Carbapenems

Question 1

Carbapenems intro

Answer 1

structural changes result in extended spectrum of activity and greater B lactamase stability

Question 2

MOA

Answer 2

Bactericidal
Inhibit cell wall synthesis by binding to and inhibiting PBPs

Penetrate very well into bacterial cell wall

Question 3

Mechanisms of resistance

Answer 3

1. B-lactamase production
2. Decreased permeability
3. Alteration in PBPs

Question 4

Carbapenem Drugs

Answer 4

Imipenem, Meropenem, Doripenem, Ertapenem, Meropenem-vaborbactam, imipenem-relebactam

Question 5

Carabapenems gram positive aerobes coverage

Answer 5

Imipenem and doripenem are the best

Group streptococci
Viridans streptococci
Pen-susc-S.-Pseumoniae
Enerococcus faecalis (bacterostatic, imipenem)
Meth-susc-S. aureus

Question 6

Carabapenems gram negative aerobes coverage

Answer 6

Doripenem and meropenem are the best

Gram negative HENPEK-CSSS
H. Influenza
Enterobacter spp.
Niessira
Pseudomonas mirabilis
E. Coli
Klebsiella
Citrobacter
Shigella
Salmonella
Serratia
Psuedomonas Aeruginosa (NOT ERTAPENEM)

Question 7

Carbapenems Gram positive Anaerobes

Answer 7

Peptostreptococcus spp. Peptococcus spp.
Clostridium perfringens and tetani

Question 8

Carbapenems Gram Negative Anaerobes

Answer 8

Bacteroides Spp.

Question 9

True/False: Carbapenems are highly stable against many β-lactamase enzymes and are considered the drugs of choice for serious infections due to ESBL- and AmpC-producing bacteria.

Answer 9

True….Carbapenems are highly stable against many β-lactamase enzymes and are considered the drugs of choice for serious infections due to ESBL- and AmpC-producing bacteria

Question 10

True/False: Meropenem-vaborbactam and imipenem-relebactam were developed to provide activity against KPC-producing Enterobacterales.

Answer 10

True….Vaborbactam and relebactam help provide activity against KPC-producing Enterobacterales including E coli, K pneumoniae and Enterobacter spp.

Question 11

Pharmacology

Answer 11

Time dependent
Time above MIC (T>MIC)

Question 12

Distribution

Answer 12

widely distributed into body tissues and fluids

CSF penetration - Meropenem is the best

Question 13

Elimination

Answer 13

Primarily eliminated by kidney

Imipenem undergoes hydrolysis by DHP in the renal border to a nephrotoxic metabolite and can stop this with concurrent sure with Cilastatin

Short elimination half lives EXCEPT FOR ERTAPENEM which has half life of 4 hours

Question 14

Clinical use

Answer 14

1. empiric therapy for hospital acquired infections
2. Polymicrobial infections
   3, Infections due to B-lactamase producing organisms (SPICE, SPACE, ESBLs)
3. complicated UTI due to KPC producing enterobacterales - Mero/vabro, Imip/rele
4. If psuedomonas is known or suspected can be used (NOT ERTAPENEM)

Question 15

ADVERSE EFFECTS

Answer 15

Hypersensitivtiy reaction - If patient has reaction to penicillin that requires ICU avoid Carbapenems if patient has other reaction and does not require ICU can use carbapenems with caution

Gastrointestinal - C. Diff

Central nervous system - confusion, dizziness, hallucinations, seizures
Risk factors for seizures include preexcisting CNS disorder, high doses, renal insufficiency