Ios 10 Quiz 2

Front 1

Clinically relevant antimicrobial activity: 1st Gen.

Back 1

+++ Gram +
+ Gram -
0 Pseudomonas
0/+ Anaerobes

Front 2

Clinically relevant antimicrobial activity: 2nd Gen.

Back 2

++ Gram +
++ gram -
0 Pseudomonas
++ Anaerobes (cephamycins only)

Front 3

Clinically relevant antimicrobial activity: 3rd Gen.

Back 3

+ Gram +
+++ Gram -
+++ Pseudomonas (ceftazidime only)
0/+ Anaerobes

Front 4

Clinically relevant antimicrobial activity: 4th Gen.

Back 4

++ Gram +
+++ Gram -
+++ Pseudomonas
0/+ Anaerobes

Front 5

progression of gram -/+ activity from 1st to 4th gen.

Back 5

2nd 3rd gen enhance gram - activity, but lost gram +

4th gen. retain gram - and improve gram + activity

Front 6

What bacteria are cephalosporins NOT effective against?

Back 6

MRSA
enterococci
Listeria
Atypical: chlamydophila, mycoplasma, legionella

Front 7

what are the atypicals?

Back 7

chlamydophila
mycoplasma
legionella

Front 8

Common 1st Gen. cephalosporins

Back 8

cephalexin (PO)

cefazolin (IV)

Front 9

Spectrum of activity 1st Gen

Back 9

narrow, primarily Gram +

Gram + aerobes (staph, strep)

Gram - aerobes (some enteric bacilli: Klebsiella, E. coli, Enterobacter, Proteus)

Anaerobes: only PCN susceptible strains (oropharynx)

Front 10

which Gram + aerobes do 1st gen. cephalosporins treat?

Back 10

primarily streptococci, staphylococci,
NOT MRSA,
no enterococci

Front 11

which gram - aerobes do 1st gen. cephalosporins treat?

Back 11

only certain enteri bacilli
(ex) Klebsiella, E. coli, Enterobacter, Proteus

Poor Beta lactamase activity

Front 12

which anaerobes do 1st gen. cephalosporins treat?

Back 12

limited to PCN susceptible strains such as those in oropharynx

Front 13

common 2nd gen. cephalosporins

Back 13

cefaclor (PO)

cefoxitin (IV)

Front 14

which 2nd gen. cephalosporins are cephamycins?

Back 14

cefoxitin
cefotetan*
defmetazole*

*have NMTT side chain

Front 15

unique feature of cephamycins (2nd gen)

Back 15

"anti aerobic"
enhanced anaerobic activity, enhanced gram - activity, decreased gram + activity compared to "true" 2nd gen cephalosporins

Front 16

what is the NMTT side chain?

Back 16

increased PBP binding...

Front 17

undesired effects of NMTT side chain

Back 17

inhibit vit K epoxide reductase (bleeding)

inhibit aldehyde dehydrogenase (cant drink EtOH)

Front 18

Spectrum of activity 2nd Gen cephalosporins

Back 18

broader in spectrum, improved gram - activity compared to 1st gen.

Gram + aerobes: Primarily streptococci and staphylococci, not quite as active as first-gen. agents

Gram - aerobes: Improved Gram-negative activity against enteric bacilli (e.g. E. coli, Klebsiella, Enterobacter, Proteus)
Also good activity against some selected β-lactamase producing organisms, e.g. Haemophilus influenzae, Moraxella catarrhalis

Anaerobes: Limited overall
Exception: cephamycins have best activity of cephalosporin class, including Bacteroides fragilis

Front 19

what gram + aerobes do 2nd gen cephalosporins treat

Back 19

Primarily streptococci and staphylococci, not quite as active as first-gen. agents

Front 20

what gram - aerobes do 2nd gen. cephalosporins treat?

Back 20

Improved Gram-negative activity against enteric bacilli (e.g. E. coli, Klebsiella, Enterobacter, Proteus)

Front 21

what beta lactamase producing microbes to 2nd gen. cephalosporins treat?

Back 21

some selected β-lactamase producing organisms, e.g. Haemophilus influenzae, Moraxella catarrhalis

Front 22

what anaerobes do 2nd gen. cephalosporins treat?

