PC 707 Module 2 Exam - Questions and Answers The Cephalosporin drug class: -beta-lactam -interferes with cell wall synthesis (just like PCN)
... [Show More] -bactericidal -often resistant to beta-lactamases -5 generations 1st generation cephalosporins -cephalexin (Keflex) -cefadroxil (Duricef) -cefazolin (Ancef) -covers gram + 2nd generation cephalosporins -cefuroxime (Ceftin) -cefprozil (Cefzil) -gram + (less than 1st gen) and gram - ---cefoxitin (Mefoxin) & cefotetan (AstraZeneca)--also covers atypical anaerobes 3rd generation cephalosporins -ceftibuten (Cedax) -cefixime (Suprax) -weak gram + and - with anti-betalactamase ---ceftazidime (Fortaz)--covers pseduomonas as well 3rd generation cephalosporins--extended -ceftriaxone (Rocephin) -cefdinir (Omnicef) -gram + and - -extended coverage to help counteract beta-lactamases 4th generation cephalosporins -cefepime (Maxipime) -gram + and - 5th generation cephalosporins -ceftobiprole (Zeftera) -gram + and - -gram + particularly for MRSA Most cephalosporins are absorbed well in the GI tract. True or false? -False--most need to be given parenterally All the cephalosporins are eliminated by the kidneys except? -ceftriaxone (Rocephin) -largely eliminated by the liver -dosage reduction is not necessary when giving to renal impaired patients Severe adverse events with cephalosporins: -potential bleeding tendencies -hemolytic anemia -C diff potential Potential drug interaction--cephalosporins with? -alcohol-can cause a disulfiram effect -particularly cefazolin (Ancef) & cefotetan (AstraZeneca) Carbapenems drug class: -beta-lactam -very broad spectrum (gram +/-) -most effective for anaerobic -none are active against MRSA -only use if not able to use a more narrow spectrum choice -not absorbed well in the GI tract--give parenterally -Ex: imipenem-cilastin (Primaxin ) & meropenem (Merram) Important drug interaction with imipenem? -it can reduce levels of valproate (seizure medication) Which generation cephalosporins should be used for bacterial infections in infants? -3rd generation Are cephalosporins safe in pregnancy? -yes Glycopeptides (Vancomycin): -used when gram + infections are resistant to 1st line treatment (PCNS) -narrow spectrum -principal indication C-diff***, MRSA, serious infections -inhibits cell wall synthesis--but does not have a beta lactam ring -major concern is nephrotoxicity -can cause red man syndrome if infused rapidly -monitor trough levels -potential ototoxicity What vancomycin derivative should be avoided in pregnancy? -telavancin -can prolong the QT interval Black box warning for vancomycin: -If used with creatinine clearance less than 5--increased risk of mortality Which antibiotic has a high potential for contributing to C-diff? -cleocin (Clindamycin) -class---> "lincosamide"--similar to macrolides What are the typical antibiotics used for c-diff? -vancomycin**** -flagyl Complications of C-diff? -dehydration, electrolytes imbalances, renal failture, toxic megacolon, pseduomembranous colitis, colon perforation, sepsis, death Which beta lactam antibiotic is considered a monobactam? -aztreonam (Azactam) -only has one beta lactam ring (hence the "mono") -inhibits cell wall synthesis like other beta lactams -narrow spectrum--only gram - aerobic -safe for PCN allergies Macrolides class: -inhibits protein synthesis -broad spectrum (mostly gram + but some gram -) -can be a good alternative to patients with PCN allergy -macro because they are "big" -mostly bacteriostatic--but can be bactericidal in high concentrations -drug of choice for bordetella pertussis -crosses placenta but not adverse effects observed -one of the safest options--no serious toxicity -can increase levels of other drugs (inhibitor of metabolism) -Ex: erthromycin (gram + & atypical) & azithromycin (gram +/- & atypical) What is the major risk with macrolides? -risk for ototoxicity -risk for prolonging QT interval -potential other drug interactions What is important to teach patients taking macrolides? -take on empty stomach with full glass of water -if GI upset occurs--can be taken with food but may decrease absorption -if enteric coated--with or without food [Show Less]