Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
38 Cards in this Set
- Front
- Back
|
what drugs are beta lactams?
|
Penicillins, Cephalosporins, Carbapenems and Monobactams
|
|
|
How does cross reactivity work between beta lactams?
|
-if a patient experiences only a mild rash without systemic symptoms to one beta-lactam class, you could try another class (i.e., rash to penicillin could try cephalosporins).
- However, if a patient has an anaphylactic reaction to any beta-lactam, all should be avoided. |
|
|
What is MOA for beta lactams?
|
-Bind to one or more penicillin binding proteins (PBPs)
-PBPs are final step of peptidoglycan synthesis in bacterial cell walls -Leads to lysis of bacterial cell wall |
|
|
which beta lactams are not safe in pregnancy?
|
Ceftriaxone—3rd trimester (kernicterus)
Imipenem—concern with AE of seizures Doripenem—safety in pregnancy/children not established Ceftaroline—safety in pregnancy/children not established |
|
|
how is beta lactam tissue penetration?
|
Adequate to most sites
-Preferred agents in CNS infections |
|
|
what are AE of beta lactams?
|
-3% to 10%- Cross-sensitivity with carbapenems, cephalosporins
-GI -Hematologic abnormalities -Interstitial nephritis -Biliary sludging and cholecystitis (ceftriaxone) -Seizures (imipenem/cilistatin) |
|
|
what is the spectrum of activity for penicillins?
|
• Wide spectrum including many gram-positive, gram-negative, and anaerobic organisms
• Dependent upon class of penicillin |
|
|
AE of penicillins?
|
• Allergic or hypersensitivity reaction
• Occurs in 3% to 10% • Allergy to individual penicillin confers to entire class • Incidence of cross-sensitivity with cephalosporins in penicillin-allergic patients without anaphylactic reaction—3% to 7% • Gastrointestinal • Elevated LFTs (Nafcillin, Oxacillin) • Cholestatic jaundice (Piperacillin, Mezlocillin) • Hematologic abnormalities • CNS • Interstitial nephritis • Thrombophlebitis (Nafcillin, Oxacillin) |
|
|
What are the natural penicillins?
|
• Aqueous Crystalline Penicillin G (IV)
• Penicillin G Procaine (IV) • Penicillin G Benzathine (IM) • Penicillin VK (PO) |
|
|
what do natural penicilins cover?
|
o Gram-positives
o Anaerobes o Treponema pallidum |
|
|
what are the penicilinase resistant penicillins?
|
• Nafcillin (IV)
• Oxacillin (IV) • Dicloxacillin (PO) |
|
|
what do penicillinase resistant penicillins cover?
|
o Staphylococcus (MSSA)
o Streptococcus |
|
|
what are the aminopenicillins?
|
• Ampicillin (IV and PO)
• Amoxicillin (PO) |
|
|
what do aminopenicillins cover?
|
o Gram-positive
o Anaerobes o Listeria o Enterococcus o Gram-negative (limited) |
|
|
what are the extended spectrum penicillin and what does it cover?
|
carboxypenicillins- Ticarcillin (Ticar®) (IV)
o Coverage • Gram-positive • Gram-negative, including Pseudomonas aeruginosa • Anaerobes |
|
|
what is the other extended spectrum penicillin?
|
Ureidopenicillins- Piperacillin (Pipracil®) (IV)
o Coverage • Gram-positives, including enterococci • Gram-negative, including Pseudomonas aeruginosa • Anaerobes |
|
|
what drugs are penicillins + beta lactamase inhibitors cover ?
|
• Amoxicillin + Clavulanic Acid (Augmentin®) (PO)
• Ticarcillin + Clavulanic Acid (Timentin®) (IV) • Ampicillin + Sulbactam (Unasyn®) (IV) • Piperacillin + Tazobactam (Zosyn®) (IV) |
|
|
what do penicillins + beta lactamase inhibitors cover?
