Beta Lactams (carbapenems, monobactams, gram positive) Flashcards
what are the carbapenems and their RoA?
imipenem + cilistatin
meropenem
doripenem
ertapenem
- all are IV
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
activity spectrum of carbapenems
strep infections (including pneumo)
MSSA (not first choice though)
mouth anaerobes
HNPEKM
aeroSCE (NO PA’s)
which carbapenem has no pseudomonas activity
ertapenem
which carbapenems have pseudomonas activity
imipenem
meropenem
doripenem
avoid using carbapenems in
MRSA
acinetobacter
enterococcus
atypical bacteria
do carbapenems achieve good CSF penetration
no
ADR of carbapenems
rash
anaphylaxis
fever
C dif (CDAD)
seizures (renal insufficiency)
when is best to use carbapenems
polymicrobial infections (broad spectrum)
MDR gram negative
many infection site
can imipenem be given alone?
no, always give with cilastatin to prevent renal metabolism
does cilastatin provide antimicrobial activity?
no
what are carbapenems generally reserved for?
penicillin allergic patients
MDR gram negative bacteria
carbapenems are drug of choice for
ESBL’s (Klebsiella and E. coli)
what is meropenem + vaborbactam used for?
complicated UTI’s with carbapenemase producing gram negative bacteria
what is imipenem + relebactam (recarbio) approved for?
complicated UTI
intrabdominal infections
HAP
what antibiotic is a monobactam? whats the RoA?
aztreonam (IV, IM)
activity of aztreonam
only gram negative activity
HNPEKM
aeroSPCE (no A)
avoid using aztreonam in which organisms
gram positive organisms
acinetobacter spp
gut anaerobes
atypical
ADR’s of aztreonam
rash
anaphylaxis
fever
neutropenia
increased hepatic transaminases (AST, ALT)
aztreonam is helpful in gram negative infections for patients with what?
severe PCN allergy who cannot tolrate PCN or cephalosporins
does aztreonam have activity against pseudomonas?
yes
what are the aminoglycosides?
gentamicin
tobramycin
amikacin
streptomycin
neomycin
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
MOA of aminoglycosides
inhibits bacterial protein synthesis by binding DIRECTLY to 30S ribosomal subunits causing faulty peptide sequence to form in the protein chain
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
IV
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
