Monobactams

Question 1

Monobactams are produced by

Answer 1

chromobacterium violaceum

Question 2

Monobactam structure

Answer 2

mono-cyclic beta-lactams; aminothiazole group=gram - spectrum; sulfonic acid= beta lactam activation; carboxy group= enhanced pseudomonas activity

Question 3

Monobactam MOA:

Answer 3

consistent with beta lactam family, aztreonam inhibits PBP which alters cell morphology and viability

Question 4

Aztreonam has a high affinity for

Answer 4

PBP-3

Question 5

Aztreonam is bactericidal/bacteriostatic

Answer 5

bactericidal

Question 6

Monobactam includes which drug

Answer 6

aztreonam

Question 7

Aztreonam oral absorption

Answer 7

poor

Question 8

Aztreonam 1/2 life

Answer 8

short

Question 9

Aztreonam elimination

Answer 9

66% renal and 12% fecal

Question 10

Aztreonam administration

Answer 10

IV, IM, inhaled

Question 11

Monobactams are ___-dependent antimicrobials

Answer 11

time

Question 12

Desired target for %T>MIC of dosing interval for Aztreonam

Answer 12

50

Question 13

4 hour dialysis can remove about ___ of Aztreonam

Answer 13

38%

Question 14

Aztreonam spectrum coverage

Answer 14

NO GRAM +
dark red: h. influenzae, m. catarrhalis, e.coli, klebsiella, p.mirabilis, Morganella, citrobacter, serratia
light red: enterobacter, p. aeruginosa
Misc: activity against NDM metal-beta-lactamases and unstable against ESBL and AmpC

Question 15

Aztreonam has activity against

Answer 15

NDM metallo-beta-lactamases

Question 16

Aztreonam resistance mechanisms

Answer 16

beta lactamases: susceptible by hydrolysis to ESBL, KPC, AmpC beta lactamases

outer membrane proteins (reduced entry)

efflux pumps

Question 17

Aztreonam penetration into tissues

Answer 17

skin
synovial fluid
bone
urine concentration=100 times higher than serum concentrations
CSF is poor without inflammation
lung
eye is poor

Question 18

Aztreonam should/should not be renal adjusted

Answer 18

should!

Question 19

Aztreonam adverse effects

Answer 19

thrombophlebitis
GI, c. diff rare
skin
hematologic
CNS
hepatic

Question 20

Aztreonam indications

Answer 20

penicillin allergic patients

metallo-beta-lactamase producing enterobacteriaceae

Question 21

Why can Aztreonam be given to patients with PCN allergy?

Answer 21

structurally dissimilar to other beta lactams

Question 22

Aztreonam can have cross reactivity with

Answer 22

ceftazidime allergy bc of similar side chain

Question 23

Aztreonam can be used only for gram

Answer 23

negatives

Question 24

Aztreonam is typically reserved for patients with

Answer 24

severe beta lactam allergy

Question 25

Aztreonam is usually well/not well tolerated

Answer 25

well