Pharmacology Penicillins 4

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  1. Would you usually use a 1st gen Cephalosporin for UTIs?
    Not usually, could be used in some cases, but we have better drugs
  2. What are the 2nd gen Cephalosporins?
    Cefoxitin, cefaclor, cefuroxime and cefotetan
  3. What advantage do 2nd gen Cephalosporins have over 1st gen?
    Increased activity against G-
  4. Cephamycins belong to what group of Cephalosporins?
    2nd generation
  5. Do 2nd generation Cephalosporins have many indications?
    No, few
  6. Which two 2nd gen Cephalosporins are more resistant to B-lactamases and why?
    Cefoxitin and cefotetan, because they have N-methylthiotetrazole side chains
  7. B. fragilis ( GI anaerobe) can be treated by what two 2nd generation Cephalosporins and why?
    Cefotetan or cefoxitin, due to the N-methylthiotetrazole side chain
  8. Which 2nd gen Cephalosporins can treat B. gonnorhoeae?
  9. What disadvantage does the N-methyltetrazole side chain of cefotetan and cefoxitin have?
    Reduces Vit. K production (increased bleeding) and inhibits aldehyde dehydrogenase 9breaks down metabolite from alcohol) causing disulfiram effects
  10. Which 2nd gen Cephalosporins should you not drink alcohol with and why?
    Cefoxitin and cefotetan because of the N-methylthiotetrazole (MTT) side chain
  11. What is cefoxitin used for?
    Abdominal infections
  12. Cefaclor is usually used for what?
    H. influenza and respiratory infections
  13. Cefuroxitine is usually used for what?
  14. What is Cefotetan usually used for?
    Surgical prophylaxis against abdominal infections
  15. What are the third generation cephalosporins?
    Cefotaxime, cefdinir and ceftriaxone
  16. How do 3rd gen Cephalosporins compare to 1st gen in terms of activity against G+ cocci?
    3rd gen are active, but less so than 1st gen
  17. In what ways do 3rd gen Cephalosporins have a broader spectrum than 2st gen Cephalosporins?
    More active against enterobacteriaceae gram negative rods (e. coli, shigella) and one is active against pseudomonas aeruginosa
  18. Do 3rd gen Cephalosporins treat C. diff?
    No, but show a strong correlation with causing C. diff
  19. Do 3rd gen Cephalosporins penetrate the CSF?
  20. What are 3rd gen Cephalosporins always not useful for?
    Pseudomonas aeruginosa (with the exception of ceftazidime), MRSA and anaerobes
  21. How are 3rd gen Cephalosporins, cefotaxime and ceftriaxone administered?
    IV and IM
  22. What is cefotaxamine primarily used for?
    Gram negative meningitis
  23. Which 3rd gen Cephalosporins is resistant to B-lactamases?
  24. Which 3rd gen Cephalosporin is a poor choice for neonates and why?
    Ceftriaxone, interacts with Ca containing drugs and precipitates in liver, lungs, kidneys leading to hyperbilirubinemia
  25. How is Ceftriaxone excreted?
    In the bile
  26. What is ceftriaxone effective against that cefotaxime is not?
    Penicillinase producing N. gonorrhoeae
  27. What is the major issue with 3rd gen Cephalosporins?
    They cause resistance to G- rods
  28. Do 3rd gen Cephalosporins cross the BBB?
  29. What is ceftriaxone primarily used for?
    N. gonorrheae, Lyme disease
  30. How is cefdinir administered?
  31. What inhibits the absorption of cefdinir and why?
    Al, Mg, Fe (reduces absorption)
