Cephalosporins

Question 1

Cephalosporin MOA

Answer 1

• Same as penicillins; bacteriocidal

Question 2

Resistance to Cephalosporins is primarily through…

Answer 2

• Beta-lactamase production
• May alter affinity or lack of PBP

Question 3

First Generation Cephalosporins

Answer 3

Oral – cephalexin and cefadroxil
IV/IM - cefazolin

Question 4

First Generation Cephalosporins are active against….

Answer 4

• Gram Positive Cocci (Not enterococci or MRSA)
• Some gram negative bacilli (E. coli, proteus, klebisella)

Question 5

T/F: First Generations can penetrate the CNS

Answer 5

• Flase

Question 6

First Generations are the drug of choice for…

Answer 6

Nothing

Cefazolin for surgical prophylaxis

Always second line

Question 7

What is the difference between cephamycin and cephalosporins?

Answer 7

• Structure wise
• Cephamycins –> Oxygen
• Cephalosporins –> Sulfur

Question 8

What structure does cephalosporins have?

Answer 8

• Beta-lactam ring

Question 9

Oral Second Generation Cephalosporins

Answer 9

• Cefuroxime axetil
• Cefprozil

Question 10

IM/IV Second Generation Cephalosporin

Answer 10

• Cefuroxime

Question 11

Second Generation Cephamycin

Answer 11

• Cefoxitin

Question 12

Second Generation Cephalosporins are active against….

Answer 12

• Gram Positive Cocci (Not enterococci or MRSA)
• Some gram negative bacilli (E. coli, proteus, klebisella)
• More coverage of gnb, but not pseudomonas aeurginosa

Question 13

Cephamycins are used in….

Answer 13

used in mixed aerobic/anaerobic infections

–> in the gut –> ruptured appendix –> also seen in diabetic foot infections

Question 14

Third Generation Cephalosporins

Answer 14

• Ceftotaxtime
• Ceftriaxone
• Ceftazidime
• Cefiixime

Question 15

Cefoxatime and Ceftriaxone covers…

Answer 15

• Gram negative cocci, but do not cover Pseudomonas aeuroginosa

Question 16

Ceftazidime Spectrum

Answer 16

• Covers/reserved for pseudomonas aeuroginosa
• Lose alot of gram positive activity

Question 17

IV/IM Route of Admin 3rd Gen Cephalosporin

Answer 17

Cefotaxime, Ceftriaxone and Cetazidine

Question 18

Oral Agent 3rd Gen Cephalosporin

Answer 18

• Cefixime

Question 19

3rd Generation Cephalosporin Spectrum of Activity

Answer 19

Decreased activity against gpc except Strep. pneumoniae
Enhanced activity against gnb

Question 20

In regards to absorption, what is the difference between 1stt, 2nd and 3rd gen cephalosporins?

Answer 20

Ability to penetrate the CNS (1st and 2nd don’t, but 3rd do)

Question 21

Fourth Generation Cephalosporins

Answer 21

• Cefepime
• Ceftaroline
• Ceftobiprole

Question 22

Cefepime Spectrum, Use

Answer 22

Enhanced activity against Enterobacter and Citrobacter; active against Ps. Aeruginosa –> use always reserved in hospital  special permission to use

Question 23

Ceftaroline and Ceftobiprole Spectrum

Answer 23

activity against MRSA, ampicillin sensitive E. faecalis and penicillin resistant S. pneumoniae

Question 24

Fourth Gen Cephalosporin Spectrum

Answer 24

• Broad spectrum

Question 25

Adverse effects of cephalosporins

Answer 25

Hypersensitivity Diarrhea Skin rash Other- fever, granulocytopenia, hemolytic anemia Biliary pseudolithiasis - ceftriaxone

Question 26

Cephalosporin Elimination

Answer 26

- Eliminated through the biliary system

Question 27

Carbapenems are related to....

Answer 27

- Beta-lactams

Question 28

Carbapenems Example

Answer 28

Imipenem-cillastatin Meropenem Ertapenem I am ME

Question 29

Can imipenem be used alone?

Answer 29

Imipenem is never given alone --> always given with cilistan Cilistatin is not anti-biotic

Question 30

Imipenem and Meorpenem have... activity.. that covers

Answer 30

Similar gram positive, gram negative, including Pseudomonas, and anaerobic organisms

Question 31

Ertapenem Dose and Activity

Answer 31

Ertapenem – long half-life (once daily); poor activity against Enterococcus sp and P. aeruginosa

Question 32

Monobactam Structure, Resistance, Example and Spectrum

Answer 32

Monocyclic beta-lactam ring Resistant to many beta-lactamases Aztreonam – not available in Canada Active against gnb including Ps. Aeruginosa