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Anti-Infectives Exam 2 > Lecture 2 - Diagnosing infection, Cephalosporins, Carbapenems, & Monobactam > Flashcards

Lecture 2 - Diagnosing infection, Cephalosporins, Carbapenems, & Monobactam Flashcards

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1
Q

Signs & Symptoms of Infection: General

A

Fever = > 100.4
1F Rectal > oral > 1F axillary
Inc WBC, HR, BP

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2
Q

Signs & Symptoms of Infection: Site Specific

A

Local signs of pain and inflammation
Swelling, erythema, tenderness, purulent drainage
Imaging

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3
Q

Signs & Symptoms of Infection: Labs + Tests

A

ESR

CRP

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4
Q

Cephalosporins MOA

A
  1. Bind to PBPs

2. Inhibit cross-linking of peptidoglycan in the cell wall

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5
Q

1st Gen Cephalosporins

A

Cefazolin (IV)
Cephalexin (PO)
Cefadroxil (PO)

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6
Q

2nd Gen Cephalosporins

A 
Cefuroxime (IV/PO)
Cefprozil (PO)
Cefaclor (PO)
Cefotetan (IV)
Cefoxitin (IV)
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7
Q

3rd Gen Cephalosporins

A 
Ceftriaxone (IV)
Cefotaxime (IV)
Ceftazidime (IV)
Cefdinir (PO)
Cefditoren (PO)
Cefixime (PO)
Cefpodoxime (PO)
Ceftibuten (PO)
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8
Q

4th Gen Cephalosporins

A

Cefepime

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9
Q

5th Gen Cephalosporins

A

Ceftaroline

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10
Q

Advanced Gen Cephalosporins

A

Cefiderocol
Ceftazidime-avibactam
Ceftolozane-tazobactam

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11
Q

1st & 2nd Gen Cephalosporins Spectrum of Activity Gram +

A

No enterococcal activity
1st gen Cefazolin = txm of choice for MSSA…maybe better than nafcillin

Not effective against MRSA
Great activity against all Strep spp.

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12
Q

3rd & 4th Gen Cephalosporins Spectrum of Activity Gram +

A

Less active than 1st/2nd gen in general
no enterococcus activity

Limited activity against MSSA
Not active against MRSA

Great activity against all Strep spp.

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13
Q

Ceftriaxone treatment of choice against….

A

Invasive Streptococcal infections (Penicillin-I or -R)

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14
Q

Ceftriaxone exception…

A

used in combo with Ampicillin for synergy in E.faecalis endocarditis

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15
Q

5th gen Cephalosporins Spectrum of activity Gram +

A

Best gram + of all gen

no Enterococcus activity

** Great against Step Aureus, MSSA, MRSA **
Great activity against all Strep spp.

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16
Q

Which Cephalosporins are used as Salvage therapy in combo with vanc or dapto for synergy?

A

5th gen

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17
Q

Advanced Gen Cephalosporins Spectrum of activity

A

Designed for Gram -

Gram + isn’t as good

No activity against S. aureus or Enterococcus

Ceftolozane-tazobactam + Ceftazidime-avibactam active against Streptococcus spp.

Cefiderocol has some activity against Streptococcus, less than other beta-lactams

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18
Q

1st & 2nd Gen Cephalosporins Spectrum of Activity Gram -

A

No activity against non-fermenters

Limited Gram - activity overall

Active against susceptible E.Coli, K pneumoniae, P.mirabilis

2nd gene more activity than 1st

2nd gen activty agisnst H.influenzae + M. catarrhalis (used in CAP for children)

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19
Q

3rd + 4th Gen Cephalosporins Spectrum of Activity Gram -

A

3rd gen (Ceftriaxone) txm of choice for E.coli, K.pneum, H.influenzae

3rd gen don’t have activity against non fermenters

4th gen have broader activity against Gram -

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20
Q

Which 3rd gen Cephalosporin has activity against non-fermenters?

A

Ceftazidime

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21
Q

Pseudomonas aeruginosa 4th gen Cephalosporin that is drug of choice?

A

Cefepime

3rd gen would be Ceftazidime

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22
Q

5th Gen Cephalosporins Spectrum of Activity Gram -

A

Limited Gram - activity similar to 2nd gene

No activity against non-fermenters

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23
Q

Advanced Gen Cephalosporins Spectrum of activity Gram -

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A

Very broad Gram - coverage

Expanded coverage against multi-drug resistant organisms

24
Q

Ceftazidime-avibactam is active against…..

