abx: carbapenems

Question 1

carbapenems

Answer 1

imipneme/cilastin
meropenem
broadest spectrum of all abx
bactericidal and cell wall inhibitor - same moa
typically used as last resort med
biggest SE: drug induced seizure activity (not super common)
all are IV and must be infused over 60 min

Question 2

imipenem/cilastin

Answer 2

combo of carbapenem with inhibitor of enzyme that breaks down imipenem so it stays working in the system longer
MOST broad spectrum
bind to pcn binding protein -> inhibit cell wall synthesis, VERY resistant to beta lactamase (works against them?)
IV admin only
can penetrate BBB and meninges
watch for seizures -> especially in elderly and with other meds that can induce seizures
used for complicated infections

Question 3

cilastin

Answer 3

not for beta lactamase, inhibits enzyme in kidneys which would otherwise break down imipenem too quickly

Question 4

meropenem

Answer 4

less coverage than imipenem: gram+ and - aerobes and anaerobes
doesn’t degrade in kidneys
less seizure activity so used a little more often
rash and d are most common SE
Dont really need to know the below
ertapenem - less spectrum but only have to give once a day
doripenem - newest, less seizure, not for pna

Question 5

CRE

Answer 5

public health emergency
carbapenem resistant enterobacteriacae
healthcare acquired, 50% mortality
KPC most common, NDM and VIM more resistant (less common), IMP and OXA not common in US

Question 6

vancomycin

Answer 6

glycopeptide abx (class)
destroys by binding to bacterial cell wall, producing immediate inhibition of cell wall synthesis and death
works on gram + infections - MRSA and pcn resistant pneumococcus
PO for c diff and pseudomembranous colitis
not for CNS
kidneys eliminate, decrease doses for renal dysfunction

Question 7

vancomycin SE

Answer 7

ototoxicity with high levels (can be reversible)
immune mediated thrombocytopenia
nephrotoxic -> watch when using with other drugs (amnioglycosides, cyclosporins, IV contrast)
watch with NM blockades (paralyzers)
red man s: usually related to rapid infusion; flushing, rash, pruritus, urticaria, tachy, hypoT; infuse slowly over longer time, usually not harmful; premedicate with Benadryl
peak (15-30 min after IV admin) and trough (30 min before next dose)