Allman - Cephalosporins + Carbapenems Flashcards Preview

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Flashcards in Allman - Cephalosporins + Carbapenems Deck (23):
1

Cephalosporin Mechanism of Action

Mimic D-ala-D-ala and, therefore, are incorporated into the active site of the transpeptidase preventing the formation of the bacterial cell wall

2

Cephalosporin R2 component

Determines metabolism and pharmacokinetic properties; Dosage depends on this site!

3

Cephalosporin Administration

50% Oral - rapidly and thoroughly absorbed; available as prodrug esters which are hydrolyzed in the intestines into the active drug; food enhances absorption
-- Cefuroxime Axetil
-- Cephalexin

50% IV

4

Cephalosporin Excretion

-Really excreted
-Require dosage adjustments for renal insufficiency
-Hepatic Elimination (80%) for Cefoperazone and Ceftriaxone

5

Cephalosporins and CSF?

3rd generation penetrates well into CSF especially with inflamed meninges.

6

Cephalosporin Adverse Effects (6 categories)

Hypersensitivity: 10% cross-reactivity with penicillins; considered safe unless patient has anaphylaxis with PCN then the cross-reactivity is 90% (DON'T USE)

Hematologic: Bleeding associated with an NMTT side chain on a cephalosporin due to hypoprothrombinemia (disturbance in vit K dependent clotting factors)

GI: Diarrhea due to primary biliary excretion, pseudomembranous colitis (C.Diff)

Renal: Interstitial Nephritis (rare)

Alcohol: Disulfiram-like intolerance; used for alcoholics to keep them from drinking (NMTT side chain)

Immunologic: serum sickness-like illness in children (cefaclor)

7

Cephalosporin Drug Interactions

1. Anticoagulants (Warfarin) -- POTENTIATION of anticoag effects
2. Alcohol -- disulfiram like reaction
3. Probenecid -- Prolongs excretion in ceps that have tubular excretion

8

ORAL Cephalosporins (2)

Cephalexin -- FIRST GEN
Cefuroxime axetil -- 2ND GEN

9

FIRST Generation IV Cephalosporin

Cefazolin
Gram + = Staph, Strep
Gram - = Piddly, E.Coli
*SURGICAL PROPHYLAXIS*

10

SECOND Generation IV Cephalosporin

Cefuroxime
Gram + = Staph, Strep
Gram - = (H.flu), (M.cat), PEK

11

SECOND (Cephamycins) Gen IV Cephs (2)

Cefoxitin
Cefotetan
Gram + = Staph, Strep
Gram - = (H.flu), (M.cat), PEK
ANAEROBES
*ABDOMINAL SURGERIES*

12

THIRD Generation IV Cephalosporin

Ceftriaxone
Gram + = Strep
Gram - = SACE
*CAP -- MENINGITIS*

13

THIRD (Antipseudomonal) IV Cephalosporin

Ceftazidime
Gram + = POOR
Gram - = SPACE
*NOSOCOMICAL PNEUMONIA -- MENINGITIS*

14

FOURTH Generation IV Cephalosporin

Cefepime
Gram + = Staph, Strep
Gram - = SPACE
*NOSOCOMICAL PNEUMONIA*

15

FIFTH Generation IV Cephalosporin

Ceftaroline
Gram + = Staph, Strep, ENTEROCOCCUS
Gram - = SCE, Pseudomonas, (MRSA)

16

Carbapenem Types

Imipenem
Meropenem
Doripenem
Ertapenem

17

Carbapenem (Imipenem) adverse effect?

SEIZURES -- esp in patients with epilepsy or if NOT adjusted appropriately for renal function

Hematologic: anemia, leukopenia, thrombocytopenia

18

Carbapenem Spectrum of Activity

-Excellent against a wide range: Gram +, Gram -, Anaerobic Bacteria -- BAZOOKA
-CIDAL effect
- good for serious nosocomial infections caused by multiple organisms
- good for ESBL producing bacteria

19

What does Doripenem cover?

SPACE + Anaerobes

20

What does Ertapenem cover?

Fence bugs
NO Enterococcus coverage
Taken ONCE daily

21

What Monobactam do we know?

AZTREONAM -- Ace In The Hole

22

Adverse effects of Aztreonam?

hematologic

23

Aztreonam spectrum of activity

Gram NEGATIVE
--> SPACE

Useful for treating serious nosocomial infections caused by multiple organisms.

CAP and HAP