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B-lactam wall inhibitors Flashcards

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1
Q

Groups of drugs that inhibit the cell wall (6)

A

Penicillins and aminopenicillins
B-lactamase inhibitors
Cephalosporins
Carbapenems
Monobactams
Non-B-lactam cell wall inhibitors

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2
Q

Natural penicillins

A

Benzylpenicillin (penicillin G)
Benzathine penicillin G
Procaine penicillin G
Penicillin V

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3
Q

Long acting natural penicillins

A

Benzathine penicillin G
Procaine penicillin G

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4
Q

Mechanism of action of natural penicillins

A

Inhibition of peptidoglycan synthesis by blocking the transpeptidation reaction of D-alanyl-D-alanine –> acetilation of transpeptidases by binding PBPs (bactericidal)

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5
Q

Benzylpenicillin Penicillin G spectrum - Gram positive bacteria

A
  • Streptococci: Rheumatic fever, endocarditis (S. viridans, S. bovis), Group B strep prophylaxis (S. agalactiae)
  • Clostridium perfringens (gas gangrene)
  • S. pyogenes, S. pneumoniae (w/ vancomycin + 3rd-gen cephalosporin)
  • Actinomyces israelii (agent of choice)
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6
Q

Benzylpenicillin Penicillin G spectrum - Gram negative bacteria

A
  • Actinomyces israelii
  • Pasteurella multocida (dog/cat bites)
  • Listeria monocytogenes (agent of choice, combined with gentamicin)
  • n. Meningitis
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7
Q

Benzylpenicillin Penicillin G spectrum - Spirochetes

A
  • Leptospira spp. (leptospirosis)
  • Treponema pallidum (syphilis)
  • Borrelia burgdorferi (Lyme disease)
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8
Q

Adverse effects of penicillin G

A
  • IgE-mediated hypersensitivity reactions
  • Direct Coombs+ hemolytic anemia
  • Drug-induced interstitial nephritis
  • Impaired hemostasis
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9
Q

Contraindications & cautions of benzylpenicilline (Penicillin G)

A
  • Never IV with benzathine formulation → toxicity
  • Uremia or Probenecid use → toxic CNS levels → seizures
  • Better CSF penetration if meninges are inflamed
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10
Q

Resistance mechanisms of Penicillin G (benzylpenicilline)

A
  • Ineffective against most S. aureus & S. epidermidis
  • β-lactamases (penicillinases) cleave β-lactam ring
  • Mutations in PBPs → decreased binding affinity
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11
Q

Long acting form of penicillin G

A

Benzathine Penicillin G = slow absorption

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12
Q

Difference in uses between penicillins G

A
  • Benzylpenicillin G = severe infections (endocarditis, meningitis, syphilis)
  • Benzathine penicillin G = long term therapy or prohylaxis
  • Procaine penicillin G = less frequent dosing
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13
Q

Main contraindication of procaine penicillin

A

IM ONLY NEVER IV (toxicity risk)

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14
Q

Procaine penicillin Spectrum – Gram-Positive Bacteria

A
  • Rheumatic fever prophylaxis
  • Left-sided endocarditis (S. viridans, S. bovis) + gentamicin
  • Group B strep (S. agalactiae) intrapartum prophylaxis
  • Clostridium perfringens (gas gangrene)
  • Streptococcus pyogenes
  • Streptococcus pneumoniae (with vancomycin + 3rd-gen cephalosporin)
  • Actinomyces israelii (agent of choice)
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15
Q

Procaine penicillin Spectrum – Gram-Negative Bacteria

A
  • Actinomyces israelii
  • Streptobacillus moniliformis
  • Pasteurella multocida (dog/cat bites)
  • Listeria monocytogenes (agent of choice, with gentamicin)
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16
Q

Procaine penicillin Spectrum – Spirochetes

A
  • Leptospira spp. (Leptospirosis)
  • Treponema pallidum (Syphilis)
  • Borrelia burgdorferi (Lyme disease)
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17
Q

