Carbapenems Flashcards
What type of bacteria do Carbapenems target?
G+/G- and anaerobes
How would one administer Imipenem w/ cilistatin?
IV or IM
How do bacteria resist carbapenems?
They have little cross resistance as they enter G- by a different route than normal
Side effects of cilastatin?
Nausea, vomiting, seizures (1.5%)
Mechanism of cilastatin?
Inhibits dehydropeptidase
What might meropenem cause?
Seizures (0.5%)
How often do you take ertapenem?
1x/day
When and how do you use doripenem?
Parenteral for complicated intra-abdominal infections & UTIs
What should doripenem not be used for?
Any form of pneumonia = up risk of death and down cure rates when compared to imipenem/cilastatin
What are the general uses for carbapenems?
Resistance infections including:
UTIs
Lower RTIs
Intra-abdominal & gynecological infections
Bacterial Septicemia
Bone, joint & skin infections
Carbapenem-resistant Klebsiella pneumonia (CRKP)
What are drug class interactions with carbapenems?
Decreased levels of valproic acid results in increased risk of seizures
Tell me about Aztroenam.
A monobactam Mechanism: binds PBP-3 of G- Bacteria > lysis of long filamentous bacteria IV/IM Excreted in Urine Unchanged Use on G- aerobes Crosses inflamed meninges
What is the main use for Vancomycin?
IV for MRSA of MSSA if allergic to beta-lactams
Oral vs pseudomembranous colitis
What causes pseudomembranous colitis?
C. difficile
What is the mechanism of Vancomycin?
Binds to D-ala-D-ala terminus & prevents removal of terminal D-ala
What are the side effects of Vancomycin?
Red Man Syndrome
Ototoxicity
Nephrotoxicity (w/ other nephrotoxic Rxs)
What is Red Man Syndrome?
Flushing of upper body & face, hypotension, tachycardia and shock.
Caused by histamine release.
What is ototoxicity?
Renal failure cause by Rx accumulation (may be permanent)
What is telavancin?
A semisynthetic derivative of vancomycin
An IV cidal lipoglycopeptide
What are the uses of telavancin?
Complicated skin & skin structure infections; hospital-aquired & ventilator-associated pneumonia from S. aureus
What are the mechanisms of telavancin?
1) binds D-ala terminus
2) disrupts membrane potential which increases membrane permeability
What are the side effects of telavancin?
NVD, taste disturbance, foamy urine
Potentially teratogenic
What is oritavancin?
IV lipoglycopeptide for ABSSSI, including MRSA
What is ABSSSI?
Acute bacterial skin & skin structure infections
What are the mechanisms of Orivavancin?
1) binds stem peptide of peptidoglycan precursors (inhibits polymerization)
2) Binds peptide bridging segments (inhibits crosslinking)
3) Disrupts membrane integrity (depolarization, up membrane permeability, cell death)
What are the side effects of oritavancin?
NVD, headache, SQ abscesses
What are some possible Rx interactions of oritavancin?
Wait 48 hours before giving heparin or may increase activated partial thromboplastin time (aPTT)
What is dalbavancin?
semisynthetic lipoglycopeptide for ABSSSI
What as the mechanism of dalbavancin?
binds D-alanyl-d-ala terminus preventing crosslinking
What are the side effects of dalbavancin?
Nausea, diarrhea, headache
What is bacitracin?
A cidal vs. G+ cocci and rods
What is the mechanism of bacitracin?
complexes w/ P~P
What is the side effect of bacitracin?
Nephrotoxic
How can bacitracin be used topically?
For minor cuts and scrapes
What ophthalmic uses are there for bacitracin?
Ulcerative conjunctivitis
Bacterial conjunctivitis
What uses are there for fosfomycin?
For short course, uncomplicated UTIs in women
What is the mechanism of fosfomycin?
Inhibits enolpyruvate transferase
Blocks adding PEP to UDP-N-acetylglucosamine
What is the action of fosfomycin?
Inhibits cell wall synthesis
