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Therapeutics V > Erdman - Cephalosporins > Flashcards

Erdman - Cephalosporins Flashcards

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1
Q

What does the six member ring of cephalosporins do?

A

Confers greater stability against some beta-lactamase enzymes

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2
Q

What is the mechanism of action of cefiderocol?

A

Acts as a siderophere and binds to extracellular iron using it as a vessel to enter bacteria

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3
Q

Why are all cephalosporins bactericidal but not penicillins?

A

Because cephalosporins do not have activity against enterococcus, which are only bacteriostatic

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4
Q

Gram-positive bacteria that produce beta-lactamase enzymes that are resistant to cephalosporins

A

Pen-R staph aureus

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5
Q

Gram-negative bacteria that produce beta-lactamase enzymes that are resistant to cephalosporins

A

-Kleb pneumoniae
-Haemophilus influenzae
-M catarrhalis
-E. coli
-Enterobacter
-Neisseria gonorrhoeae

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6
Q

Anaerobes that produce beta-lactamase enzymes that are resistant to cephalosporins

A

-Bacteroides fragilis

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7
Q

How many generations of cephalosporins are there?

A

7 generations technically

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8
Q

What is the difference between the generations of cephalosporins?

A

-Lose gram+ activity as you increase in gram- activity as you go op in generations (1-4)
-Greater beta-lactamase stability as you go from 1-4
-Miscellaneous generations have the greatest resistance to beta-lactamase enzymes

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9
Q

Gram positive activity of first generation cephalosporins

A

-Group strep
-Viridans strep
-Pen susc S. pneumoniae
-Meth susc S. aureus* (DOC)

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10
Q

Gram negative activity of first generation cephalosporins

A

(PEK)
-P. mirabilis
-E. coli
-K. pneumoniae

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11
Q

What are the first gen cephalosporins?

A

-Cefazolin (parenteral)
-Cephalexin (oral)

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12
Q

Which second generation cephalosporins have activity against anaerobes?

A

Cephamycins

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13
Q

Gram positive activity of second generation cephalosporins

A

-Group strep
-Viridans strep
-Pen-susc S. pneumoniae
-Meth-susc S. aureus*

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14
Q

Gram negative activity of second generation cephalosporins

A

(HENPEK)
-M. catarrhalis
-H. influenzae (beta-lactam negative)
-Enterobacter spp. (some)
-Neisseria spp.
-P. mirabilis
-E. coli
-K. pneumoniae

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15
Q

Anaerobe activity of second generation cephalosporins

A

(Cephamycins only)
-Bacteroides fragilis
-Bacteroides fragilis group

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16
Q

What are the cephamycins?

A

-Cefoxitin

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17
Q

What are the second generation cephalosporins?

A

-Cefuroxime (IV and oral)
-Cefprozil (oral)
-Cefoxitin

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18
Q

Which third generation cephalosporins retain the best activity against gram-positive aerobes?

A

Ceftriaxone has the best activity against gram-positive aerobes including penicillin resistant S. pneumoniae

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19
Q

Gram negative activity of third generation cephalosporins

A

(HENPECKSSS)
-Pseudomonas aeruginosa
-M. catarrhalis
-Acinetobacter sp.
-Morganella morganii
-Providencia
-H. influenzae
-Enterobacter spp.
-N. gonorrhoeae (including beta-lactamase producing)
-N. meningitidis
-P. mirabilis
-E. coli
-Citrobacter sp.
-K. pneumoniae
-Serratia marcescens
-Salmonella sp
-Shigella sp.

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20
Q

Which third generation cephalosporins cover pseudomonas?

A

-Ceftazidime
-Cefoperazone
-NOT ceftriaxone

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21
Q

What are the third generation cephalosporins?

A

-Ceftriaxone
-Ceftazidime
-Cefpodoxime

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22
Q

Gram positive activity of fourth generation cephalosporins

A

Similar to ceftriaxone (covers PRSP)

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23
Q

Gram negative activity of fourth generation cephalosporins

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A

Similar to ceftriaxone but includes pseudomonas and beta-lactamase producing spp.

