Pharm Block 2 (Cephalosporins and Vancomycin)

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Pharm Block 2 (Cephalosporins and Vancomycin)
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2010-11-26 08:39:19
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Pharm Block Cephalosporins Vancomycin
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Pharm Block 2 (Cephalosporins and Vancomycin)
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  1. What are the First generation of Cephalosporins?
  2. First Generation
    • Cefazolin
    • Cephalexin (Keflex)
    • Cefadroxil (Duricef)
  3. What are the Second generation of Cephalosporins?
  4. Second Generation
    • Cefuroxime (Zinacef)
    • Cefoxitin (Mefoxin)
    • Cefotetan (Cefotan)
    • Cefuroxime axetil (Ceftin)
    • Cefaclor (Ceclor)
    • Cefprozil (Cefzil)
  5. What are the Third Generation Cephalosporins?
  6. Third Generation
    • Cefotaxime (Claforan)
    • Ceftriaxone (Rocephin)
    • Ceftazidime (Fortaz)
    • Cefdinir (Omnicef)
    • Cefpodoxime (Vantin)
  7. What are the Forth Generation Cephalosporins?
    Cefepime (Maxipene)
  8. 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
  9. 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!!
  10. What are some clinical uses for :
    1st generation?
    2nd generation?
    • First generation
    • -Surgical prophylaxis
    • -Soft tissue infections


    • Second generation
    • -Intra-abdominal infections
  11. What are the Clinical uses for:
    3rd/ 4th generations?
    • Ceftriaxone/Cefotaxime
    • -pediatric infections (meningitis)


    • Ceftazidime
    • - Pseudomonas infections


    • Cefepime
    • -Very broad spectrum
  12. 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
  13. What are some Combinations OF BETA LACTAM ANTIBIOTICS WITH BETA LACTAMASE INHIBITORS ???
  14. Clavulanic Acid, Sulbactam,Tazobactam
    • -Amoxicillin-Clavulanic Acid
    • -Ticarcillin/Clavulanic Acid
    • -Ampicillin/Sulbactam
    • -Piperacillin/Tazobactam
  15. 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
  16. name some OTHER BETA-LACTAM ANTIBIOTICS.
    • -Aztreonam
    • -Imipenem--administered with cilastatin which inhibits renal inactivation.
    • -Meropenem
    • -Ertapenem


    These have minimal susceptability to Beta-Lactamases
  17. 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.
  18. What are the Toxicity for OTHER BETA-LACTAM ANTIBIOTICS????
    GI, Allergic, Renal, Hepatic, Hematologic, Drug fever, Bacterial or fungal Overgrowth

    *Imipenem – rare neurologic reactions
  19. 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
  20. What are some Mechanisms of Microbial resistance to Vancomycin?
  21. -Rare
    -Mutation of antibiotic binding site (target)
  22. What is Vancomycins Spectrum of action???
    -Narrow: Resistant Gram Positive Organisms including: MRSA, enterococci, and pneumococci

    -Clostridium difficile
  23. 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
  24. What are the Toxicities of Vancomycin?
    • -Renal
    • -Auditory – dose related, especially in adults
    • -“Red man” syndrome (not allergic) – ameliorated by slow infusion
  25. 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
  26. 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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