|
o Gram-positive, Enterococcus (Amp/Sulb and Pip/Tazo only)
o Gram-negative, Pseudomonas aeruginosa (Ticar/Clav and Pip/Tazo only) o Anaerobes |
|
|
what is the general rule for cephalosporin generations?
|
As a general rule, when you move up each generation you lose gram-positive coverage and gain gram-negative coverage.
|
|
|
what are the exceptions to the rule for cephalosporins?
|
exceptions are 3rd generation and their exceptional coverage of Streptococcus pneumoniae and the 4th generation, cefepime, that has very good gram-positive and gram-negative coverage. f
|
|
|
should cephalosporins be used for anaerobic coverage?
|
Cephalosporins have very limited to no anaerobic activity so you should never regard them as a suitable option for anaerobic infections
|
|
|
what are general AE of cephalosporins?
|
• Allergic or hypersensitivity reaction (1% to 3%)
• Gastrointestinal • Hematologic abnormalities • Biliary sludging and cholecystitis (Ceftriaxone) • Interstitial nephritis (rare) |
|
|
what are first generation cephalosporins?
|
• Cephalexin (Keflex®) (PO)
• Cefazolin (Ancef®) (IV |
|
|
what do first generation cephalosporins cover?
|
o Gram-positive including staphylococcus
o Limited gram-negative |
|
|
what are second generation cephalosporins
|
• Cefprozil (Cefzil®) (PO)
• Cefaclor (Ceclor®, Ceclor CD®) (PO) • Cefuroxime (Ceftin®, Zinacef®) (PO,IV) • Cefoxitin (Mefoxin®) (IV) |
|
|
what do second generation cephalosporins cover?
|
o Gram-positive with less staphylococcal coverage
o Increased gram-negative o Anaerobes (Cefoxitin only |
|
|
what are 3rd generation cephalosporins?
|
• Cefotaxime (Claforan®) (IV)
• Ceftazidime (Fortaz®) (IV) • Ceftriaxone (Rocephin®) (IV, IM) • Cefpodoxime (Vantin®) (PO) • Ceftibuten (Cedax®) (PO) |
|
|
what do 3rd generation cephalosporins cover?
|
o Limited gram-positives—good Strep. pneumonia coverage
o Superior gram-negative • Pseudomonas aeruginosa (Ceftazidime only |
|
|
what is the fourth generation cephalosporin?
|
• Cefepime (Maxipime®) (IV)
|
|
|
what does 4th generation cover?
|
o Excellent gram-positive and gram-negative
o Pseudomonas aeruginosa |
|
|
what is the 5th generation cephalosporine?
|
• Ceftaroline (Teflaro®) (IV)
|
|
|
when are 5th generation cephalosporines indicated?
|
o Complicated SSTIs
o Community-acquired pneumonia |
|
|
what do 5th generations cover?
|
-Gram-positives
• MRSA, VISA, VRSA • Streptococcus pneumonia -Gram-negatives • Morexalla catarrhalis • Haemophilus influenza |
|
|
What do carbepenems and monolactams cover?
|
o Gram-positives
o Gram-negatives o Anaerobes o Pseudomonas (Imipenem, Meropenem, Doripenem) |
|
|
what do extended spectrum beta lactams cover?
|
• Klebsiella sp
• E. Coli • Enterobacteriaceae • P. aeruginosa |
|
|
what are available carbepenems?
|
o Imipenem/Cilistatin (Primaxin®)--Addition of Cilistatin necessary to reduce incidence of nephrotoxicity
o Meropenem (Merrem®) o Ertapenem (Invanz®)—lacks Pseudomonas coverage o Doripenem (Doribax®) |
|
|
what drug is a monobactam?
|
--Aztreonam (IV)
• Coverage includes extensive gram-negative coverage |
|
|
What are AE of carbepenems and monobactams?
|
• Nausea and vomiting
• Seizures --Imipenem. Must adjust dose with renal impairment to reduce risk of development |