Procaine penicillin G adverse effects

A
  • IgE-mediated hypersensitivity reactions
  • Direct Coombs+ hemolytic anemia
  • Drug-induced interstitial nephritis
  • Impaired hemostasis
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18
Q

Procaine penicillin G contraindications & cautions

A
  • NEVER IV → Risk of Hoigné syndrome (CNS toxicity: hallucinations, seizures, anxiety, dizziness)
  • Risk of CNS toxicity (seizures) in uremic patients or when combined with Probenecid
  • Penetrates CSF better if meninges are inflamed
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19
Q

Procaine penicillin G resistance mechanisms and which are resistant microorganisms

A
  • Ineffective against most S. aureus & S. epidermidis
  • β-lactamases (penicillinases) cleave β-lactam ring
  • Mutations in PBPs → decreased binding affinity
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20
Q

Forms of administration of penicillin G

A
  • Benzylpenicillin G = IM, IV
  • Benzathine penicillin G = IM ONLY
  • Procaine penicillin G = IM ONLY
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21
Q

Aminopenicillins

A

Ampicillin
Amoxicillin

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22
Q

Ampicillin administration

A

PO and IM

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23
Q

Mechanism of action of ampicillin

A

Inhibit peptidoglycan synthesis by blocking the transpeptidation reaction of D-alanyl-D-alanine

