E2 Erdman Carbapenems Flashcards
4 carbapenems to know
imipenem
meropenem
ertapenem
doripenem
carbapenem moa, primary target
they bind to PBPs but primary one is PBP-2***
T or F:
carbapenems penetrate very well into bacterial cell walls
true
Carbapenems are (bactericidal/bacteriostatic) in a (time/conc) dependent manner
cidal
time
T or F:
carbapenems have greater stability against most b-lactamase enzymes compared to cephs
true
T or F:
cephs are the most broad spectrum agents avaiable
false, carbapenems are
T or F:
carbapenems have activity against GP and GN aerobes but no activity against anaerobes
false, they do all listed
3 mechs of resistance for carbapenems
- alterations to outer membrane porin proteins
- b-lactamase OR carbapenemase (KPC, OXA, etc) enzymes
- alterations in PBPs
which 2 exhibit the best activity against GP aerobes
imipenem
meropenem
ertapenem
doripenem
imipenem and doripenem *
target organism for imip and dori
meth-susc S. aureus**
imipenem is special because it covers one specific bacteria that others dont, what is it?
enterococcus FAECALIS (bacteriostatic too)
which 2 exhibit the best activity against GN aerobes?
imipenem
meropenem
ertapenem
doripenem
mero and dori
carbapenems are the DRUG OF CHOICE for _____ and _______ producing bacteria
ESBL
AmpC
does not cover pseudomonas aeruginosa
imipenem
meropenem
ertapenem
doripenem
ertapenem
does not have activity against acinetobacter spp
imipenem
meropenem
ertapenem
doripenem
ertapenem (again)
carbapenems SoA:
GP anaerobes (4)
- Peptococcus spp
- Peptostreptococcus spp
- Veillonella
- Clostridium spp (NOT C. DIFF tho)
carbapenems SoA:
GN anaerobes (3)
- bacteroides spp (ALL)*
- Fusobacterium
- Prevotella spp
T or F:
most carbapenems are active against MRSA and PRSP
false, none are i think
do carbapenems have activity against atypical bacteria?
no
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.
true
T or F:
Meropenem-vaborbactam and imipenem-relebactam were developed to provide activity against KPC-producing Enterobacterales.
true
clinically useful synergy, carbapenems:
GN aerobes
any carbapenem + gent/tobra/amik
T or F:
carbapenems are bactericidal against enterococcus
false, static
all carbapenems penetrate the CSF, but which one is the best at it?
meropenem**
undergoes hydrolysis by dehydropeptidase enzyme in the renal brush border to a nephrotoxic metabolite
A. Meropenem
B. Imipenem
C. Carbapenem
D. Ertapenem
B, administer with cilastatin
has a half life of 4 hours
A. Meropenem
B. Imipenem
C. Carbapenem
D. Ertapenem
D
T or F:
all carbapenems require dose adjustment in pts with renal dysfunction
true
clinical uses:
carbapenems are “typically” used for?
polymicrobial infections
T or F:
Imipenem does not have activity against pseudomonas aeruginosa
false, ertapenem is the one that doesnt
carbapenems can be used as empiric therapy for _______ infections
nosocomial (hospital acquired)
clinical uses: carbapenems
infections due to ?
b-lactamase producing organisms (SPICE, SPACE, ESBLs, etc)
clinical uses:
febrile neutropenia
imipenem and meropenem
clinical uses:
meningitis
meropenem (penetrates best)
clinical uses:
complicated UTIs caused by KPC-producing enterobacterales
the combo ones
if pseudomonas is known or suspected do NOT use _____
ertapenem
direct toxic AE of carbapenems
CNS:
seizures main thing here
3 risk factors for CNS effects from carbapenems
- preexisting CNS disorder
- high doses
- renal insufficiency
2 super random AEs affiliated with carbepenems
LFT increases
yeast infections
