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CH 84
Cephalosporins and vancomycin
| Question | Answer |
|---|---|
| what is the most widely used group of abx? | cephalosporins |
| what is the structure of cephalosporins? | beta-lactam ring |
| cephalosporins: static/cidal | cidal |
| usual administration route of cephalosporins | parenteral |
| toxicity high/low: cephalosporins | low |
| there are generations of cephalosporins... what happens to resistance as the generations go up? | bacteria become less and less resistant the higher the generation. |
| as the generations of cephalosporins progress they get better for 3 reasons: | (1) increasing action against gram negative bacteria, (2) increase resistance to beta lactamase (3) increased ability to reach CSF |
| elimination of cephalosporins | kidneys |
| mechanism of action for cephalosporins | beta-lactam abx that weaken teh bacterial cell wall causing lysis and death |
| major cause of resistance to cephalosporins = | production of betalactamase |
| drug interactions for cephalosporins | PROBENECIDE (delays renal excretion of some cephalosporins which can prolon their effects), ALCOHOL (disulfiram-like reaction), DRUGS THAT PROMOTE BLEEDING, CALCIUM AND CEFTRIAXONE (potentially fatal) |
| adverse effects of cephalosporins | allergy, bleeding, thrombophlebitis |
| therapeutic uses for 1st and 2nd generation cephalosporins: | rarely used for active infections because of resistance |
| therapeutic uses for 3rd generation cephalosporins: | preferred therapy for several infections. highly active against Gram negative organisms. Able to penetrate to meninges and CSF |
| therapeutic uses for fourth generation cephalosporins | yet to be established |
| what is the mechanism of action for vancomycin? | inhibits cell wall synthesis (lysis/death) |
| uses of vancomycin | severe infections only!! MRSA/Staph epidermidis. oral dose used for C. diff if metronidazole was tried and ineffective. |
| side effects of vancomycin | Ototoxicity, red man syndrome, thrombophlebitis, thrombocytopenia, allergy |
| is the ototoxicity from vancomycin permanent? | can be either |
| what are you responsible for if your pt is on vancomycin? | you are responsible for monitoring vancomycin levels before administration. >30 can cause ototoxicity |
| what vancomycin levels can cause ototoxicity? | vancomycin >30 |
| what is Red Man Syndrome | an adverse effect of vancomycin. red rash, extreme flushing, itching, extreme tachycardia, hypotension. |
| what is Red Man Syndrome caused by? | rapid infusion of vancomycin |
| you should push vancomycin over how much time? | at least 60 minutes |
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