C10. Carbapenems, monobactams, beta lactamases

Question 1

Carbapenems

Mention 1st and 2nd generation drugs

Answer 1

1st generation:
Ertapenem
2nd generation:
impienem
meropenem
doripenem

Question 2

mechanism of carbapenems

Resistant to ?

Answer 2

cell wall synthesis inhibitors

Resistant to beta lactamases

Question 3

spectrum of carbapenems

Answer 3

Gram + aerboic Yes
Gram + anerobic Yes
Gram - aerobic Yes
Gram - anaerboic yes

Gram positive cocci gram negative rods (enterobacter and pseudomonas spp.) and anerobs.

Broad spectrum- bactericidal:
Includes pseudomonas, acinetobacter, penicillin resistant pneumococci, enterococcus faecalis and B frailis
Not active against MRSA/E and more.

Question 4

Kinetics of carbapenems:

Answer 4

enters CNS
kidney elimination
Imipenem is given with cilastatin, a dihydropeptidase inhibitor (to prevent inactiveion in the kidneys).

Question 5

administration of cabapenems

Answer 5

PArental only, 3x4 times a day

Question 6

Indications of carbapenems:

Answer 6

hospital infections
multimicrobial infections
Infections with unknown cause
sepsis

Question 7

adverse effects of carbapenemes

Answer 7

GI symptoms, pseudomembrenous colitis
allergy, seizures (imipenem).
Allergy

Question 8

Monobactam drug?

Answer 8

Aztreonam
Resistant to Beta lactamase
SAme mechanism as other beta lactamas

Uses:
IV drug mainly active versus gram negative rods
No cross allergenicity with penicilins or cephalosporins

Gram positive anerobic and anerobic = NO
Only work against gram negative aerobs

Given IV
Penetrates CNS

Question 9

clinical use of monobactam

Answer 9

aztreonam

Pneumonia, meningitis, sepsis causeed by G- bacteria

Question 10

Beta lactamase inhibitors

Answer 10

clavulanic acid, sulbactam, tazobactam

Amoxicillin+ clavulanic acid
Ampicillin Sulbactam
Piperacillin and tazobactam