24
Q

How are fourth generation cephalosporins effected by beta-lactamase enzymes?

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A

Stable against beta-lactamases and are poor inducers of AmpC inducible enzymes

25
What are the fourth generation cephalosporins?
Cefepime (IV)
26
Gram positive activity of ceftaroline (Teflaro)
Similar to ceftriaxone (PRSP) but also covers MRSA
27
Gram negative activity of ceftaroline (Teflaro)
Similar to ceftriaxone and does not cover pseudomonas aeruginosa
28
Gram positive activity of cefiderocol (Fetroja)
None
29
Gram negative activity of cefiderocol (Fetroja)
Similar to cefepime but includes many ESBLs, AmpCs, and CREs
30
Gram positive activity of ceftolozane-tazobactam (Zerbaxa)
Covers streptococcus (not good for this)
31
Gram negative activity of ceftolozane-tazobactam (Zerbaxa)
Similar to cefepime also includes some ESBLs and AmpCs (resistant pseudomonas aeruginosa) (most active against pseudomonas in cephalosporin class)
32
Gram positive activity of ceftazidime-avibactam (Avycaz)
Covers streptococcus (not good for this)
33
Gram negative activity of ceftazidime-avibactam (Avycaz)
Similar to cefepime but also includes many ESBLs, some AmpCs and KPC/OXA CREs (not VIM or NDMs)
34
What are cephalosporins dependent on to kill bacteria?
-Time dependent -Time>MIC is PD parameter that correlates with efficacy
35
What synergy is used clinically to treat viridans strep?
Ceftriaxone plus gentamicin
36
What synergy is used clinically to treat staph aureus?
Cefazolin plus gentamicin
37
What synergy is used clinically to treat gram-negative aerobes?
Ceftriaxone, ceftazidime, or cefepime plus gentamicin, tobramycin or amikacin
38
Which cephalosporins achieve therapeutic concentrations in the CSF?
-Parenteral cefuroxime -Third gen agents -Fourth gen agents
39
Which cephalosporins are not eliminated through the kidney?
-Ceftriaxone -Cefoperazone
40
What is the one cephalosporin with a long half-life?
Ceftriaxone has a half-life of 8 hours and is dosed once or twice daily
41
Clinical uses of first gen cephalosporins
-Bacteremia due to MSSA -Surgical prophylaxis
42
Is cefuroxime still used for meningitis?
No
43
Which cephalosporins are used for polymicrobial infections or surgical prophylaxis for abdominal surgery?
(Cephamycins) -Cefoxitin -Cefotetan
44
Clinical uses of third gen cephalosporins
-Ceftazidime if Pseudomonas is suspected or documented -Ceftriaxone is used for uncomplicated gonorrhea (one IM dose), community-acquired pneumonia, PRSP, viridans strep endocarditis
45
Clinical uses of fourth gen cephalosporins
Febrile neutropenia due to gram negative bacteria (including pseudomonas)
46
Clinical uses of ceftaroline
-MRSA -Does not cover pseudomonas
47
Clinical uses of cefiderocol
Current place in therapy still being determined
48
Clinical uses of Avycaz and Zerbaxa
Current place in therapy still being determined
49
Cephalosporin adverse effects
-Hypersensitivity -Hypoprothrombinemia -Ethanol intolerance -IV calcium precipitates with ceftriaxone -Nonconvulsive status epilepticus
50
What percent of patients with a penicillin allergy will have cross-reactivity with cephalosporins?
1-5%
51
When should cephalosporins be avoided in penicillin allergic patients?
-Allergic reaction causing ICU admission -Delayed severe skin reaction
52
When should cephalosporins with a similar R1 side chain be avoided in penicillin allergic patients?
Allergic reaction that causes general rash or itching
53
Which cephalosporins have a MTT side chain?
-Cefamandole -Cefotetan -Cefmetazole -Cefoperazone -Moxalactam
54
What does the MTT side chain cause?
-Hypoprothrombinemia -Ethanol intolerance
55
How can you avoid calcium and ceftriaxone precipatates?
Calcium should not be given within 24 hours of ceftriaxone

Therapeutics V (52 decks)

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