Carbapenems

Question 1

Drugs

Answer 1

Imipenem, meropenem, ertapenem, doripenem

Question 2

MoA

Answer 2

Inhibitors of cell wall synthesis by binding to and inhibiting PBPs

Time dependent

MOST BROAD SPECTRUM AGENTS

Question 3

MoR

Answer 3

B-lactamase produciton, decreased permeability, alteration in PBPs

Question 4

Spectrum of Activity

Answer 4

Gram+ and gram- AND anerobes

Big, big gun

Question 5

Bacteria not covered by carbapenems

Answer 5

MRSA
PRSP
VRE
Coagulase- staph
C.diff
atypical bacteria
S.maltophilia

Question 6

Pharmacology

Answer 6

Widely distribute, CSF penetration (mero is best)

Primarily eliminated by kidney, need dosage adjustment

Imipenem undergoes hydrolysis in renal brush border to a nephrotoxic metabolite, needs to be given with cilastatin (DHP inhibitor)

Question 7

Monobactams

Answer 7

Synthetic monocyclic B-lactam
Bactericidal - time-dependent
Resistance occurs through hydrolysis by B-lactamases or decreased permeability

Distribute throughout tissues and fluids, penetrates CSF IN PRESENCE of inflamed meninges

Mainly eliminated in urine, needs dose adjustment

NO CROSS-REACTIVITY WITH PENICILLINS. Can be used in penicillin-allergic patients