Acylates transpeptidases by binding PBPs

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24
Q

Without with clavulanic acid for β-lactamase protection, ampicillin is…

A

Penicillinase-sensitive

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25
Gram-positive bacteria with ampicillin coverage
- Enterococci (more sensitive than to penicillin)    * Endocarditis (combine with gentamicin or ceftriaxone) - Listeria monocytogenes    * Meningitis (combine with vancomycin + 3rd-gen cephalosporin) - Streptococcus pyogenes - Streptococcus pneumoniae
26
Gram-negative bacteria with ampicillin coverage (HHELPSS)
- Haemophilus influenzae - Helicobacter pylori - Escherichia coli (non-resistant strains) - Listeria monocytogenes - Proteus mirabilis - Salmonella - Shigella
27
Major adverse effects of ampicillin
- Hypersensitivity reactions - Rash - Pseudomembranous colitis (C. difficile overgrowth)
28
Contraindications of ampicillin
- Infectious Mononucleosis (IM) / Epstein-Barr Virus Infection → Rash - Severe renal impairment (without dose adjustment) - Interaction with Allopurinol (increases rash risk) - Hepatotoxic in severe liver disease
29
Ampicillin adverse effects
- Increased risk of C. difficile colitis (gut flora disruption) - Hepatotoxic in severe liver disease
29
Resistance mechanism of ampicillin
- β-lactamase hydrolyzes the drug → Requires β-lactamase inhibitor (e.g., clavulanate, sulbactam) - Penicillinase cleaves β-lactam ring
30
Role of clavulanate or sulbactam in ampicillin use
Expands activity spectrum against β-lactamase-producing bacteria
31
Administration method of amoxicillin
Oral intake (food does not interfere with absorption)
32
Amoxicillin MOA
Inhibit peptidoglycan synthesis by blocking the transpeptidation reaction of D-alanyl-D-alanine Acylates transpeptidases by binding PBPs
33
Gram-positive espectrum of amoxicillin
- Enterococci - UTIS || combine with clavulanate - Lysteria monocytogenes - S. pneumoniae - S. pyogenes - Staph
34
Gram-negative espectrum of amoxicillin
Gram negative bacteria - Klebsiella - UTIs || combine with clavulanate - H. influenzae - H. pylori - E. coli (non-resistant strains) - Proteus mirabilis - Salmonella - Shigella (↓↓ effective than ampicilin)
35
Amoxicillin works as empiric treatment for
Community acquired pneumonia
36
Alternative treatment to penicillin for bacterial pharyngitis
Amoxicillin + clavulanate
37
Adverse effects of amoxicillin
- Hypersensitivity reactions - Rash - Pseudomembranous colitis
38
When should you NOT give amoxicillin?
- History of severe hypersensitivity reactions - Infectious mononucleosis or Epstein-Barr virus - Severe renal impairment - When taking ALLOPURINOL - In hepatic dysfunction
39
Amoxicillin mechanism of resistance
- Hydrolization by B-lactamases - Penicillinase cleaves B-lactam ring
40
41
Antipseudomonal carboxypenecillins
- Carbenicillin - Ticarcillin
42
Admin. of carbenicillin
PO
43
Antipseudomonal carboxypenicillins mechanism of action
Inhibit peptidoglycan synthesis by blocking the transpeptidation reaction of D-alanyl-D-alanine Acylates transpeptidases by binding PBPs
43
Antipseudomonal carboxypenicillins (carbenicillin & ticarcillin) therapeutic use
ONLY urinary infections by proteus spp. and pseudomonnas aeruginosa
44
Antipseudomonal carboxypenicillins (carbenicillin & ticarcillin) adverse effects
- Hypersensitivity reactions (Anaphylaxis) - Impaired hemostasis (platelet disfunction and neutropenia) - Hypokalemia - Nephrotoxicity - GI effects - Neurotoxicity
45
Food absorption and aminopenicillins
Amoxicillin - doesn't affect Ampicillin - reduces absorption
46
Carbenicillin resistant microorganism
P. mirabilis
47
Carboxypenicillins mechanisms of resistance
- B-lactamase production - Altered PBPs - Efflux pumps
48
Resistance to carboxypenicillins by Pseudomonas aeruginosa occurs because of
Porin mutations in the gram-negative bacteria
49
Antipseudomonal Ureidopenicillin
Piperacillin (Puperacillin)
50
Acid stable carboxypenicillin (PO)
Carbenicillin
51
Discontinued IV carboxypenicillin
Ticarcillin
52
Divisions of antipseudomonal B-lactamase-inhibitors
Carboxypenicillins and ureidopenicillins
53
