Term
| What are the oral 2nd generation cephalosporins? |
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Definition
- Ceftin/Cefuroxime
- Ceclor/Cefaclor
- Lorabid/Loracarbef
- Cefzil/Cefprozil |
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Term
| What cephalosporins are 2nd generation? |
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Definition
- Cefuroxime/Ceftin
- Cefoxitin/Mefoxin
- Cefotetan/Cefotan
- Cefoclor/Ceclor
- Loracarbef/Lorabid
- Cefprozil/Cefzil |
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Term
| What agents are 3rd generation cephalosporins? |
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Definition
- Cefotaxime/Claforan
- Ceftizoxime/Cefizox - Q 12
- Ceftriaxone/Rocephin - q8h
- Cefixime/Suprax - no longer first line for gonorrea due to resistance
- Cefdinir/Omnicef
- Cefpodoxime/Vantin |
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Term
| What cephalosporin is tx of choice for penicillin sensitive meningitis? |
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Definition
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Term
| What 3 organisms cause meningitis? |
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Definition
- Strep pneumoniae
- N. menigitidis
- H. influenzae - vaccine exists
**Choroid plexus produces CSF, which surrounds brain and spinal cord. CSF is sterile! Turbidity = bad. |
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Term
| What is the meningitis reaction? |
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Definition
| Infiltrates into the CSF cause a violent autoimmune reaction by the body - inflammation, increased pressure leading to HA, fever. TNF, IL-1, etc. |
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Term
| What 3rd generation cephalosporin covers Pseudomonas? |
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Definition
| - Ceftazidime/Fortaz - only weak gram(+). Does NOT require beta lactamase inhibitor due to structure! |
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Term
| What is the 4th generation cephalosporin? |
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Definition
| Cefepime/Maxipime - also works for MSSA, Pseudomonas, meningitis, other beta lactamase expressing organisms |
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Term
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Definition
Nature's answer to cephalosporins: extended spectrum beta-lactamases. Resistance to cephalosporins due to hydrolysis!
**Options: Carbapenems |
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Term
| What is the 5th generation cephalosporin? |
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Definition
Ceftaroline Fosamil/ Teflaro - IV only. Works on MRSA, VRSA, and Zyvox resistant SA. Also covers Pseudomonas, CAP, and entero.
**INACTIVATED by EBSL |
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Term
| What are the Carbapenems? |
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Definition
- Imipenem + Cilastatin/Primaxin - broad, resistant to beta lactamases. Inhibits many gram(-) including bacteroides, pseudomonas, and meningitis
- Meropenem/Merrem - more stable to DPP-1. For meningitis
- Doripenem/Doribax - most potent. For UTI
- Ertapenem/Invanz - E. coli, Bacteroides, MSSA, S. pyogenes. NO AERUG coverage. Long half life |
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Term
| When is Imipenem not an option? |
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Definition
| Kidney infections - cleaved by renal DHP-1 --> dosed with Cilastatin which inhibits DPP-1 |
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Term
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Definition
Carbapenem resistant enterobacteriaceae - resistant to carbapenems as well as cephalosporins. At risk: catheters and ventilators
**TX: Colistin, Tigecycline, rifampin |
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Term
| What are the main points of the articles on CREs? |
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Definition
- USA today: CRE Klebsiella, other infections. Mortality up to 40%. No national data or screening
- CDC - multiple mechanisms responsible. Can infect or colonize. Antibiotic and ventilation are risk factors. |
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Term
| What antibiotic is a monolactam? |
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Definition
| Aztreonam/Azactam - only works on gram(-) aerobes -- Enterobacteriaceae, P. aerug, H. influenzae, gonorrea |
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Term
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Definition
A lipoglycopeptide cell wall inhibitor that has NO oral availability. Pain at infusion site, can cause RED MAN syndrome. AE: nephro and ototoxicity
**5 binding points. Works on MRSA! |
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Term
| What is the Vancomycin spectrum? |
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Definition
| ONLY gram(+) organisms, particularly cocci - MRSA, MRSE, E. faecalis, S. pyogenes and pneumoniae, C. diff (only oral use), and C. tetani |
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Term
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Definition
Televancin/Vibativ - similar to Vanc w/ a lower MIC - still only works on gram(+). MAY WORK ON Vanc-resistance!
**Also B. anthracis and Listeria. Pokes holes in membranes.
**CANNOT be used in pregnancy. Nephrotoxic. Can also CAUSE C.diff, interfere with INR |
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Term
| What is Dalbavancin/Zeven? |
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Definition
An investigational drug w/ same MoA as televancin. Active against MSSA/MRSA and E. faecalis/Faecium, S. pneumoniae, Listeria.
**Does not work on VRE |
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Term
| How is Bacitracin A used? |
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Definition
IV formulas are highly neuro- and nephro- toxic, so used topically. Inhibits lipid transporter, increased by Zn.
**Gram(+) and Neisseria, H. influenzae, C. diff |
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Term
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Definition
Disrupts cytoplasmic membrane = leakage. Inactivates LPS, an endotoxin
**Used for CRE, aeresolized into ventilators. High MIC! |
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Term
| What are Colistin and Colistimethate? |
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Definition
Polymixin E.
- Colistin - gram(-) coverage especially P. aerug
- Colistimethate/Colymycin M - Entero, E. coli, Klebsiella, P. aerug
**Renally toxic, CNS effects |
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Term
| What is Daptomycin/Cubicin? |
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Definition
Depolarizes membranes causing a slow leakage, NOT rupture. ONLY give IV, will rupture skeletal muscle IM.
**ONLY gram(+) coverage - enterococci (VRE included), MRSA, VRSA, strep. Skin and endocarditis |
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