E2 Erdman Carbapenems

Question 1

4 carbapenems to know

Answer 1

imipenem
meropenem
ertapenem
doripenem

Question 2

carbapenem moa, primary target

Answer 2

they bind to PBPs but primary one is PBP-2***

Question 3

T or F:
carbapenems penetrate very well into bacterial cell walls

Answer 3

true

Question 4

Carbapenems are (bactericidal/bacteriostatic) in a (time/conc) dependent manner

Answer 4

cidal
time

Question 5

T or F:
carbapenems have greater stability against most b-lactamase enzymes compared to cephs

Answer 5

true

Question 6

T or F:
cephs are the most broad spectrum agents avaiable

Answer 6

false, carbapenems are

Question 7

T or F:
carbapenems have activity against GP and GN aerobes but no activity against anaerobes

Answer 7

false, they do all listed

Question 8

3 mechs of resistance for carbapenems

Answer 8

• alterations to outer membrane porin proteins
• b-lactamase OR carbapenemase (KPC, OXA, etc) enzymes
• alterations in PBPs

Question 9

which 2 exhibit the best activity against GP aerobes
imipenem
meropenem
ertapenem
doripenem

Answer 9

imipenem and doripenem *

Question 10

target organism for imip and dori

Answer 10

meth-susc S. aureus**

Question 11

imipenem is special because it covers one specific bacteria that others dont, what is it?

Answer 11

enterococcus FAECALIS (bacteriostatic too)

Question 12

which 2 exhibit the best activity against GN aerobes?
imipenem
meropenem
ertapenem
doripenem

Answer 12

mero and dori

Question 13

carbapenems are the DRUG OF CHOICE for _____ and _______ producing bacteria

Answer 13

ESBL
AmpC

Question 14

does not cover pseudomonas aeruginosa
imipenem
meropenem
ertapenem
doripenem

Answer 14

ertapenem

Question 15

does not have activity against acinetobacter spp
imipenem
meropenem
ertapenem
doripenem

Answer 15

ertapenem (again)

Question 16

carbapenems SoA:
GP anaerobes (4)

Answer 16

• Peptococcus spp
• Peptostreptococcus spp
• Veillonella
• Clostridium spp (NOT C. DIFF tho)

Question 17

carbapenems SoA:
GN anaerobes (3)

Answer 17

• bacteroides spp (ALL)*
• Fusobacterium
• Prevotella spp

Question 18

T or F:
most carbapenems are active against MRSA and PRSP

Answer 18

false, none are i think

Question 19

do carbapenems have activity against atypical bacteria?

Answer 19

no

Question 20

T or F:
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 20

true

Question 21

T or F:
Meropenem-vaborbactam and imipenem-relebactam were developed to provide activity against KPC-producing Enterobacterales.

Answer 21

true

Question 22

clinically useful synergy, carbapenems:
GN aerobes

Answer 22

any carbapenem + gent/tobra/amik

Question 23

T or F:
carbapenems are bactericidal against enterococcus

Answer 23

false, static

Question 24

all carbapenems penetrate the CSF, but which one is the best at it?

Answer 24

meropenem**

Question 25

undergoes hydrolysis by dehydropeptidase enzyme in the renal brush border to a nephrotoxic metabolite A. Meropenem B. Imipenem C. Carbapenem D. Ertapenem

Answer 25

B, administer with cilastatin

Question 26

has a half life of 4 hours A. Meropenem B. Imipenem C. Carbapenem D. Ertapenem

Answer 26

D

Question 27

T or F: all carbapenems require dose adjustment in pts with renal dysfunction

Answer 27

true

Question 28

clinical uses: carbapenems are "typically" used for?

Answer 28

polymicrobial infections

Question 29

T or F: Imipenem does not have activity against pseudomonas aeruginosa

Answer 29

false, ertapenem is the one that doesnt

Question 30

carbapenems can be used as empiric therapy for _______ infections

Answer 30

nosocomial (hospital acquired)

Question 31

clinical uses: carbapenems infections due to ?

Answer 31

b-lactamase producing organisms (SPICE, SPACE, ESBLs, etc)

Question 32

clinical uses: febrile neutropenia

Answer 32

imipenem and meropenem

Question 33

clinical uses: meningitis

Answer 33

meropenem (penetrates best)

Question 34

clinical uses: complicated UTIs caused by KPC-producing enterobacterales

Answer 34

the combo ones

Question 35

if pseudomonas is known or suspected do NOT use _____

Answer 35

ertapenem

Question 36

direct toxic AE of carbapenems

Answer 36

CNS: seizures main thing here

Question 37

3 risk factors for CNS effects from carbapenems

Answer 37

- preexisting CNS disorder - high doses - renal insufficiency

Question 38

2 super random AEs affiliated with carbepenems

Answer 38

LFT increases yeast infections