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Pharmacology > L23: Cephalosporins > Flashcards

L23: Cephalosporins Flashcards

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1
Q

Cefazolin, Cephelexin, and Cefadroxil belong to:
A. First Generation Cephalosporins
B. Second Generation Cephalosporins
C. Third Generation Cephalosporins

A

A. First Generation

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2
Q

Fedoxitin, Cefuroxime, and Cefotetan are:
A. First Generation Cephalosporins
B. Second Generation Cephalosporins
C. Third Generation Cephalosporins

A

B. Second Generation

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3
Q

Ceftriaxone, Ceftazidime, Cefixime, and Ceftazidime + Avibactam belong to which group?
A. 1st gen cephalosporins
B. 2nd gen cephalosporins
C. 3rd gen cephalosporins

A

C. 3rd gen cephalosporins

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4
Q

Cefepime is a ____ generation cephalosporin while Cetaroline fosamil, as well as ceftolozane + tazobactam are ___ a generation cephalosporin

A
  • 4th generation
  • 5th generation
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5
Q

True or False: 4th and 5th generation cephalosporins are only administered via IM

A

False - only administered via IV

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6
Q

Cephalosporins first isolated from ____

A

Acremonium (Cephalosporium)

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7
Q

What is the MOA used by cephalosporins?

A

Bind PBP’s and prevent wall cross-links

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8
Q

None of the cephalosporins have activity against ORSA, except a 5th generation cephalosporin known as….
A. Cefepime
B. Cetaroline fosamil
C. Ceftriaxone
D. Ceftazidime
E. Cefixime

A

B. Cetaroline fosamil

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9
Q

True or False: Gram (-) efficacy decreases in subsequent generations of cephalosporins, often with increasing gram (+) efficacy

A

False – Gram (+) efficacy INCREASES in subsequent generations of cephalosporins, often with DECREASING gram (+) efficacy

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10
Q

True or False: First generation cephalosporins are reserved for serious nosocomial infections

A

False - LATER generations are reserved for serious nosocomial infections

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11
Q

R1 vs. R2???

A

R1: anti-bacterial activity changes
R2: metabolism and PK changes

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12
Q

True or False: The later the generation of cephalosporins, the more gram (-) activity and broad spectrum

A

True

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13
Q

Why are cephalosporin generations 1-4 “LAME”

A

No activity against
- Listeria
- Atypicals
- MRSA
- Enterococci

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14
Q

What feature do cephalosporins share with penicillin? Exception?

A

1) Short 1/2 life

Exception: Ceftriaxone

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15
Q

Cephalosporins have adequate penetration into most tissues, but its penetration into
CNS depends on generation.

Which generations do NOT typically enter CNS, even with
inflamed meninges??

A

1st and 2nd gen

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16
Q

Which 2nd generation cephalosporin enters ocular fluids and CNS?

A

Cefuroxime

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17
Q

Which three 3rd generation cephalosporins enter CNS?

A

Ceftriaxone
Cefotaxime
Ceftazidime

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18
Q

Which 4th generation cephalosporins enter the CNS?

A

Cefepime

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19
Q

True or False: Like penicillins, nearly all of the cephalosporins are cleared by the kidney, so dosing adjustments
may be necessary for patients with renal deficiencies

A

True

3rd generation ceftriaxone

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20
Q

___ extends circulating time of cephalosporins

A

Probenacid

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21
Q

Although there’s only 5-10% frequency of cross-allergy with penicillins, ____ are contraindicated in those with previous serious
reaction to penicillins

A

cephalosporins

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22
Q

____ are a major source of cephalosporin resistance

A

Lactamases

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23
Q

Due to ___ ___, cephalosporins are generally more
resistant to lactamases compared to penicillins

A

steric factors

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24
Q

___ generation cephalosporins are increasingly stable to
lactamases, compared to ___ generations
A. earlier; later
B. later; earlier

