C.10. Carbapenems. Monobactams.beta-lactamase inhibitors. pharmacotherapy of respiratory infections.

Question 1

are carbapenems and monobactams bacteriostatic or bacteriocidal?

Answer 1

bacteriocidal

Question 2

what is Aztreonam?

Answer 2

a monobactam

Question 3

what is the mechanism of monobactams?

Answer 3

binds PBP-3 found only in gram - bacteria

can not bind to gram + PBP

Question 4

what is the spectrum and clinical use of Aztreonam?

Answer 4

narrow
gram - aerobes (klebsiella, pseudomonas, serratia)
gram - in patients with penicillin allergy

Question 5

what is Aztreonam and carbapenems resistant to?

Answer 5

most beta-lactamases

carbapenems–> including ESBL

Question 6

how is Aztreonam given?

Answer 6

parenteral

Question 7

Aztreonam has a synergistic effect with…

Answer 7

aminoglycosides

*Usually used in patients that cant tolerate aminoglycosides due to renal insufficiency

Question 8

can Aztreonam and carbapenems enter the CNS?

Answer 8

YES

Question 9

Aztreonam mechanism or resistance

Answer 9

alteration of PBP

Question 10

adverse effects of Aztreonam

Answer 10

1. hypersensitivity reaction
2. GI symptoms, maybe superinfection
3. headache, vertigo
4. hepatotoxicity (rare)

Question 11

what is Ertapenem?

Answer 11

1st generation Carbapenem

Question 12

what is Imipenem and Meropenem?

Answer 12

2nd generation Carbapenem

Question 13

how are carbapenems given?

Answer 13

parenteral

Question 14

which carbapenem has a cross allergy with penicillin?

Answer 14

meropenem

Question 15

strains resistant to carbapenems

Answer 15

MRSA strains

Carbapenemase (MBL- metallo beta lactamase) in klebsiella. acinetobacter, pseudomonas., enterobacter

Question 16

side effects of carbapenems

Answer 16

hypersensitivity reaction
GI symptoms
skin rash
Imipenem-CNS presentation at high plasma levels (seizures)

Question 17

with what is Imipenem given?

Answer 17

Cilastatin

a renal dehydropeptidase inhibitor in the renal tubules. DHP inhibits imipenem’s metabolism, hence cilastatin prevents nephrotoxicity.

Question 18

what is Vaborbactam and with what drug is it given?

Answer 18

β-lactamase inhibitor

given with Meropenem

Question 19

Meropenem + Vaborbactam is used for the treatment of…

Answer 19

complicated UTI
pyelonephritis
abdominal infections caused by CRE

Question 20

what is the treatment for acute sinusitis and otitis media?

Answer 20

Amoxicillin+ Clavulanate PO

Question 21

what is the 1st line treatment of Strep throat (Group A streptococcal)?

Answer 21

Penicillin V PO or
Amoxicillin PO or
Cephalexin PO

Question 22

what is the alternative treatment of Strep throat (Group A streptococcal)? in case of penicillin allergy..

Answer 22

Clindamycin PO or

Azithromycin PO

Question 23

what is the 1st line treatment of community-acquired pneumonia (previously healthy, out-patient)?

Answer 23

Clarithromycin PO or

Azithromycin PO

Question 24

what is the alternative treatment of community-acquired pneumonia (previously healthy, outpatient)?

Answer 24

Doxycycline PO

Question 25

what is the 1st line treatment of community-acquired pneumonia (comorbidities, outpatient)?

Answer 25

Amoxicillin+ Clavulanate PO

Question 26

what is the alternative treatment of community-acquired pneumonia (comorbidities, outpatient)?

Answer 26

Moxifloxacin PO or

Levofloxacin PO

Question 27

what is the 1st line in-patient treatment of pneumonia?

Answer 27

β-lactam (Ceftriaxone IV, ampicillin IV)
and
Macrolide (clarithromycin PO)

Question 28

what is the alternate in-patient treatment of pneumonia?

Answer 28

Moxifloxacin PO/IV or

Levofloxacin PO/IV

Question 29

what is the 1st line ICU treatment of Pneumonia?

Answer 29

β-lactam (Ceftriaxone IV, ampicillin IV)
and
Fluoroquinolone (Moxifloxacin IV, Levofloxacin IV)

Question 30

what is the 1st line treatment of aspiration Pneumonia?

Answer 30

Ceftriaxone IV and metronidazole PO/IV

Question 31

what is the 2nd line treatment of aspiration Pneumonia?

Answer 31

Levofloxacin PO/IV and Metronidazole PO/IV