Study These Flashcards
A

carbapenemase-producing organisms (commonly via KPC enzyme)

25
Ceftolozane-tazobactam has expanded coverage against...
MDR P. aeruginosa
26
Cefiderocol has activity against....
MDR Acinetobacter, MBL producing Enterobacterales, along with all the other stuff
27
Cephalosporins Anaerobes Spectrum of activity
overall not that great Most have activity against Peptostreptococcus ** Cefoxitin + Cefotetan ** have best activity
28
Cephalosporins Spectrum of activity for Atypical?
none
29
Cephalosporins M & E
Few are extensively metabolized Oral prep stable in Acid/ GI tract None of the oral achieve therapeutic conc in CSF Most excreted in kidney, 1/2 life 1-2hrs, some up to 3-8hrs allowing for 12-24hr dosing intervals (ceftriaxone)
30
Cephalosporins ADR
GI - Obstructive biliary toxicity (ceftriaxone) Hepatic CNS - Encephalopathy, seizures (cefepime) Hypersensitivity = less than penicillins
31
Cephalosporins Drug Interactions
Interact w/ warfarin and increase inhibition of Vit K reductase, increased risk of bleeding Probenecid = inc plasma lvls of cephalosporins
32
Using Ceftriaxone in MSSA?
nah, not preferred because MICs can be intermediate and treatment failure can be seen
33
Non-Pseudomonal Carbapenem
Ertapenem
34
Pseudomonal Carbapenems
Imipenem | Meropenem
35
Carbapenem + Beta-lactamase inhibitor
Meropenem-vaborbactam | Imipenem-relebactam
36
Carbapenems Spectrum of Activity Gram +
Limited Enterococcal activity Active against MSSA but not MRSA Active against all Strep spp.
37
Imipenem considered active against E.faecalis if...
its a Penicillin-susceptible one
38
Carbapenems Spectrum of Activity Gram -
Broad Gram - activity No activity against Stenotrophomonas maltophilia
39
Ertapenem will not cover against which gram -
non-fermentors
40
Carbapenems active against Pseudomonas aeruginosa.....
Meropenem and Imipenem
41
Carbapenems are often used for....
ESBL producing strains
42
Carbapenems + Beta-lactamase inhibitor combo spectrum of activity is...
extended against carbapenemase-producing organisms (commonly via KPC enzyme) active but not as helpful against MDR Acinetobacter or Pseudomonas no activity against Stenotrophomonas maltophilia Reserved for MDR gram - usually
43
Carbapenems Spectrum of activity for Anaerobes
Great activity against both Gram -/+ anaerobes Used for polymicrobial infections that include anaerobes
44
Carbapenems Spectrum of activity for Atypicals
none
45
Carbapenems DI
Valproic acid = avoid combo Probenecid = avoided, increase plasma levels
46
Carbapenems ADR
``` GI = N,V,D CNS = Seizures ( Imipenem>meropenem>ertapenem) Hypersensitivity = low cross reactivity w/ penicillin < 1% ```
47
Carbapenems M & E
Imipenem subject to degradation by DHP-1, made w/ something to prevent its breakdown all distribute well, CNS too Imi/Mero dosed every 6-8hr (1hr 1/life) erta dosed every 24hrs (4hr 1/2life all have renal elim, so need dose adjustment
48
Aztreonam MOA
Binding ot PBPs, specifically high affinity for PBP3 | Inhibit cross-linking of peptidoglycan in cell wall
49
Aztreonam Spectrum of activity
Gram + = 0 Anaerobes = 0 Atypical = 0
50
Aztreonam Spectrum of Activity Gram -
Active against E.Coli, K. Pneumoniae, P. mirabilis Not active against ESBL or KPC organisms Active against MBLs No activity against other nonfermentors (only P.aeruginosa)
51
Aztreonam is considered treatment of choice against....
Pseudomonas aeruginosa, in patients who are beta-lactam intolerant/allergic
52
Aztreonam M & E
not extensively metabolized and not absorbed in GI tract Distributes well into tissues + fluids, CNS too 1.7hrs 1/2life, prolonged in renal dysfunction
53
Monobactam drug
Aztreonam
54
Aztreonam ADR
``` GI = N,V,D Derm = rash ```
55
Aztreonam DI
no significant DI

Anti-Infectives Exam 2 (8 decks)

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