A

B. later; earlier

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25
True or False: 3rd generation cephalosporins are less susceptible to Gram (-) lactamases
True
26
Although 4th generation cephalosporins are even more stable than 3rd, they are still susceptible to ____ and ____
KPC (carbapenemase) metallo-β-lactamases
27
Altered ___ with low affinity for beta lactams is important resistance mode for cephalosporins
PBPs
28
__ generation cephalosporins are good for routine infections caused by gram positive cocci A. First B. Second C. Third D. Fourth E. Fifth
A. First
29
True or False: In gram positive organisms that remain sensitive, 1st gen > 2nd and 3rd gens
True
30
___ is a first generation cephalosporin that is injectable only -- choice for surgery prophylaxis
Cefazolin
31
Which four gram (-) enterics can be treated with 1st generation cephalosporins? (Hint: PECK)
P. mirabilis E. coli Klebsiella pneumoniae
32
_____ is now the only parenteral 1st gen cephalosporin available in the US
Cefazolin
33
Which three 1st generation cephalosporins are orally available?
Cephalexin, cefadroxil, or cephradine
34
Uses for 1st gen cephalosporins?
- Mild ear infection - UTI - Pneumonia - Endocarditis - Throat infection - Cellulitis, abscess, (polymicrobial infections)
35
Orally available 1st generation cephalosporins are poorly active against penicillin-resistant pneumococci, such as ____
P. aeruginosa
36
How do 2nd generation cephalosporins compare to 1st gen?
2nd generations are better against Gram (-) organisms (e.g. H. influenzae, Moraxella catarrhalis), but sacrifices some Gram (+) efficacy
37
Which two 2nd generation cephalosporins are effective against anaerobes, including B. fragilis?
1) Cefoxitin 2) Cefotetan
38
___ is a 2nd generation cephalosporin that has oral availability
Cefuroxime
39
Unlike most 2nd gen, _____ has good CNS penetration, but inferior to 3rd generation for meningitis
Cefuroxime
40
Clinical uses of Cefuroxime?
- Sinusitis - Otitis media - Community acquired pneumonia
41
Which pathogens does Cefuroxime (oral 2nd gen cephalosporin) have activity against?
S. pneumoniae H. influenzae M. catarrhalis P. pyogenes K. pneumoniae
42
True or False: Cephamycins are notable for activity against Bacteroides anaerobes
True
43
Which two 2nd gen cephalosporins are injectable only and used for anaerobic infections?
Cefoxitin Cefotetan
44
____, a 2nd gen cephalosporin, is the choice for prophylaxis in surgery of abdominal and pelvic cavities A. Cefoxitin B. Cefotetan
A. Cefoxitin
45
True or False: For infections outside of the abdominal and pelvic areas, cephamycins have MANY advantages over the 1st generation cephalosporins
False - for infections outside of the abdominal and pelvic areas, cephamycins have NO advantages over the 1st generation cephalosporins
46
True or False: 2nd gen cephalosporins are better than 3rd generation for treating gram (-) pathogens
False - 3rd generation cephalosporins are better than 2nd generations for treating gram negative infections
47
True or False: 3rd gen cephalosporins are stable to the beta-lactamases produced by Neisseria, H. influenzae, but are ineffective against gram-positives
True
48
Which two 3rd gen cephalosporins can get into the CNS easily, thereby treat meningitis?
Ceftriaxone Ceftazidime
49
____ is a good 3rd generation cephalosporin that is good for treating penicillin-resistant Strep Pneumoniae A. Ceftriaxone B. Ceftazidime
A. Ceftriaxone
50
True or False: Enterobacter becomes resistant to 3rd gen cephs
True
51
Sepsis, UTI, infections of respiratory tract, skin, bone/joints can be best treated with which generation of cephalosporins? A. First B. Second C. Third D. Fourth
C. Third
52
3rd Generation Ceftazidime is particularly useful against _____ A. E. coli B. P. aeruginosa C. S. aureus D. S. pneumo
B. P. aeruginosa
53
Which generation cephalosporin is stable to the beta-lactamases produced by Pseudomonas aeruginosa strains resistant to the anti-pseudomonal penicillins? A. First generation B. Second generation C. Third generation D. Fourth generation
C. Third generation
54
Ceftazidime (3rd gen cephalosporin) is good for meningitis due to pseudomonas, but it is ineffective against _____ A. Gram (+) B. Gram (-)
A. Gram (+)
55
Cefoperazone is similar to ceftazidime, but inferior. Why?
Greater vulnerability to lactamases, and adverse effects including anticoagulation
56
Properties of Ceftriaxone?
1. Extensive billary clearance (no dose adjustments for renal insufficiency) 2. Resistant to some B-lactamases -- but vulnerable to ESBL's 3. Good at penetrating CSF/peipheral fluids
57
What is the recommended therapy for Neisseria gonorrhoeae, even penicillin-resistant forms?
Ceftriaxone IM
58
True or False: Oral cefixime also effective for N. gonorrheae
True
59
What are 3 conditions that can be treated with Ceftraxione?
1. N. gonorrhoeae (even penicillin resistant forms!) 2. S. pneumo 3. Neuro complications from Lyme (B. burgdorferi)
60
Limitations of Ceftriaxone?
1. Poor activity against P. aeruginosa 2. No activity against ORSA (LAME) 3. Not effective against Enterobacter 4. Precipitation toxicities

Pharmacology (53 decks)

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