Monobactams/Carbapenems/Glycopeptides

Question 1

Monobactams

Answer 1

Aztreonam

OK to use inpatient with anaphylactic rxn to PCN, unless the reaction is to ceftazidime

MOA and ADRs the same as other B lactams

Question 2

Monobactam microbial coverage

Answer 2

Resistant aerobic GNBs (pseudomonas)

No gram + or anaerobes covered

Question 3

Monobactam clinical indications

Answer 3

Mostly nosocomial infections

Question 4

Pseudomonal carbapenems

Answer 4

Imipenem
Meropenem***
Doripenem

MOA/ADRs the same as other B lactams

Question 5

Non-pseudomonal carbapenems

Answer 5

Ertapenem

MOA/ADRs same as other Beta lactams

Question 6

Carbapenems microbial coverage

Answer 6

• Typically used for complicated infections caused by resistant GNB, MDR GNB, or ESBL GNB including Pseudomonas
• Extremely broad spectrum (G+, G-, anaerobes)

Question 7

What organisms do carbapenems NOT cover?

Answer 7

MRSA
VRE
CRE
C diff

Question 8

Carbapenems indications

Answer 8

Mostly nosocomial infections

Question 9

Glycopeptides

Answer 9

VANCOMYCIN

MOA: cell wall synthesis inhibition

MOR: alteration in the binding site

Question 10

Glycopeptide pharmacology

Answer 10

• overlapping toxicity with nephrotoxic agents (AG, contrast dye)
• renal excretion
• Time and concentration-dependent killing
• No oral absorption of PO formulation
• Bactericidal

***Slow the infusion (>60 min) to prevent Red Man Syndrome

Question 11

Glycopeptide ADRs

Answer 11

Red man syndrome&raquo_space;nephrotoxicity»ototoxicity

Question 12

Glycopeptide microbial coverage

Answer 12

Oral: C diff

IV/PAR: MRSA, MSSA, various streptococcal species, enterococci infections in PCN allergic pt

Question 13

Cyclic lipopeptides

Answer 13

Daptomycin

-MOA: Binds to components of cell membrane –> rapid depolarization and inhibition of DNA/RNA production

Question 14

Cyclic lipopeptide pharmacology

Answer 14

• may have overlapping toxicity profile with statins/fibrates (myalgias)
• D/c lipid agent while on abx
• renal excretion
• concentration-dependent bacterial killing

Question 15

What is a pearl about cyclic lipopeptides and pneumonia?

Answer 15

-inactivated by surfactant –> Don’t use!!!

Question 16

Cyclic lipopeptides ADRs

Answer 16

Myopathy

Use with caution in pts receiving other myopathy inducing drugs (statins)

Question 17

Cyclic lipopeptides microbial coverage

Answer 17

• use for MRSA and VRE

- use for MSSA, various streptococcal species, enterococci in PCN allergic pt

Question 18

Cyclic lipopeptides indications

Answer 18

MRSA and VRE infections mostly

Question 19

Lipoglycopeptides

Answer 19

1st gen
-Telavancin (Don’t use!)

2nd gen

• Dalbavancin
• Oritavancin

Question 20

Lipoglycopeptides MOA

Answer 20

Dual

• inhibit bacterial cell wall production
• disrupts the bacterial cell membrane function

Question 21

Lipoglycopeptide interactions

Answer 21

Telavancin: QTc prolongation
Oritavancin: don’t use UFH within 48 hours –> aPTT may be falsely elevated

Question 22

Lipoglycopeptide pharm

Answer 22

• concentration-dependent killing
• renal excretion
• Infuse slowly to prevent Red Man syndrome

Question 23

Lipoglycopeptide CI/precautions

Answer 23

• QT interval issues

- Women of childbearing age should have a serum pregnancy test prior to taking abx*** (BBW)

Question 24

Lipoglyclopeptide ADRs

Answer 24

1st gen (Don't use)
-Telavancin causes foamy urine, taste disturbance, QTc prolongation, renal dysfunction

2nd gen
-Dalbavancin/oritavancin –> N/V/D, hypersensitivity rxn

Question 25

Lipoglycopeptides microbial coverage

Answer 25

SSTI’s caused by susceptible G+ bacteria including MRSA, VISA, VRSA, some VRE

Use as alternatives to vanco, Linezolid/tedizolid, daptomycin, tigecycline, ceftaroline