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USMLE Step 2 > Infectious Disease: Beta lactams > Flashcards

Infectious Disease: Beta lactams Flashcards

(63 cards)

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1
Q

What drug classes are considered Beta Lactam Abx

A

Carbapenems

Aztreonam

Cephalosporins

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2
Q

What is the mechanism of B-Lactam Abx

A

similar to penicillin

Binds Transpeptidases

prevents peptidoglycan crosslinking in cell wall

Autolysis

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3
Q

What drugs are Carbapenems

A

Imipenem
Meropenem
Ertapenem
Doripenem

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4
Q

What is unique about carbapenems

A

resistance to cleavage by most B-Lactamase enzymes

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5
Q

What are Carbapenems Effective against

A

ESBL-Producing bacteria

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6
Q

What type of bacteria have ESBL

A

only gram (-)

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7
Q

What is the drug of choice for ESBL bacteria

A

Carbapenems

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8
Q

What is the key drug class for Enterobacter

A

Carbapenems

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9
Q

What patient population are Carbapenems commonly used for

A

Hospitalized
-Sepsis
-Pneumonia
-Meningitis
-Intra abdominal infections

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10
Q

Where is Imipenem Metabolized

A

Kidneys
-proximal tubule enzyme Dehydropeptidase I

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11
Q

What does metabolizm of Imipenem produce

A

Nephrotoxic metabolites

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12
Q

What is Given with Imipenem

A

Cilastatin

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13
Q

What is the MOA of Cilastatin

A

Enzyme Inhibitor to prevent nephrotoxicity with Imipenem

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14
Q

What is a benefit of Ertapenem over other Carbapenems

A

1x daily dosing

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15
Q

What adverse effect is associated with Carbapenems

A

CNS Toxicity: seizures

Mental status change

Myoclonus

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16
Q

What Carbapenem Drug has the lowest risk of seizures

A

Meropenem

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17
Q

What are the risk factors for Carbapenems causing seizures

A

High Doses

Renal Failure

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18
Q

What is unique about the MOA of aztreonam

A

Binds Penicillin-binding protein 3 (BP3)
-found in gram (-) bacteria

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19
Q

What is Aztreonam active against

A

only gram (-) Bacteria
-includes Pseudomonas

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20
Q

How is Aztreonam given

A

IV

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21
Q

What is Aztreonam synergistic with

A

Aminoglycosides

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22
Q

Can Azteronam be used in Penicllin allergic patients

A

yes

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23
Q

What do 1st generation cephalosporins cover

A

Mostly Gram (+)

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24
Q

What 1st generation cephalosporin is commonly used

A

Cefazolin

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25
What is Cefazolin commonly used against
Skin Flora -nonpurulent cellulitis -surgical skin infections -pre-op to prevent skin infections
26
What were 2nd generation cephalosporins designed for
Treatment of amoxicllin-resistant infections
27
What changes with the spectrum of coverage in 2nd generation cephalosporins
Increased G (-) coverage Increased anaerobic coverage less active against S. Aureus
28
What bug are 2nd generation cephalosporins less active against
S. Aureus
29
What gram (-) bugs do 2nd generation cephalosporins cover
H. Influenzae Enterobacter Proteus E. Coli Klebsiella Serratia N. Gonorrhea
30
What are commonly used 2nd generation Cephalosporins
Cefuroxime Cefaclor Cefprozil Cefoxitin Cefotetan
31
What noteable Anerobe is covered by 2nd generation cephalosporins
B. Fragilis
32
What changes in coverage with 3rd generation cephalosporins
Broad G (-) coverage Less G (+) coverage
33
What are common 3rd generation cephalosporins
Cefotaxime Ceftazidime Ceftriaxone
34
What 3rd generation cephalosporin covers Pseudomonas
Ceftazidime
35
What condition are 3rd generation cephalosporins commonly used for
Meningitis -S. Pneumoniae -N. Meningitidis
36
What 3rd generation Cephalosporin is commonly used to cover Meningitis
Ceftriaxone
37
What bugs are associated with Pelvic Inflammatory Disease
N. Gonorrhoeae C. Trachomatis
38
What is the usual Abx regiment for Pelvic Inflammatory Disease
Cephalosporin + Doxycycline
39
What is the typical Abx regiment for inpatient management of Pelvic Inflammatory Disease
IV Cefoxitin + PO Doxycycline
40
What is the typical Abx regiment for outpatient management of Pelvic inflammatory Disease
IM Ceftriaxone + PO Doxycycline
41
What are the treatment options for outpatient management of CAP with comorbidities
PO therapy Fluoroquinolone B-lactam + Azithromycin
42
What fluoroquinolone is commonly used to treat Typical CAP with comorbidities in an outpatient setting
Levofloxacin
43
What B-Lactam is common used in combination with azithromycin to treat Typical CAP with comorbidities in the outpatient setting
Amoxicillin
44
What are the inpatient treatment options for a patient with Typical CAP
Fluoroquinolone B-lactam + azithromycin
45
What fluoroquinolone is commonly used to treat Typical CAP in an inpatient setting
Levofloxacin
46
What B-lactam is commonly used in combination with Azithromycin to treat Typical CAP in an inpatient setting
Ceftriaxone
47
What coverage change is seen with 4th generation cephalosporins
Broader spectrum -MSSA -many gram + -many gram - -Pseudomonas Effective against ESBL bacteria
48
What is a common 4th generation Cephalosporin
Cefepime
49
What patient population is Cefepime typically used for
Hospitalized patient with gram (-) infection
50
What change in coverage is seen with 5th generation cephalosporins
Covers MRSA
51
What drug is a 5th generation Cephalosporin
Ceftaroline
52
What does Ceftolozane-tazobactam cover
gram (-) -pseudomonas -ESBL bacteria
53
What unique adverse effect can cephalosporins results in
Vitamin K deficiency
54
Where is Vitamin K1 from
Diet -green leafy vegetables
55
Where is vitamin K2 from
GI bacterai
56
How do cephalosporins lead to vitamin K deficiency
reduce bacterial vitamin K production
57
What results from Vitamin K Deficiency
Increased INR and Potential Bleeding
58
What patients can vitamin K deficiency be problematic in
Patients on Warfarin
59
How can cephalosporins cause Hypoprothrombinemia
Inhibit Epoxide reductase leading to decreased hepatic synthesis of clotting factors similar to warfarin
60
What cephalosporins are associated with Hypoprothrombinemia
Cefotetan and Cefazolin
61
What is seen when taking cephalosporins with alcohol
Disulfiram reaction -inhibition of acetaldehyde dehydrogenase -accumulation of Acetaldehyde
62
What are the common symptoms of Disulfiram reaction
Warmth Flushing Sweating
63
What Cephalosporin is associated with a Disulfiram reaction
Cefotetan (2nd gen)

USMLE Step 2 (39 decks)

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