FARM 2-2
Terms
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- what are the fourth generation cephalosporins
- cefepime (P)
- what allows cephalosporins greater structural diversity and stability?
- 2-3 R groups make it more stable to beta lactamase and less allergenic
- what are the 1st generation cephalosporins?
-
cephalexin(O)
cefazolin (P) - what are the second generation cephalosporins
-
cefprozil (O)
cefuroxime (O & P)
cefotetan (P) - what are the third generation cephalosporins
-
ceftriaxone
ceftazidime (P)
cefdiner (O)
cefpodoxime (O) -
1st Generation Cephalosporins
Cefalexin
Cefazolin -
Cefalexin... Cefazolin
Class: 1st generation cephalosporin
MOA: same as beta lactam
Use: PEcK - Proteus, E.coli, Klebsiella.. G+ cocci (except enterococci) and a few G- bacilli - SKIN/SOFT TISSUE, UTI, SURGICAL PROPHYLAXIS
AE: Hypersensitivity rxn, platelet dysfxn and bleeding
Contra: if pt had rxn to penecillin
Interaction:
Admin: parental - IM/IV
CEFAZOLIN - longer duration of axn, penetrates well to bone, prophylaxis prior to surgery -
2nd generation cephalosporins
cefprozil
cefuroxime
cefotetan -
Cefprozil...Cefuroxime... Cefotetan
Class: 2nd generation cephalosporin
MOA: same as beta lactam
Use: HEN - H. influenzae, Enterbacter aerogenes, Neisseria
more active against G-
OTITIS MEDIA, SINUSITIS (ORAL)
PELVIC/INTRAABDOMINAL INFECTION (CEFOTETAN)
AE: Hypersensitivity rxn,
cefotetan - platelet dysfxn and bleeding + disulfiram effect (intolerance to ingested alcohol b/c INHIBIT ALDEHYDE DEHYDROGENASE)
Contra: if pt had rxn to penecillin
Interaction:
Admin: parental - IM/IV
cefuroxime - longer half life, crosses blood brain barrier, used for community aquired bronchitis or pneumonia in elderly and immunocompromised -
3rd generation cephalosporins
ceftriaxone,
ceftazidime,
cefdiner,
cefpodoxime -
ceftriaxone, ceftazidime, cefdiner, cefpodoxime
Class: 3rd generation cephalosporin
MOA: same as beta lactam
Use: strepto, pneumococci... enhanced against G-
AE: Hypersensitivity rxn, platelet dysfxn and bleeding
Contra: if pt had rxn to penecillin
Interaction:
Admin: parental - IM/IV
ceftazidime - only one against pseudomonas
ceftriaxone - longest half life, once daily dosing - DOC gonorrhea, lyme dz - can b used in renal insufficiency b/c EXCRETED IN BILE
ceftriaxone/cefotaxime - empiric therapy adult meningitis, add vancomycin if pneumococci resistant - also late lympe dz - arthritis, carditis, neurologic, pediatric
cefpodoxime - URI -
4th generation cephalosporins
cefepime -
4th generation cephalosporins - cefepime
Class: 4th generation cephalosporin
MOA: same as beta lactam
Use: G- bacilli resistant to other agents
AE: Hypersensitivity rxn, platelet dysfxn and bleeding
Contra: if pt had rxn to penecillin
Interaction:
Admin: parental - IM/IV - Vancomycin
-
Vancomycin
Class: glycopeptide antibiotic
MOA: bind D-alanyl-D-alanine of cell wall precursor --> prevents peptidoglycan synthesis - weaken cell wall
Use: staph (METHICILLIN SENSITIVE + MRSA), ENTERO, G+ (C.diff) *RX RESISTANT BACTERIA*
SYNERGISTIC WITH AMINOGLYCOSIDES - RX ENTEROCOCCAL ENDOCARDITIS*
AE: flushing, hypotension, skin rash, chills, drug fever, auditory impairment,
shock with fast infusion
Contra:
Interaction:
Admin: IV - systemic
oral - life threatening ab associated colitis (C. diff or staph) when metronidazole ineffective - Bacitracin
-
Bacitracin
Class: peptide antibiotic
MOA: inhibit incorporation of mucopeptide - inhibit cell wall synthesis
Use: G+ COCCI + BACILLI - RX SUPERFICIAL INFECTIONS
AE: renal failure with systemic use
Contra: if pt had rxn to penecillin
Interaction:
Admin: topical b/c nephrotoxicity - Fosfomycin
-
Fosfomycin
Class: phosphonic acid derivative
MOA: inhibits early step in cell wall synthesis
Use: antimicrobial activity - enterococci, G- rods
ACUTE UNCOMPLICATED LOWER UTI (CYSTITIS) SINGLE 3G DOSE
AE:
Contra:
Interaction:
Admin: oral - high [ ] in urine