carbapenems/monobactams

Question 1

• synthetic monocyclic beta lactams
• single ring as the core structure
• binds to PBPs and disrupts cell wall synthesis
• bacteriocidal
• resistance to many beta lactamases
• ONLY active against gram neg aerobes
• NO activity against gram pos\anaerobes\bacteriodes fragilis
• minimal effect on GI flora

Answer 1

monobactams

- Aztreonam

Question 2

monobactams/aztreonam have activity against

Answer 2

• Neisseria
• Haemophilus
• Psuedomonas
• Enterobacter

Question 3

• administered IV/IM only NOT orally
• t1/2 is 1.7 hrs
• shows allergic cross reactivity w other beta lactam antibiotics
• relatively nontoxic and is renal sparing
• alternative to aminoglycosides or 3rd gen cephs for pataients w gram neg infections and beta lactam allergy

Answer 3

Aztreonam

Question 4

aztreonam indications

Answer 4

• intra abdominal
• joint and bone
• skind and soft tissue
• lower respiratory
• gyenocologic and obestitrics

Question 5

aztreonam antibiotic map coverage

Answer 5

• all gram negs!
• Proteus mirabilis
• e. coli
• Klebsiella pneumonia
• Serratia
• H. Influenzae
• N. meningitis
• Enterobacter spp
• Pseudomonas

Question 6

• inhibitors of beta lactamases
• pyrrolidine ring increases stability and spectrum
• Last line antibiotics
• trans configuration increases potency

Answer 6

• carbepenems

Question 7

• must be administered w DHP-1 inhibitor cilastatin

Answer 7

imipenem

Question 8

• mechanism of action and resistance of carbapenems

Answer 8

• PBP inhibitors
• inhibiting certain beta lactamases
• stable in presence of AmpC beta lactamases and extended spectrum beta lactamases
• resistance includes sstructural changes to PBP
• metallo beta lactamases
• changes in membrane permeability

Question 9

• broadest spectrum activity
• active against gram pos and neg including anaerobes except c. diff
• lack activity against MRSA, enterococcus faecium and stenotrophomonas amltophilia or atypical bacteria

Answer 9

ertapenem carbapenems

Question 10

• imipenem
• meropenem
• doripenem
  are typically fairly active against most…

Answer 10

• Psuedomonas

Question 11

• ertapenem is less active against gram pos and not active against

Answer 11

• P. aueruginosa or enerococci

Question 12

• given IV/IM
• R1 is H, no R group
• given w Cilastatin blocking degragation by renal enzymes

Answer 12

Imipenem

Question 13

• IV
• does not require cilistatin booster
• R1 is CH3

Answer 13

• Meropenem

Question 14

• IV
• very broad spectrum
• needs more clinical data
• t 1/2 is 1 hr
• not used much and availability varies

Answer 14

• Doripenem

Question 15

• iV/IM

- given once daily injectable carbapenem which has 4 fold longer plasma halflife

Answer 15

• ertapenem

Question 16

goracillins over…think APE

Answer 16

• Acinetobacter
• Psuedomonas
• Enterococcus

Question 17

only carbapenem active against atypical bacteria

Answer 17

• Imipenem

Question 18

carbapenems lack activity against

Answer 18

• MRSA
• Enterococcus
• Stenotrophomonas

Question 19

• combo of beta lactamase inhibitor (cyclic boronic complex)
• approved for complicated UTI
• extended coverage against resistant gram neg organisms except resistant APEs
• side effects include headache, nauseam diarrhea, seizure, anaphylaxis
• have to use in 4 hours after mixing
• very expensive

Answer 19

• Meropenem/vaborbactam

Question 20

clinical uses for carbapenems

Answer 20

• lower respiratory
• intrabdominal
• UTIs
• skin/soft infections
• CSF/CNS infetions

Question 21

• indicated for moderate to sever nosocomial infections and polymicrobial infections

Answer 21

• Imipenem\cilastatin

- meropenem

Question 22

• indicated for community acquired infections, outpatient IV antimicrobial therap

Answer 22

• entrapenem

Question 23

• similar to meropenem but more active against p aeruginosa

Answer 23

• doripenem

Question 24

• antibiotic map covergame for imipenem/meropenem/doripenem

Answer 24

• covers everything but MRS and VRE

Question 25

• ertapenem antibiotic map coverage

Answer 25

• covers all but enterococcus’s, MRSA and pseudomonas