadest of the cephalosporins?
cefepime
44
activity of 4th gen cephalosporin, cefepime
- superior gram neg activity, with good activity against pseudomonas - staph and strep cvg is comparable to the earlier generations - NO activity against MRSA.
45
cefepime as an empiric abc
excellent
46
oncologic indication for cefepime
febrile neutropenia
47
distribution of 4th gen ceph, cefepime
same as 3rd gen.
48
5th generation cephalosporin
ceftaroline
49
ceftaroline claim to fame
anti MRSA
50
spectrum of activity of 5th generation cephalosporin, ceftaroline
``` very wide gram neg gram pos aerobic anaerobic ```
51
what conditions may you see 5th generation cephalosporin, ceftaroline, used in and what condition will you NOT see it in? (3, 1)
respiratory infections MRSA S. pneumo NOT pseudomonas.
52
why would you give cefepime and Vanco and metronidazole? (empiric)
cefepime for the broad spectrum and pseudomonas coverage Vanco for MRSA flagyl for anaerobic cvg. then you'll de escalate as your cultures come back
53
General monitoring when on cephalosporins
c&s CBC c diff LFTs RFTs
54
pregnancy/lactation considerations for cephalosporins (4)
category B cross placenta may see inc Vd / clearance crosses breast milk in small amounts
55
Pediatric considerations for cephalosporins
longer half lives | *no ceftriaxone in hyper-bilirubinemia infants.
56
Geriatric considerations for cephalosporins
dose adjust for renal insufficiency
57
considerations for critically ill patients receiving cephalosporins and example
may need higher doses | ie: ceftriaxone dosing for meningitis
58
obesity considerations for cephalosporins
may be dose adjusted up
59
when is the only time you'll see ceftriaxone dosed more than once a day?
meningitis
60
cefepime vs ceftaroline
cefepime coveres psuedomonas but not MRSA | ceftaroline covers MRSA but not psuedomonas
61
3rd generation cephalosporins: ceftazidime | 5
- best for pseudomonas - weak against strep and MSSA compared to the others - poor activity against gram neg anaerobes (covers <50% b fragilis) - excellent CSF levels - may see c diff

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