Back 22

Limited overall

Exception: cephamycins have best activity of cephalosporin class, including Bacteroides fragilis

Front 23

common 3rd gen. cephalosporins

Back 23

ceftazidime (IV)
cefpodoxime proxetil* (PO)
cefditoren pivoxil* (PO)

*prodrug

Front 24

spectrum of activity 3rd gen. cephalosporins

Back 24

BROAD spectrum, excellent gram - activity
much more stable against beta lactamases produced by gram +/-

Useful for broad range of community-acquired and nosocomial infections (IV agents) due to good Gram-positive and excellent Gram-negative activity

Gram + aerobes: primarily streptococci and staphylococci, less active than other generations but still clinically useful

Gram - aerobes: Active against wide range of organisms, but still subject to inactivation by many β-lactamases

Excellent against Enterobacteriaceae
Also excellent against H. influenzae, M. catarrhalis, Neisseria

Ceftazidime has good activity against P. aeruginosa

Anaerobes: Limited to oropharyngeal strains

Front 25

which gram + aerobes do 3rd gen. cephalosporins treat?

Back 25

primarily streptococci and staphylococci, less active than other generations but still clinically useful

Front 26

which gram - aerobes do 3rd gen. cephalosporins treat?

Back 26

Gram - aerobes: Active against wide range of organisms, but still subject to inactivation by many β-lactamases

Excellent against Enterobacteriaceae

Also excellent against H. influenzae, M. catarrhalis, Neisseria

Front 27

what microbe is ceftazidime good against?

Back 27

Pseudomonas aerigunosa

Front 28

what anaerobes do 3rd gen. cephalosporins treat?

Back 28

limited to oropharyngeal strains

Front 29

what is the 4th gen. cephalosporin?

Back 29

cefepime (IV)

Front 30

spectrum of activity of 4th gen. cephalosporin cefepime

Back 30

Has good Gram-positive activity, similar to first- and second-generation agents

Has excellent Gram-negative activity, including P. aeruginosa
More stable than third-generation agents to many β-lactamases, particularly those produced by Enterobacteriaceae

Front 31

safety/side effects of cephalosporins

Back 31

Cephalosporins are considered to be among the safest of antimicrobial and are associated with few serious adverse effects

Front 32

side effect profile cephalosporins

Back 32

generally similar to penicillins

PCN SE:
Gastrointestinal: nausea, vomiting, abdominal pain, diarrhea (20-30% incidence with ampicillin)

Skin: rash  most commonly reported with ampicillin and amoxicillin (5-10% vs. 1-2% with other penicillins)
Rash during ampicillin administration does NOT necessarily signify a serious hypersensitivity reaction

Hematologic: neutropenia, prolonged bleeding times, thrombocytopenia

CNS: mental status changes, seizures in high-risk patients

Electrolytes: hypokalemia, hypernatremia

Hepatic: transaminase elevations

Renal: interstitial nephritis, acute tubular necrosis

Clostridium difficile-associated disease
Caused by disruption of normal bowel flora
Allows overgrowth of Clostridium difficile
C. difficile causes infection of colon
Toxin-mediated inflammation, diarrhea, mucosal injury
Significant morbidity and mortality
Associated with nearly all antibiotic classes, especially broad-spectrum agents with anaerobic activity

Superinfection:
Antibiotic-induced suppression of susceptible organisms allows growth of different and/or less susceptible organisms
Leads to new infections with more resistant bacterial organisms as well as fungal organisms, e.g. Candida
Most commonly associated with broad-spectrum antibiotics

Front 33

hypersensitivity of cephalosporins

Back 33

Hypersensitivity reactions occur in 1-3% of patients
Reactions range from rash to anaphylactic reactions
Approximately 7-10% of patients with true penicillin allergy will have cross-sensitivity to cephalosporins
Many patients will develop rash to penicillins (e.g. ampicillin), does not necessarily contraindicate cephalosporin administration but care should be exercised

Front 34

unique side effect of ceftriaxone

Back 34

billiary sludging

Front 35

unique side effect of NMTT side chain cephalosporins

Back 35

hypothrombinemia (increased bleed time)

disulfiram-like rxns when used in pts. w/ recent EtOH use

Front 36

which cephalosporins have NMTT side chain? what is their generation?

Back 36

2nd Gen:
cefamandole
cefotetan (cephomycin)
cefmetazole (cephomycin)

3rd Gen:
cefoperazone