Combined with tazobactam (B-lactamase inhibitor) this antipseudomonal ureidopenicillin has the broadest spectrum of penicillins
Piperacillin
54
Admin form of piperacillin
IV
55
Piperacillin MOA
Inhibit peptidoglycan synthesis by blocking the transpeptidation reaction of D-alanyl-D-alanine Acylates transpeptidases by binding PBPs
56
Therapeutic uses of piperacillin
Bacteremias Pneumonias (P. aeruginosa, H. influenzae) Infections following burns UTIs (resistant to ampicillin; Klebsiella) Mixed intra-abdominal infections (E. coli)
57
Piperacillin gram-positive bacteria spectrum
E. faecalis and MSSA
58
Gram-negative spectrum of piperacillin
- P. aeruginosa - Enterobacterales (non-ß-lactamase producing) - Bacteroides spp. - H. influenzae - B. fragilis - E. coli - Klebsiella
59
Piperacillin adverse effects
- Hypersensitivity reactions (anaphylaxia) - Impaired hemostasis (platelet disfunction and neutropenia)
60
Piperacillin contraindications
Allergy to penicillins or beta-lactams History of severe hypersensitivity reactions Renal impairment Concurrent use with methotrexate (increased toxicity risk) Severe electrolyte imbalance
61
Dicloxacillin, Nafcillin, Oxacillin, Floxacillin and Methicillin belong to...
Penicillinase-resistant penicillins
62
Administration of Dicloxacillin, Nafcillin, Oxacillin, Floxacillin and Methicillin
Oral or IV
63
Why are penicillinase-resistant penicillins effective?
Penicillinase resistant because bulky R group (side chains) blocks access of β-lactamase to β-lactam ring and its further hydrolyzation
64
MOA of penicillinase-resistant penicillins
Inhibit peptidoglycan synthesis by blocking the transpeptidation reaction of D-alanyl-D-alanine Acylates transpeptidases by binding PBPs
65
Gram positive spectrum of PR-Penicillins
S. aureus NON MRSA (Gram positive aerobes)
66
Penicillinase-resistant penicillins adverse effects
Hypersensitivity reactions Interstitial nephritis (methicillin) Hepatitis
67
Doxacillin, oxacillin, methicillin, nafcillin and foxacillin contraindications
Hypersensitivity
68
Mechanism of resistance of penicillin-resistant-penicillins
- Alteration of PBP binding site = reduced affinity = pathogen is not bound or inactivated by B-lactam - MRSA alteration of PBP target is one of its main virulence factors
69
Penicillins are effective against amebae, plasmodia, rickettsiae, fungi or viruses
FALSE
70
Interaction of PROBENECID + penicillins
Decreases tubular secretion and VOD of penicillins Penicillins stay more time on the body
71
Interaction between food and penicillins
Food ingestion may interfere with enteric absorption of ALL penicillins
72
Clavulanate acid, Clavulanate, Sulbactam, Tazobactam and Avibactam are...
B-lactamase inhibitors
73
ADME of clavulanate and clavulanate acid
PO and parenteral
74
PO form of clavulanate must be combined with
Amoxicilin
75
Parenteral form of clavulanate must be combined with
Ticarcilin
76
Older B-lactamase inhibitors (Clavulanate, sulbactam, tazobactam) MOA
Inactivate plasmid-encoded B lactamases
77
Older B-lactamase inhibitors fail to provide protection against...
AmpC β-lactamases encoded chromosomally in some gram-negative bacilli and carbapenemases
78
Amoxicillin + clavulanate target
Staphylococcus aureus Haemophilus influenzae Certain enterobacterales
79
Clavulanate/clavulanate acid adverse effects
GI disturbances; nausea and diarrhea Hypersensitivity Hepatotoxicity
80
Clavulanate contraindications
Allergy to penicillins or B lactams Severe liver disease
81
Clavulanate and food
Better tolerated Delayed absorption (not significant)
82
B-lactamase inhibitors + methrotexate
Reduction of renal clearance of methotrexate = increased toxicity risk
83
Clavulanate or sulbactam + warfarin
Enhanced anticoagulant effects = more bleeding risk
84
B-lactamase inhibitors + probenecid
Increased drug levels and prolonged effects
85
Amoxicillin + clavulanate and allopurinol increase the risk of...
Rash
86
Sulbactam ADME
IV or IM Combined with ampicillin and cefoperazone
87
Sulbactam therapeutic use
Activity against Acinetobacter spp Multidrug-resistant acinetobacter infections
88
Sulbactam adverse effects
