Other Beta Lactams

Question 1

What is the broadest spectrum antibiotic currently available?

Answer 1

Imipenem/Cilastatin

Question 2

What is the MOA of Cilastatin?

Answer 2

It is a Dyhydropeptidase Inhibitor:

Protects the parent drug from cleavage, so it does not get broken down into a nephrotoxic metabolite

Question 3

What are some common adverse effects of Cilastatin?

Answer 3

N/V and Diarrhea

Question 4

What are some LESS common adverse effects of Cilastatin?

Answer 4

1. Eosinophilia
2. Neutropenia
3. **HIGH levels may provoke seizures

Question 5

T or F: Imipenem/Cilastatin penetrates well into the tissues and CSF even when not inflamed.

Answer 5

True

Question 6

What is the purpose of Imipenem/Cilastatin?

Answer 6

Serves as Empiric therapy until you find out what is causing the infection

Question 7

What is Aztreonam?

Answer 7

A monobactam

Question 8

What is specific about the structure of Aztreonam?

Answer 8

The beta lactam ring is not fused to another ring

Question 9

What is the ONE job of Aztreonam?

Answer 9

Narrow spectrum:
Gram (-) rods only
Enterobacteria

Question 10

Because Aztreonam is excreted via Kidney, i.e. urine, what should you be weary of?

Answer 10

Renal failure pts

This accumulates in the kidneys

Question 11

T or F: Aztreonam is the one IV drug that is affordable.

Answer 11

False: Most IV drugs are expensive; Aztreonam is expensive!

Question 12

How do you administer Aztreonam?

Answer 12

IM/IV

Question 13

Are Cephs CIDAL or STATIC?

Answer 13

CIDAL

Question 14

Is Vancomycin static or cidal?

Answer 14

Cidal

Question 15

Structrally, what is Vancomycin?

Answer 15

Tricyclic Glycopeptide

Question 16

Why would you use Vancomycin?

Answer 16

It is effective against Gram (+) resistant drugs

MRSA; MRSE

Question 17

What is the use of Vancomycin restricted to?

Answer 17

1. Life threatening C. dif infections that are antibiotic associated
2. Life threatening Staph inf where the pt is allergic to B-lactam drugs
3. Gram (+) resistant drugs

Question 18

How would you administer Vancomycin in a life threatening C. dif infection that is antibiotic associated ?

Answer 18

PO

Question 19

What other drug does Vancomycin act synergistically with?

Answer 19

Amino glycosides

Question 20

If a pt is diagnosed with Streptococcal endocarditis, what can you use if they are allergic to PCN?

Answer 20

Vancomycin

Question 21

Random question: If a pt is diagnosed with Enterococcal endocarditis, what can you use if there are no allergies?

Answer 21

PCN with Streptomycin

Question 22

A patient is seen with flushing “red man syndrome”; what agent caused this? And what is the red due to?

Answer 22

Vancomycin

The red is due to the histamine release.

Question 23

With increased plasma levels, what adv rx can you expect to see with Vancomycin? What increases the pts chance of getting this adv rxn?

Answer 23

1. Ototoxicity

2. Renal failure (drug is not getting excreted so it accumulates in the ear)

Question 24

How is Vancomycin administered?

Answer 24

IV

Question 25

Structurally, what is Bacitracin?

Answer 25

It is a mixture of polypeptides that inhibit bacterial cell wall synthesis

Question 26

Is Bacitracin static or cidal?

Answer 26

static

Question 27

How is Bacitracin administered?

Answer 27

Topically

Question 28

Why is Bacitracin only administered topically?

Answer 28

Due to nephrotoxity potential

Question 29

T or F: Bacitracin is used against a wide variety of gram (-).

Answer 29

False: Bacitracin is used against a wide variety of gram (+) bugs

Question 30

Structurally, what is Polymyxin B Sulfate?

Answer 30

A basic polypeptide that acts like a cationic detergent to disrupt cell membrane of gram (-) bugs

Question 31

What are the 2 indications of Polymyxin B Sulfate?

Answer 31

1. Resistant Gram (-) inf | 2. Pseudomonas in cystic fibrosis

Question 32

How is Polymyxin B Sulfate administered?

Answer 32

Topically

Question 33

Why is Polymyxin B Sulfate given topically?

Answer 33

Extreme nephrotoxicity/neurotoxicity when given

Question 34

What other adverse effect is associated with Polymyxin B, besides Nephron/Neurotoxicity?

Answer 34

Respiratory paralysis: | due to neuromuscular blockade

Question 35

How is Daptomycin administered?

Answer 35

IV

Question 36

Which agent DEPOLARIZES the cell, disrupts the membrane function and inhibits DNA/RNA protein synthesis?

Answer 36

Daptomycin

Question 37

What drug is used as an alternative to Linezolid for resistant gram (+) including MRSA and VRE?

Answer 37

Daptomycin

Question 38

What is a critical limitation to Daptomycin?

Answer 38

Cannot be used with pneumonia patients

Question 39

Why is Daptomycin contraindicated in pneumonia?

Answer 39

Because it is deactivated by the pulmonary surfactants

Question 40

What should be monitored while taking Daptomycin?

Answer 40

Liver function

Question 41

What is an adv effect of Daptomycin?

Answer 41

Myalgia: | Additive with statins (discontinue if this occurs)

Question 42

In what event would you discontinue Daptomycin?

Answer 42

In the even the patient is experiencing myalgia

Question 43

What drug is used for complicated skin infections and bacteremia?

Answer 43

Daptomycin

Question 44

What drug is a lipoprotein derived from Vancomycin?

Answer 44

Telavancin

Question 45

How is Telavancin given?

Answer 45

IV

Question 46

What is the MOA of Televancin?

Answer 46

Similar to Vancomycin and Daptomycin?

Question 47

Which drug is used as an alternative to Linezolid for resistant gram (+) including MRSA and complicated skin infections?

Answer 47

Televancin

Question 48

Should you prescribe Telavancin to a pregnant patient?

Answer 48

Nope.

Question 49

What are some other critical adverse reactions of Telavancin ?

Answer 49

1. Prolongs QT interval | 2. Interferes with coagulation tests (PT and PTT)

Question 50

How does Cycloserine work?

Answer 50

Disrupts cell wall synthesis | Similar to B lactams

Question 51

What is Cycloserine used for?

Answer 51

Restricted for use of treatment of tuberculosis certain UTIs

Question 52

Is Cycloserine static or cidal?

Answer 52

Both