Antimicrobials II Flashcards

1
Q

all cephalosporins are inactive against what organisms

A
MACELL
Mycoplasma
Actinobacter
Chlamydia
Enterococci
Listeria
Legionella
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2
Q

explain the activity of the generations of cephalosporin

A
  • going from 1st to 3rd: activity against gram pos diminishes and activity against gram neg increases
  • 4th: activity against gram pos (like 1ST) and active against all gram neg bacilli
  • 5th: same as 3rd gen but has activity against MRSA
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3
Q

what are the first generation cephalosporin

A

Cefazolin (parenteral)

Cephalexin (oral)

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4
Q

organisms that first generation cephalosporin are active against (name them)

A

cefazolin and cephalexin

PEcK
Gram pos cocci
Proteus
E. coli
Klebsiella
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5
Q

major use of cefazolin

A

surgery prophylaxis (especially preventing staph aureus infections) due to its long half life

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6
Q

what are the second generation cephalosporin

A
AAOO
Cefaclor
Cefamandole
Cefotetan
Cefoxitin
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7
Q

what are second generation cephalosporins used for (name them)

A

cefoxitin, cefaclor, cefotetan cefamandole

sinus, ear, and resp infections caused by H. influenza, M. catarrhalis, bacterioides fragillis

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8
Q

what are the third generation cephalosporins

A
Cefoperazone
Cefotaxime
Ceftazidime
Ceftriaxone
Cefixime
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9
Q

what are third generation cephalosporins used for (name them)

A

cefoperazone, cefotaxime, ceftazidime, ceftriaxone, cefixime

against gram neg bacteria that are resistant against beta lactams and they can penetrate BBB

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10
Q

ceftriaxone is drug of choice for what condition

A

PALM

Penicillin resistant gonorrhea
Ampicillin resistant H. influenza meningitis
Lyme disease
prophylaxis for Meningitis in exposed individuals like pregnant women

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11
Q

drugs in third generation cephalosporin are usually reserved for what conditions (name them)

A

cefoperazone, cefotaxime, ceftazidime, ceftriaxone, cefixime

reserved for serious infections with exception to gonorrhea and acute otitis media

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12
Q

Cefotetan, Cefoperazone, Cefomandole all contain what as part of their molecular structure and the importance

A

N-methylthiotetrazole side chain which competitively inhibits Vitamin K action increasing PT –> increased bleeding

side chain also has disulfiram like reaction to alcohol

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13
Q

what is the fourth generation cephalosporin and is it used for

A

Cefepime

more resistant to beta lactamases produced by gram negative

activity against both gram pos (like 1st gen) and against gram neg

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14
Q

what is the fifth generation cephalosporin and mechanism

A

Ceftaroline

bind to penicillin binding protein 2a (PBP-2a) produced by MRSA

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15
Q

which cephalosporin are available for oral use

A

Cephalexin
Cefaclor
Cefixime

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16
Q

which cephalosporin causes the BBB easily hence probably suitable for treatment of meningitis

A

Ceftriaxone

17
Q

adverse effects of cephalosporins

A

DDT HAPeNS
Diarrhea
Disulfarim like reactions because of NMTT
Thrombophlebitis

Hypoprothrombinemia because of NMTT
Allergy (hypersensitivity)
Pain
Nephrotoxicity and Neurotoxicity (ceftriaxone cross BBB and causes kernicterus in fetus)
Superinfections - secondary infections
18
Q

what are the carbapenems

A

Imipenem
Meropenem

low susceptibility to beta lactamases

19
Q

carbapenems are drug of choice for what (name them)

A

imipenem and meropenem

enterobacter infections and extended spectrum beta lactamase producing gram negatives

20
Q

what drug must imipenem be given with and why

A

imipenem must be given with Cilastatin, a dihydropeptidase inhibitor (with imipenem, the kill is LASTIN’ with ciLASTIN)

imipenem is rapidly inactivated by renal dihydropeptidase I to form a nephrotoxic metabolite so it is given with cilastatin, a dihydropeptidase inhibitor, which increases half life of imipenem and inhibits formation of the nephrotoxic metabolite

21
Q

adverse effects of carbapenems (name them)

A

imipenem and meropenem

GI distress (nausea, vomiting, diarrhea)
CNS toxicity (seizures)
22
Q

what is the monobactam

A

Aztreonam

23
Q

monobactam has activity against what microorganisms (name it)

A

Aztreonam

activity against aerobic gram neg rods (including those with beta lactamases) includes Pseudomonas

no activity against gram pos or anaerobes

24
Q

adverse effect of monobactam (name it)

A

aztreonam

rashes and elevated aminotransferases
thromophlebitis and pain at injection site

if inhaled, cough