Local injection site reactions Hypersensitivity Hepatotoxicity
89
Sulbactam and tazobactam contraindications
Allergy to penicillins or B lactams Severe renal impairment
90
Resistance in sulbctam is due to:
AmpC β-lactamases and carbapenemase-producing bacteria
91
Tazobactam ADME
Parenteral Combinated with piperacillin and ceftolozane
92
Tazobactam + piperacillin attacks
Pseudomonas aeruginosa Enterobacterales Anaerobes
93
Tazobactam + ceftolozane
ESBL-producing gram negative bacteria
94
Tazobactam side effects
GI disturbances Hypersensitivity reactions Elevated liver enzymes
95
Resistance to tazobactam is due to
AmpC β-lactamases and metallo-β-lactamases
96
New generation B-lactamase
Avibactam
97
Avibactam is coformulated with
Ceftazidime
98
Avibactam MOA
Narrow- and extended-spectrum β-lactamase (ESBL)-type Chromosomal AmpC KPC-type β-lactamases
99
Avibactam has no action against
metallo-B-lactamases
100
Avibactam + ceftazidime therapeutic uses
Carbapenem-resistant enterobacterales Multidrug resistant pseudomonas aeruginosa
101
Avibactam adverse effects
GI disturbances CNS effects Hypersensitivity reactions
102
Avibactam contraindications
Allergy to cephalosporins Severe renal impairment
103
Why is there no food interaction with sulbactam, tazobactam or avibactam?
They're given parenterally
104
Cephalosporins MOA
Inhibition of cell wall synthesis but PBPs differ somewhat from penicillins
105
1st gen cephalosporins
Cephalexin Cefazolin Cefalotin
106
2nd gen cephalosporins
Cefaclor Cefuroxime Cefoxitin Cefotetan "Fake fox furious for tea"
107
3rd generation cephalosporins
Ceftriaxone Cefotaxime Ceftizoxime Ceftixime Ceftazidime
108
4th gen cephalosporins
Cefepime Cefpirome Cefpiramide
109
5th generation
Ceftaroline Ceftobiprole Ceftolozane
110
First generation cephalosporins adme
IV, Oral
111
1st gen cephalosporin of choice for surgical prophylacxis
Cephazoline - prevent S. aureus infections
112
Cephazolin IM is preferred for
Endocarditis
113
First gen cephalosporins therapeutic uses
Skin and soft­tissue infections Serious infections due to MSSA Perioperative surgical prophylaxis UTI infections
114
1st gen cephalosporins have excellent effect on...
Gram positive streptococcus and MSSA
115
1st gen cephalosporins PEcK
Gram negative infections: Proteus E. coli Klebsiella
116
1st gen cephalosporin resistance mechanisms
Inactivation by hydrolisis of the B-lactam ring Susceptible to hydrolisis by inducible ampC B-lactamases in gram-negative bacteria Inactivation by cephalosporinase Change in PBP structure
117
Cephalosporin generation against upper respiratory tract infections (sinusitis, otitis media)
2nd generation
118
Cefoxitin/Cefotetan main therapeutic uses are:
Gynecologic infections, perioperative surgical prophylaxis
119
2nd generation cephalosporins have good activity against these gram positive microbes
MSSA Streptococci
120
Gram negative spectrum of 2nd generation cephalosporins (HENSPEcK)
H. influenzae E. aerogenes Neisseria spp Serratia marcescens Proteus mirabilis E. coli Klebsiella
121
2nd generation meds with some activity against B. fragilis
Cefotetan Cefoxitin
122
Main resistance mechanism of 2nd generation cephalosporins
Susceptible to hydrolysis by inducible ampC B-lactamases in gram-negative bacteria (Citrobacter, Enterobacter and Pseudomonas)
123
ADME of 3rd generation cephalosporins
IV Ceftriaxone = IM
124
3rd gen cephalosporins that cross BBB
Ceftriaxone and cefotaxime
125
Main therapeutic uses of 3rd gen cephalosporins
Community ­acquired pneumonia Meningitis Urinary tract infections Streptococcal endocarditis Gonorrhea Severe Lyme disease
126
3rd gen cephalosporin that treats borrelia burdorferi lyme disease gonorrhea
Ceftriaxone (IM)
127
3rd generation cephalosporin that treats Pseudomonaz
CeftAZidime
128
3rd gen drugs that treat meningitis by S. pneumoniae
Ceftriaxone Cefotaxime
129
3rd generation resistance mechanisms
Alterations in two PBPs (1A and 2X) Change in transpeptidase (PBP) structure hHydrolysis by inducible ampC B-lactamases in gram-negative bacteria Cephalosporinases
130
Antipseudomonal cephalosporins
4th generation Cefepime Cefpirome Cefpiramide
131
ADME of 4th generation cephalosporins
