Pharm - Monobactams/Carbapenems/B lactamase inhibitors

Question 1

true or false

monobactams are beta lactams

Answer 1

true

Question 2

differentiate between the spectrum of beta lactams vs monobactams

Answer 2

monobactams have a much narrower spectrum and are really reserved for pseudomonas infection

active against AEROBIC GRAM NEGATIVE RODS (pseudomonas)

Question 3

monobactams are INACTIVE AGAINST:

Answer 3

gram positive bacteria and anaerobic bacteria

Question 4

explain what monobactams are/are not resistant to

Answer 4

are resistant to many b lactamases

not resistant to chromosomal encoded beta lactamases (AmpC and extended spectrum)

Question 5

name a monobactam

Answer 5

aztreonam

Question 6

how is aztrenoam administered

Answer 6

monobactam

IV/IM

Question 7

distribution aztreonam

Answer 7

good - distributes to CSF

Question 8

true or false

there are no MAJOR hypersensitivities for aztreonam

Answer 8

true

however, there is occassional elevation of aminotransferases, an indicator of hepatotoxicity

Question 9

MOA of monobactams

Answer 9

same as beta lactams, just binds to PBP-3 and PBP1A

Question 10

name 4 carbapenems

Answer 10

doripenem
etrapenem
imipenem
meropenem

Question 11

importans consideration when administering imipenem

Answer 11

by itself, it will be inactivated by the kidneys (dehydropeptidases) in the renal tubules

THEREFORE, we always give it with cilastatin

Question 12

spectrum imipenem

Answer 12

broad - gram pos, neg, anaerobes

DOES NOT cover MRSA, C DIFF, ENTEROCCI

Question 13

imipenem is resistant to beta lactamases but not…..

Answer 13

carbapenamases or metallo-B lactamases, C diff, or MRSA

Question 14

how is imipenem excreted

Answer 14

renally - need to lower dose

Question 15

clinical uses carbapenems

Answer 15

reserved antibiotics

for bacteria that are resistant to other drugs (like pseudomonas), mixed aerobe and anaerobic infections, enterobacter infections

Question 16

AE of carbapenems that is common to all b lactams

Answer 16

seizures in impaired kidney function and you give high dose

Question 17

is there any penicillin cross-sensitivity in carbapenems

Answer 17

low but possible

Question 18

which carbapenem has a longer half life? it is thus best for which infections?

Answer 18

etrapenem - good for abdominal infections

Question 19

true or false

both carbapenems and monobactams are bacteristatic

Answer 19

FALSE - both bactericidal

have basically same MOA - present cell well synthesis by binding and inhibiting transpeptidases

Question 20

true or false

beta lactamase inhibitors are NEVER used as single agents

Answer 20

true always combined with penicillins or cephalosporins

they do not kill bacteria - just extend spectrum

Question 21

name 4 beta lactamase inhibitors

Answer 21

clavulanic acid
sulbactam
tazobactam
avibactam (not chemically a beta lactam, but still beta lactamase inhibitor)

chemically, the other 3 are beta lactams

Question 22

MOA beta lactamase inhibitors

Answer 22

potent IRREVERSIBLE inhibitors of bacterial beta lactamases (NOT ALL OF THEM - NOT AGAINST CHROMOSOMALLY ENCODED ENTEROBACTER, CITROBACTER, OR PSEUDOMODAS)

Question 23

true or false

beta lactamase inhibitors are reversible inhibitors of beta lactamases

Answer 23

FALSE - irreversible

Question 24

name 6 penicillins/cephalosporins that come with B lactamase inhibitor

Answer 24

amoxicillin (clav)
ampicillin (sulbactam)
pipercillin (tazobactam)
ticarcillin (clav)
ceftazidime (avibactam)
ceftolozane (5th gen) (tazobactam)

Question 25

what is the spectrum of the beta lactamase inhibitors

Answer 25

do NOT have their own spectrum - it’s the same as that of the beta lactam used with it

Question 26

indications for using beta lactamase in combo with beta lactams

Answer 26

empiric therapy - when need wide range of treatment for mixed aerobe and anaerobe

(like intra-abdominal infection)

Question 27

beta lactamase inhibitors extend the effect of penicillin to ___________ bacteria

Answer 27

bacteria that produce beta lactamase

EXTEND THE SPECTRUM

Question 28

What are “class A beta lactamases”

Answer 28

inhibit plasmid encoded beta lactamases

Question 29

beta lactamase inhibitors resemble what?

Answer 29

beta lactams

Question 30

beta lactamase inhibitors protect…..

Answer 30

penicillins and cephalosporins