T2 - Micro - Pharm - Cephalosporin / Vancomycin

Front 1

cephalosporins - what are the general divisions of them? what's the difference between them and penicillins?

Back 1

generations, based on when they came out.

differ from penicillins in that penicillins have 4 membered beta lactam rings, whereas cephalosporins have 6 membered rings that include sulfur. penicillin has sulfur too, though, and when it's subtracted, you get a carbinicillin. this is anti pseudomonas, as is "tic" and "piperizan"

note that they all work by inhibiitng cell wall synthesis, particularly the D-ala/glycine bond in the peptidoglycan

Front 2

talk about the first generation cephalosporins

Back 2

don't forget, all these drugs have no effect on anerobes.

keflex, really called cephalexin, is the first one. a lot like ampicillin in that it's broader range than simple penicillin (it attacks gram negatives too).

note that these can BE TAKEN ORALLY.

though you can also kill klebsiella with it.

the other one is cephazolin - used in surgical prophylaxis.

Front 3

second generation? what drugs are there and what do they do?

Back 3

cephoxatin - a lot like the first generation, better gram negative coverage, adding in bacteriodies.

cefaclor - abdominal prophylaxis in surgery, h influenzae

cefprozil - h. influenzae, respiratory infections.

Front 4

thid generation cephalosporins - what are they? method of elimination?

Back 4

third generation = cefotaxime, ceftriaxone, ceftazidime.

cefotaxime = h. influenzae

ceftriaxone = this is the guy to know. has a half life of 7 or 8 hours, longer than the rest, so take once per day.

DRUG OF CHOICE FOR BACTERIAL MENINGITIS. gonoccus, meningococcus.

DO NOT GIVE WITH CALCIUM - it precipitates and kills you.

also, excreted into bile, so it's fine to use with kidney patients.

ceftazidime = p. aeruginosa, other bacteremias, given with aminoglycosides.

Front 5

third generation drugs sound good. what are they not good agains? when is pen G good to use?

Back 5

less active against gram + than the penicillins.

also, not good against enteroccals. use PenG.

note that both penicillins and cephalosporins are used in concert with AMINOGLYCOSIDES for full coverage.

Front 6

4th generation? what drugs? used for what?

Back 6

not a lot better than 3rd. here our drug is Cefepime.

BETTER AGAINST ENTEROBACTER. pseudomonas, etc.

Front 7

what are cephalosporin side effects?

Back 7

penicillin anaphalaxis - don't use.

don't use with calcium! ceftriaxone.

also, because it's no help with enteroccus, it can lead to super infection with candidia/enteroccus/enterobacter (if not 4th generation)

Front 8

so as a review, what conditions are cephalosporins used in?

Back 8

meningococus/meningitis. (note - H. influenzae not killed by PenG, so if the meningitis is caused by it, you won't help. so to be safe, use 3rd gen cephalosporins)

pneumococcals.

bacterial endocarditis

gonorrhea

syphillis. or penG.

tonsilitis - s. pyogenese. or use amoxicillin.

bacteremia (third gen + aminoglcycoside).

typhoid fever.

UTI.

surgical prophylaxis.

Front 9

Vancomycin - what does it do? how is it given?

Back 9

cell wall synthesis inhibitor, messing with D-ala/Dala transglycosylation.

can't be taken orally for systemic disease. if GI problem (C. dificil), can use orally for local problem.

can't be given in bolus - has to be given slowly.

IV.

Front 10

what diseases can you treat with it? what about penicillin allergies?

Back 10

MRSA can be treated with it, endocarditis due to streps,

also pseudomembranous colitis due to c. dificil.

okay to use in patients allergic to penicillin and cephalosporins.

Front 11

if you have a patient with endocarditis and is allergic to penicillin?

Back 11

vancomycin with aminoglycosides.

note that you also use aminoglycosides with penicillins.

Front 12

toxic reactions of vancomycin?

Back 12

phlebosclerotic, nephrotoxcisity, ototoxcisity. hypersensitivity.

the aminoglycosides are similar - so using together can make you sicker.

Front 13

what else can you use with MRSA?

Back 13

polymixins - old nephrotoxic drugs. used with vancomycin. messes with cell walls.