Parenteral IV
132
4th gen cephalosporins main therapeutic use
Nosocomial infections: pneumonia, meningitis, urinary tract infections, intra­abdominal infections
133
4th gen cephalosporins have excellent activity against
H. influenzae Proteus E. coli Klebsiella Serratia Neisseria streptococci MSSA Pseudomonas aeruginosa
134
Cephalosporin generation that works against MRSA
5th
135
5th gen cephalosporins (IV)
Ceftaroline Ceftobiprole Ceftolozane
136
Ceftaroline fosamil therapeutic uses
MRSA Penicillin-resistant S. pneumoniae Gram negative activity
137
Ceftobiprole medocaril
MRSA Penicillin resistant S. pneumoniae Pseudomonas spp.
138
Generation susceptible to resistance because of EFFLUX, hydrolysis by ESBLs and to a significant extent to KPCs
4th
139
Generations that cross BBB
3rd and 4th
140
Organisms not covered by 1-4th generation are LAME
Listeria Atypical chlamydia, mycoplasma MRSA Enterococci
141
At high doses, ------ can cause encephalopathy
Cefepime
142
Cephalosporin generations with good CSF penetration
3 and 4
143
Ceftaroline is mostly used for:
Community ­acquired pneumonia Skin and soft­ tissue infections
144
Most important cephalosporins adverse effects
Autoinmune hemolytic anemia Vitamin K deficiency Disulfram-like reaction (flushing, tachycardia, hypotension) Neurotoxicicty Positive coombs reaction Granulocytopenia
145
Effects of cephalosporins in neonates
Hyperbilirrunemia or jaundice - ceftriaxone Administer cefotaxime
146
Cephalosporins + aminoglycosides cause
NEPHROTOXIC EFFECT
147
When using cephalosporins for intra-abdominal infections, ------- is required
Anaerobic coverage (ex. metronidazole)
148
C. difficile and campylobacter jejuni can be treated with cephalosporins
NORRRRR
149
Patients with mononucleosis or epstein barr should not take
Ampicillin
150
Ampicillin + allopurinol
Increases rash risk
151
Combo para tratar la meningitis por l. monocytogenes
Ampicillin + vancomycin + 3rd gen cephalosporin
152
tx. empirico para meningitis por s. pneumoniae
Vancomicina + ceftriaxona
153
Tx. para meningitis por H. influenzae
Ceftriaxona (3rd gen cephalosporine)
154
Resistance mechanism against Ampicillin
Hydrolization by ß-lactamases Penicillinase cleaves the ß-lactam ring
155
Based on the resistance mechanisms, what must be applied with ampicillin
A b-lactamase inhibitor (clavulanate, tazobactam or sulbactam)
156
Happens when you add clavulanate or sulbactam to ampicillin
Activity spectrum against resistan microorganisms expands
157
Aminopenicillin that is not affected by food ingestion
Amoxicillin
158
Effective concentrations of oral -------- stay 2x as long in plasma than ---------
amoxicillin ampicillin
159
Effect of probenecid on amoxicillin
Delays excretion
160
Aminopenicillins MOA
Inhibition of peptidoglycan synthesis by blocking the transpeptidation reaction of D-alanyl-D-alanine
161
Carbapenems and Monobactams are...
B-lactam wall inhibitors
162
-nems (imipenem, meropenem, ertapenem and doripenem) are classified as
Carbapenems
163
Carbapenems MOA
Bind to PBP's to disrupts bacterial cell wall synthesis and dead to susceptible microorganisms
164
Are carbapenems bactericidal or bacteriostatic?
Bactericidal
165
In general, carbapenems are used for nosocomial infections such as:
UTIs LRTI (pneumonia) Intraabdominal and gynecologic infections Skin, soft tissue, bone and joint infections
166
why is imipenem combined with cilastatin?
Cilastatin inhibits tubular degradation and extends t1/2
167
Why are cilastatin + relabactam added to imipinem?
Cilastatin extends half life Relebactam contains a ß-lactamase inhibitor against carbapenemases
168
Imipinem's primary role
Empiric treatment of serious infections in hospitalized patients at risk for resistant pathogens
169
Carbapenems act against:
Gram positive cocci Gram negative rods Anaerobes
170
Imipenem's main gram positive targets
Staph aureus Streptococcus (pneumoniae, pyogenes, agalactiae) Enterococcus faecalis
171
Imipenem's gram negative targets (EKEPPA)
Enterobacterales E coli Klebsiella Enterobacter Proteus Pseudomonas Acinetobacter
172
Imipinem is not effective against
MRSA and C. difficile
173