  32. What is ceftazidime useful against that other 3rd gen Cephalosporins are not?
    Pseudomonas aeruginosa
  33. What is cefdinir approved for?
    Skin infections and respiratory infections
  34. How is ceftazidime administered?
    IV or IM
  35. What is the t1/2 of ceftazidime?
    2 hours
  36. What is ceftazidime not very active against?
    Gram positive bacteria
  37. Will ceftazadime be effective against H. influenzae?
  38. Will ceftazadime be effective against Enterobacteriaceae?
  39. Will ceftazadime be effective against Neiserria?
  40. What is the fourth generation cephalosporin?
  41. How does the spectrum of cefepime compare to the earlier generation cephalosporins?
    Broadest spectrum w/ activity against G- and +
  42. Does cefepime enter the CNS well?
  43. Is cefepime resistant to B-lactamases?
  44. What is the major use for cefepime?
    Treatment of multi drug resistant bacteria and pseudomonas aeruginosa
  45. Is cefepime a good choice for empiric therapy in the hospital, why or why not?
    Yes, because of its broad spectrum
  46. Is cefepime good for rational empiric therapy?
    Yes, because it is broad spectrum
  47. What drugs fall in the 5th generation cephalosporins?
  48. Which generation of cephalosporins are active against MRSA?
    5th: ceftaroline
  49. What is Ceftaroline used for?
    MRSA, acute bacterial infection snad community acquired pneumonia
  50. Would you use ceftaroline for empiric therapy?
  51. In what areas does ceftaroline have poor activity compared to other cephalosporins?
    Poor activity against gram-negative bacteria and no activity against Pseudomonas aeruginosa
  52. What are the major adverse effects of cephalosporins?
    Hypersensitivity, superinfection, nephrotoxicity (rare if used alone), diarrhea, disulfarin and anticoagulant effect
  53. What are the rare side effects of cephalosporins?
    Hemolytic anemia and bone marrow suspension
  54. Which cephazolin has an anticoagulant effect by inhibiting the production of Vit. K?
  55. Which cephalosporins are associated with the disulfiram effect?
    Cefotetan and cefoxitin
  56. How is Imipenem classified?
    B-lactam carbapenem
  57. What is the MOA for imipenem?
    Binds to PBPs and inhibits cell wall synthesis
  58. Imipenem is useful against aerobes or anerobes?
  59. Is Imipenem resistant to B-lactamases?
  60. Is imipenem useful against mixed infections?
  61. The main organisms that are sensitive to imipenem include:
    Pseudomonas, Enterobacter, Citrobacter, Strep, Listeria, Enterococci and Serratia
  62. What are the adverse effects of Imipenem?
    Nausea, vomiting and seizures particularly when used in combination with valproate
  63. Does Imipenem exhibit cross allergies with penicillins?
    Yes, rare
  64. Why would you use cilastatin with Imipenem?
    Inhibits a dipeptidase in the brush border of the proximal tubule which metabolizes imipenem. When imipenem is not metabolized it can be used for UTIs
  65. Carbapenams are excreted in what way?
  66. Are carbapenems first choice or last resort drugs?
    Last resort
  67. Does Imipenem penetrate the BBB?
  68. Does Imipenem treat MRSA?
  69. Why is Imipenem good for UTIs?
    Because it is excreted directly into the urine
  70. ESDL means what?
    Extended spectrum B-lactams
  71. Is Imipenem broad or narrow spectrum?
  72. What is valproate used to treat?
  73. Is Imipenem useful to treat meningitis and why?
    Avoid, because it can cause seizure when it crosses the BBB
  74. What is the classification of Meropenem?
    B-lactam carbapenem
  75. What is the classification of Ertapenem?
    B-lactam carbapenem
  76. What is the classification of Doripenem?
    B-lactam carbapenem
  77. How does Meropenem differ from Imipenem?
    Similar but not sensitive to kidney dipeptidase like Imipenem
  78. Is Ertapenem sensitive to the kidney dipeptidase?
  79. Is Ertapenem usedul in mixed aerobic/anerobic infections?
  80. What important bacteria is Ertapenem not effective against?
    Pseudomonas aeruginosa, enterococci and acinetobacter
  81. Doripenem is useful for what purposes?
    Some intra-abdominal infections and UTIs
  82. What is Aztreonam's classification?
    Monocyclic B-lactam
  83. How is Aztreonam administered?
    IV or IM
  84. What is the t1/2 of Aztreonam?
    1.5 hours
  85. What major bacteria is Aztreonam effective against?
    Enterobacteriaceae, Pseudomonas aeruginosa and H. influenza
  86. Is Aztreonam cross allergenic with penicillins?
    Dose not appear to be ( except for Ceptazadine)
  87. If a patient is allergic to Ceptazadine wil it be allergic to
  88. Does Aztreonam treat G+ or G-?
  89. How is Aztreonam excreted?
    Metabolized in liver, excreted in the liver
  90. (True/False) Aztreonam is a good back up drug particularly for people who are allergic to penicillin.
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Pharmacology Penicillins 4
Pharmacology Penicillins 4
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