Arrange the following cephalosporins as per their order of generation?
a. Cefepime
b. Cefuroxime
c. Cephalexin
d. Ceftriaxone

Appeared in: MNS 2024

Explanation

The question requires arranging the cephalosporins in ascending order of their generation (from first to fourth).
Cephalexin (c) is a first-generation cephalosporin, primarily used for Gram-positive infections.
Cefuroxime (b) is a second-generation cephalosporin with increased activity against Gram-negative bacteria.
Ceftriaxone (d) is a third-generation cephalosporin with broad-spectrum activity, notably its ability to cross the blood-brain barrier.
Cefepime (a) is a fourth-generation cephalosporin with an extended spectrum, including activity against Pseudomonas.
Following this classification, the correct sequence is Cephalexin (1st), Cefuroxime (2nd), Ceftriaxone (3rd), and Cefepime (4th), which corresponds to the order C, B, D, A.

Option A: This sequence (A, B, C, D) corresponds to 4th, 2nd, 1st, 3rd generation, which is not in the correct ascending order.
Option B: This sequence (B, A, D, C) corresponds to 2nd, 4th, 3rd, 1st generation. The order is incorrect and does not follow the chronological and spectral progression of the generations.
Option C: This sequence (C, B, A, D) corresponds to 1st, 2nd, 4th, 3rd generation. It incorrectly places the fourth-generation drug (Cefepime) before the third-generation drug (Ceftriaxone).

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Classification of cephalosporin antibiotics by generation as background academic context rather than a clinical decision trigger.
Understanding cephalosporin generations is crucial for nurses to anticipate an antibiotic's spectrum of activity and its appropriateness for specific infections, ensuring effective treatment.
Nurses should be aware of the potential for cross-sensitivity between penicillins and cephalosporins. Patients with a history of severe anaphylactic reaction to penicillin should not receive cephalosporins.
Monitoring for adverse effects is key. While generally safe, common side effects include diarrhea, cramps, and rash. A disulfiram-like reaction can occur with certain cephalosporins (like cefotetan) if alcohol is consumed.

How to Approach the Question

First, identify the core task: to arrange the given cephalosporin drugs according to their generation.
Recall or use your pharmacology knowledge to classify each drug into its respective generation.
List the drugs with their generation number: Cephalexin (1st), Cefuroxime (2nd), Ceftriaxone (3rd), and Cefepime (4th).
Assign the corresponding letters to this order: C (1st), B (2nd), D (3rd), A (4th).
The correct sequence is therefore C, B, D, A.
Finally, match this sequence with the provided options to select the correct answer.

Concept Tested & Keywords

Concept Tested: Classification of cephalosporin antibiotics by generation.
Stem keywords: cephalosporins, order of generation, Cefepime, Cefuroxime, Cephalexin, Ceftriaxone
Lead-in keywords: Arrange
Negative lead-in flag: false

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E6 Pharmacology Nursing Lilley 11e Part 2 p. 302-304

E6 Pharmacology KD Tripathi Essentials 9e Part 3 p. 56-58

Practise the full MNS 2024

Attempt every question from this paper in a timed mock, then review the full solution for each one.