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What are the First generation of Cephalosporins?
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First Generation
- Cefazolin
- Cephalexin (Keflex)
- Cefadroxil (Duricef)
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What are the Second generation of Cephalosporins?
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Second Generation
- Cefuroxime (Zinacef)
- Cefoxitin (Mefoxin)
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- Cefotetan (Cefotan)
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- Cefuroxime axetil (Ceftin)
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- Cefaclor (Ceclor)
- Cefprozil (Cefzil)
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What are the Third Generation Cephalosporins?
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Third Generation
- Cefotaxime (Claforan)
- Ceftriaxone (Rocephin)
- Ceftazidime (Fortaz)
- Cefdinir (Omnicef)
- Cefpodoxime (Vantin)
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What are the Forth Generation Cephalosporins?
Cefepime (Maxipene)
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How are most Cephalosporins eliminated?
How are Cefoperazone and Ceftriaxone eliminated?
Any reach good CNS levels?
- - renal elimination
- -biliary tract
- - Only the 3rd generations reach good CNS levels
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Which Cephalosprins are good for:
-gram positive activity?
-good anaerobic coverage?
-Borellia bergdorfi infection?
- Which are good for Enterococci, Listeria or MRSA?
- -First generation Cephalosporins ( as you move from 1st to 4th generations you increase in Gram neg activity)
- -Cefoxitin and Cefotetan
- -Ceftriaxone
- - NONE!!
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What are some clinical uses for :
1st generation?
2nd generation?
- First generation
- -Surgical prophylaxis
- -Soft tissue infections
- Second generation
- -Intra-abdominal infections
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What are the Clinical uses for:
3rd/ 4th generations?
- Ceftriaxone/Cefotaxime
- -pediatric infections (meningitis)
- Ceftazidime
- - Pseudomonas infections
- Cefepime-Very broad spectrum
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What are some Cephalosporin Toxcitys?
- - Allergic reactions (minimal cross allergy sensitivity between penicillins and cephalosporins)
- -Disfiram-like reaction--cefamandole or cefoperazone
- -Bleeding Diathesis
- -Phlebitis at the infusion site
- -Biliary Obstruction---Ceftriaxone
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What are some Combinations OF BETA LACTAM ANTIBIOTICS WITH BETA LACTAMASE INHIBITORS ???
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Clavulanic Acid, Sulbactam,Tazobactam
- -Amoxicillin-Clavulanic Acid
- -Ticarcillin/Clavulanic Acid
- -Ampicillin/Sulbactam
- -Piperacillin/Tazobactam
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What is in the spectrum of COMBINATION OF BETA LACTAM ANTIBIOTICS WITH BETA LACTAMASE INHIBITORS????
- -Broadens spectrum against:
- S. aureus,
- H. influenzae,
- Bacteroides,
- Moraxella catarrhalis,
- Gram negative enteric bacteria
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name some OTHER BETA-LACTAM ANTIBIOTICS.
- -Aztreonam
- -Imipenem--administered with cilastatin which inhibits renal inactivation.
- -Meropenem
- -Ertapenem
These have minimal susceptability to Beta-Lactamases
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What are the spectrums of..
Aztreonam?
Ertapenem (Carbapenems)?
- gram negative organisms including pseudomonas but NOT anaerobes
- very broad spectrum often drugs of last resort for resistant organisms. Not effective against Anaerobes.
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What are the Toxicity for OTHER BETA-LACTAM ANTIBIOTICS????
GI, Allergic, Renal, Hepatic, Hematologic, Drug fever, Bacterial or fungal Overgrowth
*Imipenem – rare neurologic reactions
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What is VANCOMYCIN's structure like?
What is its mechanism of action?
A complex Gluco-polypeptide, unrelated to other antibiotics
- -Irreversibly inhibits biosynthesis of peptidoglycan polymers in cell wall of dividing gram positive organisms
- -Blocks cell wall synthesis
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What are some Mechanisms of Microbial resistance to Vancomycin?
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-Rare
-Mutation of antibiotic binding site (target)
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What is Vancomycins Spectrum of action???
-Narrow: Resistant Gram Positive Organisms including: MRSA, enterococci, and pneumococci
-Clostridium difficile
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What is the Clinical used of Vancomycin?
-Drug of choice for serious infections with resistant gram positive organisms MRSA, PCN resistant pneumococci
-Not as effective for lung infections
-Drug of second choice for Pseudomembranous colitis caused by clostridium difficile
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What are the Toxicities of Vancomycin?
- -Renal
- -Auditory – dose related, especially in adults
- -“Red man” syndrome (not allergic) – ameliorated by slow infusion
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What is Daptomycin's mechanism?
what is its Antimocorbial action?
-Mechanism of action: Unique, Cidal. Disrupts multiple aspects of bacterial plasma membrane function, including peptidoglycan synthesis, lipoteichoic acid synthesis, and bacterial membrane potential.
- -Narrow: Gram positive organisms,
- including: Linazolide resistant MRSA
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What are some Clinical uses of Daptomycin?
what are some of its adverse effects?
- -Skin and soft tissue infections
- -Sepsis
- -Endocarditis - (With resistant gram positive infections)
*Transient muscle weakness, myalgias
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