Cephalosporins, Carbapenems and monobactams Flashcards Preview

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Flashcards in Cephalosporins, Carbapenems and monobactams Deck (40):
1

1st generation options

Cefadroxil (Duracef), Cefazolin (Kefzol), Cephalexin (Keflex)

2

2nd generation options

Cefaclor (Ceclor), Cefotetan (Cefotan), Cefuroxime (Kefurox, Zinacef), Cefoxitin (Ceftin)

3

3rd generation options

Cefotaxime (Claforan), Ceftriaxone (Rocephin), Ceftazidime (Fortaz), Ceftazidime/Avibactam (Avycaz), Cefpodoxime (vantin), Cefdinir (Omnicef)

4

4th generation options

Cefepime (Macipime)

5

5th generation options

Ceftaroline (Teflaro), Ceftolazane/Tazobactam (Zerbaxa)

6

MOA of cephalosporins

inhibit cell wall synthesis by binding to PBPs, time dependent, bactericidal (rapid)

7

What is the spectrum of cephalosporins

No cephalosporin has enterococcal or listeria activity, inc gram - coverage as go from 1st-> 3rd generation and lose some gram + coverage, 4th and 5th regain staph

8

Dose of 1st generations

Cefazolin (Ancef) 1gm IV Q8hrs, Cephalexin (Keflex)- 500 mg PO QID

9

Spectrum of 1st generations

strep, staph MSSA only, most oral anaerobes

10

What do 1st generations not cover?

strep. pneu, limited gram -

11

Clinical use of 1st generation

skin, skin structures, UTI (but resistance now), IV for definitive bacteremia/endocarditis, osteomyelitis, surgical prophylaxis

12

What is the DOC for surgery prophylaxis?

1st generation

13

2nd generation dosage

Cefuroxime (Zinacef)- 1.5gm IV q6h, Cefoxitin (Mefoxin)- 2gm IV q 12 h

14

Spectrum of 2nd generation

increased aerobic gram-, h. influenzae, neisseria, proteus, e coli, klebsiella, moraxella catarrhalis, staph aureus

15

Subcategory of 2nd generation

Cephamycins- cefoxitin, cefotetan- introduce anaerobic coverage (Bacteroides), less gram + than others, important for abd surgeries

16

Clinical use of 2nd generations

URI, CAP, Neisseria, UTI, SSTI, cefoxitin, cefotetan-abd surg prophylaxis, cardiothoracic surg prophylaxis- cefuroxime

17

3rd generation dosage

rocephin- 1gm IV daily, ceftazidime (Fortaz)- 1 gm IV TID, Cefpodoxime (Vantin)- 200 mg PO BID, Cefdinir (Omnicef)- 300 mg PO BID

18

Spectrum of 3rd gen

enhanced gram -, enterobacteriaceae, serratia, citrobacter, enterobacter, morganella, salmonella, shigella, strep, ceftazidime- pseudo

19

3rd gen not good for?

staph

20

Clinical use of 3rd generation

IV- CNS, C/HAP, gonorrhea (ceftriaxone), endocarditis, pyelonephritis, oral- URI, skin, terrible [blood] no pseudo coverage

21

What is the first cephalosporin available with a beta lactamase inhibitor?

Ceftazidime/avibactam (Avycaz)- broad spectru,, good for chronically ill with abd infxn, UTi

22

4th gen spectrum

enhance gram +, MSSA, S pneu, better enterobacter, citrobacter and serratia, pseudo,

23

4th gen does not cover

anaerobics, enterococcal, MRSA

24

Clinical use of 4th gen

febrile neutropenia, post neurosurg infxn, nosocomial pneu, SSTI, UTI

25

5th gen spectrum

penicillin resistant s pneu, MRSA, gram - similar to ceftriaxone

26

5th gen not used for

pseudo or anaerobes

27

Clinical use of 5th gen

pneumonia, SSTI

28

New IV 5th gen

ceftolozane/tazobactam (Zerbaxa)- indicated for intra-abdominal infxn, UTI, broad spectrum

29

ADRs of cephalosporins

allergy, if anaphylaxis w/ penicillin do not give!, NVD, abx colitis?, hematologic

30

Carbapenems

Imipenem/cilistatin (Primaxin), Meropenem (Merrem), Ertapenem (Invanz), Doripenem (Doribax)

31

MOA of carbapenems

inhibit cell wall synthesis by binding to PBPs, bind to wider variety of PBPs, bactericidal, time dependent, highly stable

32

Spectrum of carbapenems

great anaerobic, very broad spectrum

33

What do carbapenems not cover?

MRSA, vanc resistant enterococcus, stenotrophomonas maltophilia, burkholderia cepacia, ertapenem- pseudo

34

ADRs of carbapenems

neurotoxicity/seizures (greatest with imipenem/cilistatin, similar to B-lactams if start to accumulate

35

Clinical use of carbapenems

reserved for resistant bacterial infxn, LRTI (nosocomial pneu), CNS infxn, intra abd infxn, febrile neutropenia, bacteremia, cystic fibrosis, ssti's

36

Monobactam option

aztreonam (Azactam) IV only

37

MOA of monobactam

inhibit cell wall synthesis by binding to PBPs

38

Spectrum of monobactam

gram neg only, including enterobacteriaceae and pseudomonas

39

What does monobactam not cover?

no anaerobic activity

40

Clinical use of monobactam

penicillin (anaphylaxis) pts with gram - infxn