ID I: Beta-lactams COPY Flashcards by steph h

As a class, penicillins are NOT active against

MRSA or atypical organisms

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Natural penicillins coverage

Gram positive cocci (streptococci and enterococci, NOT staphylococci)

Gram positive anaerobes (mouth flora)

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Aminopenicillins coverage

Gram positive cocci (streptococci and enterococci)

Gram positive anaerobes (mouth flora)

Gram negative bacteria (Haempaphilus, Neisseria, Proteus, E.coli

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Aminopenicillins + beta lactamase inhibitors

(clavulaunte, sulbactam, tazobactam) have activity against:

MSSA

more resistant strains of gram-negative (HNPEK)

gram negative anaerobes (B. fragilis)

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Extended-spectrum penicillins combined with a beta-lactamase inhibitor (pip/tazo) = coverage

BROAD!!!!

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What do ESBLs cover?

Gram positive (MSSA, streptococci, enterococci)

Gram positive mouth flora

mores resistant strains of HNPEK

Gram negative anaerobes (B. fragilis)

PLUS

CAPES & pseudomonas aeruginosa

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What organisms are in CAPES

citrobacter

acinetobacter

providencia

enterobacter

serratia

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Antistaphylococcal penicillins cover

streptococci

enhanced activity against MSSA

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What are the natural penicillins?

Pen V potassium

Pen G Benzathine (Bicillin L-A) - IM

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What are the aminopenicillins?

Amoxicillin

Amox/Clav

Ampicillin (NS)

Ampicillin/Sulbactam (NS)

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What are the Extended spectrum penicillins?

Pip/Tazo - INJ

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The antistaphylococcal penicillins?

Dicloxacillin - PO

Nafcillin - INJ

Oxacillin

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The preferred agent for MSSA soft tissue, bone and joint, endocarditis and bloodstream infections?

anti staphylococcal penicillins

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Which penicillin is a vesicant?

nafcillin

cold packs & hyaluronidase if extravasation occurs

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What drug can increase levels of beta lactams by interfering with renal excretion?

probenecid

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What is the exception of administering penicillins in those that have a beta-lactam allergy?

pregnant patients with syphilis

*desensitize and treat with benzathine penicillin

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All penicillins increase the risk of … if accumulation occurs

SEIZURES

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First line treatment for strep throat and mild non purulent skin infections (no abscess)

PenVK

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First line treatment for acute otitis media (80-90mg/kg/day)

Amoxicillin

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Drug of choice for infective endocarditis prophylaxis before dental procedures (2g PO x1 30-60 mins before procedure)

amoxicillin

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First line treatment for acute otitis media (90mg/kg/day) and for sinus infections (if an antibiotic is indicated)

amox/clav (augmentin)

lowest dose of clav to reduce diarrhea

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Drug of choice for syphillis

Pen G benathine (Bicillin L-A) 2.4 million units IM x1

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Only penicillin active against pseudomonas

Pip/Tazo (Zosyn)

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Cover MSSA only, no renal adjustment needed

Dicloxacillin, Oxacillin, Nafcillin

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As a class, cephalosporins are not active against...

Enterococcus or atypical organisms

First generation coverage:

gram-positive cocci (streptococci, staphylococci) | if cephalosporin used for MSSA, first generation is it

Second generation (cefuroxime) coverage:

staphylococci more resistant strains of S. pneumoniae plus HNPEK

Second generation coverage (cefotetan, cefoxitin) coverage:

staphylococci more resistant strains of S. pneumoniae plus HNPEK Gram-negative anaerobes (B. fragilis)

Third generation coverage (ceftriaxone, cefotaxime)

more resistant streptococci (S. Pneumoniae and viridian's group streptococci) staphylococci (MSSA) Gram positive anaerobes (mouth flora) More resistant strains of HNPEK

Third generation coverage (ceftazidime)

LACKS gram positive *covers pseudomonas

ceftazadime/avibactam and ceftolozane/tazobactam have added activity against..

MDR pseudomonas and other MDR gram negative rods

Fourth generation coverage (cefepime)

broad gram negative activity (HNPEK, CAPES, pseudomonas) (+ similar gram pos activity to ceftriaxone: more resistant streptococci (S. Pneumoniae and viridian's group streptococci) staphylococci (MSSA) Gram positive anaerobes (mouth flora))

Fifth generation (ceftaroline) coverage:

~HNPEK (meh gram negative) but broad gram positive activity, covers MRSA

What cephalosporin has broad gram negative activity?

cefepime | *covers pseudomonas too!

What cephalosporin has broad gram positive activity?

ceftaroline *covers MRSA first gen *covers MSSA

Brand: Ancef

generic: cefazolin

Brand: Keflex

generic: cephalexin PO: 250-500mg PO Q6-12H

Brand: cefuroxime

generic: ceftin

Brand: Cefotetan

generic: cefotan

Brand: Fortaz

Generic: ceftazidime

Brand: Maxipime

generic: cefepime

Brand: Teflaro

generic: ceftaroline fosamil

Cefazolin | Cephalexin

first gen

Cefuroxime Cefotetan Cefoxitin

second gen

Cefdinir Ceftriaxone Cefotaxime

3rd generation group 1

Ceftazidime

3rd generation group 2

cefepime

4th generation

ceftaroline

5th generation

What is the contraindication of ceftriaxone?

do not use in hyperbilirubienmic neonates OR concurrent use in calcium containing IV products in neonates <28 days old

Which cephalosporin has a side chain that increases bleeding and causes a disulfiram-like reaction with alcohol?

cefotetan

Side effects of cephalosporins

seizures with accumulation

Due to small risk of cross-reactivity do not choose a cephalosporin on the exam if a patient has a penicillin allergy EXCEPT FOR WHEN:

pediatric patients with acute otitis media

Patient has skin infection (MSSA) and strep throat.. which generation is best?

first! cephalexin

acute otitis media CAP sinus infection

2nd gen: cefuroxime

first line CAP

3rd generation: cefdinir

Surgical prophylaxis

1st gen cefazolin

anaerobic coverage (B. fragilis)

2nd gen: Cefotetan and cefoxitin

surgical prophylaxis with colorectal procedures

2nd gen: Cefotetan and cefoxitin

CAP, meningitis, SBP, pyelonephritis

3rd gen: ceftriaxone and cefotaxime

cephalosporins that are active against pseudomonas

ceftazidime and cefepime

Used for MDR gram negative organisms (including pseudomonas)

ceftolozane/tazo and ceftazidime/avibactam

only beta lactic active against MRSA

ceftaroline

Drug of choice in ESBL-producing organisms

carbapenems

All carbapenems cover pseudomonas except

ertapenem

What do carbapenems not cover? *caution with drugs that are used for seizure control!!!

atypicals VRE MRSA C diff stenotrophomonas

Ertapenem does not cover:

PEA pseudomonas acinetobacter enterococcus

moderate-severe diabetic foot infection treatment

carbapenem (erta)

empiric therapy when resistant organisms are suspected

carbapenems

Resistant pseudomonas or acinetobacter infections

carbapenems (not erta)

Brand: Merrem

generic: meropenem

Brand: Ivanz

generic: ertapenem

This beta lactic can be used in a penicillin allergy

monobactam

Aztreonam coverage

gram negative (including pseudomonas) ****NO gram- positive or anaerobic activity*****

Brand: Azactam

generic: aztreonam

ID I: Beta-lactams COPY Flashcards

(74 cards)