Beta Lactams (carbapenems, monobactams, gram positive) Flashcards by Elie H

what are the carbapenems and their RoA?

imipenem + cilistatin
meropenem
doripenem
ertapenem

all are IV

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what is the moa of carbepenems and what type of killing do they display?

interferes with bacterial cell wall synthesis during active multiplication and displays time dependent killing

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activity spectrum of carbapenems

strep infections (including pneumo)
MSSA (not first choice though)
mouth anaerobes
HNPEKM
aeroSCE (NO PA’s)

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which carbapenem has no pseudomonas activity

ertapenem

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which carbapenems have pseudomonas activity

imipenem
meropenem
doripenem

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avoid using carbapenems in

MRSA
acinetobacter
enterococcus
atypical bacteria

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do carbapenems achieve good CSF penetration

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ADR of carbapenems

rash
anaphylaxis
fever
C dif (CDAD)
seizures (renal insufficiency)

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when is best to use carbapenems

polymicrobial infections (broad spectrum)
MDR gram negative
many infection site

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can imipenem be given alone?

no, always give with cilastatin to prevent renal metabolism

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does cilastatin provide antimicrobial activity?

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what are carbapenems generally reserved for?

penicillin allergic patients
MDR gram negative bacteria

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carbapenems are drug of choice for

ESBL’s (Klebsiella and E. coli)

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what is meropenem + vaborbactam used for?

complicated UTI’s with carbapenemase producing gram negative bacteria

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what is imipenem + relebactam (recarbio) approved for?

complicated UTI
intrabdominal infections
HAP

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what antibiotic is a monobactam? whats the RoA?

aztreonam (IV, IM)

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activity of aztreonam

only gram negative activity
HNPEKM
aeroSPCE (no A)

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avoid using aztreonam in which organisms

gram positive organisms
acinetobacter spp
gut anaerobes
atypical

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ADR’s of aztreonam

rash
anaphylaxis
fever
neutropenia
increased hepatic transaminases (AST, ALT)

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aztreonam is helpful in gram negative infections for patients with what?

severe PCN allergy who cannot tolrate PCN or cephalosporins

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does aztreonam have activity against pseudomonas?

yes

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what are the aminoglycosides?

gentamicin
tobramycin
amikacin
streptomycin
neomycin

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what are the RoA’s of
gentamicin
tobramycin
amikacin
streptomycin
neomycin

g - IV, IM
T - IV, IM, inhalation
A - IV, IM, Inhalation
S - IM
N - po

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MOA of aminoglycosides

inhibits bacterial protein synthesis by binding DIRECTLY to 30S ribosomal subunits causing faulty peptide sequence to form in the protein chain

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what type of killing do aminoglycosides display

concentration dependent, bactericidal killing

uses of aminoglycosides

used in combo with cell wall active agents as SYNERGY against MRSA, enterococcus (gram positive) HPEKM (no N) SPACE pseudomonas

which type of organisms should aminoglycosides NEVER be used alone in

gram positive

what can be used for treatment of hepatic encephalopathy in patients with liver disease

neomycin

avoid using aminoglycosides in what

gut anaerobes atypical organisms

ADR's of aminoglycosides

**** NEPHROTOXICITY **** OTOTOXICITY neuromuscular blockade (the top two are starred a bunch of times)

synergy against gram positive organisms treated with combination of aminoglycosides and other agents usually exhibits what type of dosing compared to gram negative?

lower doses

when is aminoglycoside monotherapy okay?

UTI

which aminoglycosides have activity against pseudomonas

gentamicin tobramycin amikacin

Gram positive only antibiotics

vancomycin (IV) linezolid (IV, po) daptomycin (IV) telvancin (IV( dalbacancin (IV) oritavancin (IV) quinupristin/dalfopristin (IV)

moa of vancomycin

inhibits bacterial cell wall synthesis

what type of killing does vancomycin display

time dependent

main uses of vanc

strep (+ strep pneumoniae) MRSA enterococcus

oral vanc is only used to treat what

cdif

what is a problem with vanc

VRE

avoid use of vanc in what

gram negative gut anaerobes atypical

ADR of vancomycin

vancomycin infusion reaction (red-man's syndrome) hypersensitivity fever rare: nephrotoxicity, ototoxicity

vancomycin can treat what sites of infection

skin blood tissue lung urine

target AUC for vanc

400 - 600

MoA of linezolid

inhibits bacterial protein synthesis by binding to bacterial 23S ribosomal RNA of the 50S subunit. Prevents formation of a functional 70S initiation complex that is essential for the bacterial translation process

what is a weak inhibitor of monoamine oxidase (MAO-I) inhibitors

linezolid

main uses of linezolid

gram + streptococcus (including pneumoniae) staph (MRSA and MSSA) enterococcus ** EFFECTIVE FOR VRE**

avoid linezolid use in

gram - infections gut anaerobes atypical organisms

ADR of linezolid

GI - N/V HA thrombocytopenia (if duration of 2 weeks or more) serotonin syndrome

what can cause serotonin syndrome when used in combination with linezolid

antidepressants sympathomimetics fentanyl

linezolid is mainly used for

lung infections VRE

daptomycin MOA

binds to components of the cell membrane of susceptible organisms and causes rapid depolarization inhibiting intracellular synthesis of DNA, RNA, and protein

what type of killing does daptomycin exhibit

concentration dependent

main uses of daptomycin

gram positive only strep (including pneumo) staph (MRSA and MSSA) enterococcus VRE good UTI drug

avoid using daptomycin in what

lung infections gram neg atypical

why isn't daptomycin used in lung infections?

inactivated by pulmonary surfactant

ADR of daptomycin

N/V HA rash MYOPATHIES WITH CPK ELEVATIONS

the myopathy side effect of daptomycin presents as what

myalgia and muscle weakness

what is the dosage form of telavancin, dalbavancin, oritavancin

what are the vancin drugs main uses

gram positive strep (Pneumo included) staph (MRSA and MSSA) enterococcus (only if vanc susceptible) skin and soft tissue infections

avoid vancin use in what

gram negative gut anaerobes atypical BLOODSTREAM INFECTIONS

when are the vancin's useful?

when adherence is in question one time or two time dose one week apart

MOA of quinupristin and dalfopristin and ROA

inhibits bacterial protein synthesis by binding to different sites on the 50S bacterial ribosomal subunit and thereby inhibiting protein synthesis both IV

main uses of quinupristin and dalfopristin

gram positive strep (pneumo too) staph (MRSA MSSA) enterococcus FAECIUM only (this is the only VRE it treats)

ADRs of quinupristin and dalfopristin

poorly tolerated overall increased bilirubin pain at injection site (central line only) myopathies