Imipinem's anaerobe sprectrum
Bacteroides Clostridium Fusobacterium
174
Drug combo reserved for treatment of gram negative pathogens resistant to all or almost all other antibiotics
Imipinem + relabactam
175
Imipinem adverse effects
Nausea Vomiting Seizures Hypersensitivity
176
Meropenem is less active then imipinem when treating ------ but more active when treating --------
Gram + (enterococcus) Gram negative
177
Preferred carbapenem for the treatment of meningitis
Meropenem
178
Meropenem + vaborbactam are reserved for
Multi-drug resistant gram negative pathogens
179
Therapeutic use of meropenem
Hospital-onset infections when cephalosporin or penicillin-resistant organisms are suspected RTI GI UTIs
180
Meropenem is less likely to cause ------ but SHOULD NOT be administered with -------
Seizures Valproic acid
181
Meropenem is combined with -------- ro reduce resistance
Vaborbactam (ß-lactase inhibitor)
182
Ertapenem administration
IV or IM
183
Ertapenem MOA
Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs)
184
Ertapenem has -------- activity
Bactericidal
185
Ertapenem therapeutic uses
***Complicated*** UTIs Skin and soft tissue inf. CAP Pelvic infections
186
Ertapenem and doripenem adverse effects
GI distress Headache Injection side reactions Hypersensitivity Anaphylaxis Seizures
187
Ertapenem and doripenem should not be administered in cases of
Hypersensitivity to other ß-lactams Seizure disorders like epilepsy Severe renal impairment
188
Ertapenems and doripenems major resistant issue
Carbapenemase-producing Enterobacterales (CPE)
189
Other resistance mechanisms to Ertapenem and Doripenem
Efflux pumps Porin mutations ESBL-producing bacteria
190
Gram positive spectrum of ertapenem and doripenem
S. pneumoniae S. pyogenes S. agalactiae MSSA
191
Gram negative spectrum of ertapenem KHEEP
Klebsiella pneumoniae Haemophilus influenzae E. coli Enterobacter Proteus mirabilis
192
Bacteroidis fragilis, prevotella and fusobacterium are anaerobes treated with
Ertapenem or Doripenem
193
Doripenem ADME
IV ONLY
194
Doripenem ADME
Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs)
195
Doripenem has ----- action with ------ activity
Bactericidal Broad spectrum
196
Doripenem therapeutic uses
Complicated intra abdominal infections Complicated UTIs Nosocomial pneumonia
197
Indicated ß-lactam antibiotic for pyelonephritis
Doripenem
198
Doripenem is highly effective against...
Multi-drug resistant gram negative infections
199
Carbapenem used for pseudomonas aeruginosa
Meropenem
200
Regarding gram - bacteria, doripenem is more active against ------- than ertapenem
Pseudomonas aeruginosa
201
Aztreonam is classified as a
Monobactam
202
Aztreonam ADME
IV, IM, inhalation
203
B-lactam used in cystic fibrosis patients
Aztreonam (inhalation formulation)
204
Aztreonam MOA
Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs)
205
Aztreonam is bactericidal against...
Gram negative susceptible bacteria
206
Aztreonam is stable against most β-lactamases, but not effective against
ESBL or carbapenemase-producing bacteria
207
T or F: Aztreonam has high activity against gram-positive bacteria or anaerobes
F
208
Aztreonam is highly active against
H. influenzae
209
Inhaled aztreonam is used for
Reduction of pseudomonas-associated pulmonary exacerbations in cystic fibrosis patients
210
Monobactam used for serious gram negative infections like pneumonia, UTIs and sepsis
Aztreonam
211
Monobactam used as an alternative for penicillin-allergic patients
Aztreonam
212
Aztreonam causes ------- especially in infants and young children
Hepatotoxicity (elevated liver enzymes)
213
Aztreonam contraindications
Hypersensitivity against ceftazidime Severe renal impairment
214
ESBL (extended-spectrum β-lactamases) and Carbapenemases (KPC, NDM, OXA-type enzymes) are resistance mechanisms of
Aztreonam
215
Aztreonam bacterial spectrum KHEEPP
Klebsiella pneumoniae H. influenza E. coli Enterobacter Proteus Pseudomonas
216
Preferred treatment for ESBL infections
Carbapenems
217
Should be avoided in ESBL infections
Penicillins, most cephalosporins, aztreonam

Antimicrobial's pharmacology (7 decks)

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