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Therapeutics Exam 2 - antibiotics:( > Beta Lactams (carbapenems, monobactams, gram positive) > Flashcards

Beta Lactams (carbapenems, monobactams, gram positive) Flashcards

1
Q

what are the carbapenems and their RoA?

A

imipenem + cilistatin
meropenem
doripenem
ertapenem

  • all are IV
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2
Q

what is the moa of carbepenems and what type of killing do they display?

A

interferes with bacterial cell wall synthesis during active multiplication and displays time dependent killing

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3
Q

activity spectrum of carbapenems

A

strep infections (including pneumo)
MSSA (not first choice though)
mouth anaerobes
HNPEKM
aeroSCE (NO PA’s)

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4
Q

which carbapenem has no pseudomonas activity

A

ertapenem

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5
Q

which carbapenems have pseudomonas activity

A

imipenem
meropenem
doripenem

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6
Q

avoid using carbapenems in

A

MRSA
acinetobacter
enterococcus
atypical bacteria

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7
Q

do carbapenems achieve good CSF penetration

A

no

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8
Q

ADR of carbapenems

A

rash
anaphylaxis
fever
C dif (CDAD)
seizures (renal insufficiency)

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9
Q

when is best to use carbapenems

A

polymicrobial infections (broad spectrum)
MDR gram negative
many infection site

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10
Q

can imipenem be given alone?

A

no, always give with cilastatin to prevent renal metabolism

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11
Q

does cilastatin provide antimicrobial activity?

A

no

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12
Q

what are carbapenems generally reserved for?

A

penicillin allergic patients
MDR gram negative bacteria

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13
Q

carbapenems are drug of choice for

A

ESBL’s (Klebsiella and E. coli)

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14
Q

what is meropenem + vaborbactam used for?

A

complicated UTI’s with carbapenemase producing gram negative bacteria

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15
Q

what is imipenem + relebactam (recarbio) approved for?

A

complicated UTI
intrabdominal infections
HAP

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16
Q

what antibiotic is a monobactam? whats the RoA?

A

aztreonam (IV, IM)

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17
Q

activity of aztreonam

A

only gram negative activity
HNPEKM
aeroSPCE (no A)

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18
Q

avoid using aztreonam in which organisms

A

gram positive organisms
acinetobacter spp
gut anaerobes
atypical

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19
Q

ADR’s of aztreonam

A

rash
anaphylaxis
fever
neutropenia
increased hepatic transaminases (AST, ALT)

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20
Q

aztreonam is helpful in gram negative infections for patients with what?

A

severe PCN allergy who cannot tolrate PCN or cephalosporins

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21
Q

does aztreonam have activity against pseudomonas?

A

yes

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22
Q

what are the aminoglycosides?

A

gentamicin
tobramycin
amikacin
streptomycin
neomycin

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23
Q

what are the RoA’s of
gentamicin
tobramycin
amikacin
streptomycin
neomycin

A

g - IV, IM
T - IV, IM, inhalation
A - IV, IM, Inhalation
S - IM
N - po

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24
Q

MOA of aminoglycosides

A

inhibits bacterial protein synthesis by binding DIRECTLY to 30S ribosomal subunits causing faulty peptide sequence to form in the protein chain

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25
Q

what type of killing do aminoglycosides display

A

concentration dependent, bactericidal killing

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26
Q

uses of aminoglycosides

A

used in combo with cell wall active agents as SYNERGY against MRSA, enterococcus (gram positive)
HPEKM (no N)
SPACE
pseudomonas

27
Q

which type of organisms should aminoglycosides NEVER be used alone in

A

gram positive

28
Q

what can be used for treatment of hepatic encephalopathy in patients with liver disease

A

neomycin

29
Q

avoid using aminoglycosides in what

A

gut anaerobes
atypical organisms

30
Q

ADR’s of aminoglycosides

A

** NEPHROTOXICITY
** OTOTOXICITY
neuromuscular blockade

(the top two are starred a bunch of times)

31
Q

synergy against gram positive organisms treated with combination of aminoglycosides and other agents usually exhibits what type of dosing compared to gram negative?

A

lower doses

32
Q

when is aminoglycoside monotherapy okay?

A

UTI

33
Q

which aminoglycosides have activity against pseudomonas

A

gentamicin
tobramycin
amikacin

34
Q

Gram positive only antibiotics

A

vancomycin (IV)
linezolid (IV, po)
daptomycin (IV)
telvancin (IV(
dalbacancin (IV)
oritavancin (IV)
quinupristin/dalfopristin (IV)

35
Q

moa of vancomycin

A

inhibits bacterial cell wall synthesis

36
Q

what type of killing does vancomycin display

A

time dependent

37
Q

main uses of vanc

A

strep (+ strep pneumoniae)
MRSA
enterococcus

38
Q

oral vanc is only used to treat what

A

cdif

39
Q

what is a problem with vanc

A

VRE

40
Q

avoid use of vanc in what

A

gram negative
gut anaerobes
atypical

41
Q

ADR of vancomycin

A

vancomycin infusion reaction (red-man’s syndrome)
hypersensitivity
fever
rare: nephrotoxicity, ototoxicity

42
Q

vancomycin can treat what sites of infection

A

skin
blood
tissue
lung
urine

43
Q

target AUC for vanc

A

400 - 600

44
Q

MoA of linezolid

A

inhibits bacterial protein synthesis by binding to bacterial 23S ribosomal RNA of the 50S subunit. Prevents formation of a functional 70S initiation complex that is essential for the bacterial translation process

45
Q

what is a weak inhibitor of monoamine oxidase (MAO-I) inhibitors

A

linezolid

46
Q

main uses of linezolid

A

gram +
streptococcus (including pneumoniae)
staph (MRSA and MSSA)
enterococcus
** EFFECTIVE FOR VRE**

47
Q

avoid linezolid use in

A

gram - infections
gut anaerobes
atypical organisms

48
Q

ADR of linezolid

A

GI - N/V
HA
thrombocytopenia (if duration of 2 weeks or more)
serotonin syndrome

49
Q

what can cause serotonin syndrome when used in combination with linezolid

A

antidepressants
sympathomimetics
fentanyl

50
Q

linezolid is mainly used for

A

lung infections
VRE

51
Q

daptomycin MOA

A

binds to components of the cell membrane of susceptible organisms and causes rapid depolarization inhibiting intracellular synthesis of DNA, RNA, and protein

52
Q

what type of killing does daptomycin exhibit

A

concentration dependent

53
Q

main uses of daptomycin

A

gram positive only
strep (including pneumo)
staph (MRSA and MSSA)
enterococcus
VRE
good UTI drug

54
Q

avoid using daptomycin in what

A

lung infections
gram neg
atypical

55
Q

why isn’t daptomycin used in lung infections?

A

inactivated by pulmonary surfactant

56
Q

ADR of daptomycin

A

N/V
HA
rash
MYOPATHIES WITH CPK ELEVATIONS

57
Q

the myopathy side effect of daptomycin presents as what

A

myalgia and muscle weakness

58
Q

what is the dosage form of telavancin, dalbavancin, oritavancin

A

IV

59
Q

what are the vancin drugs main uses

A

gram positive
strep (Pneumo included)
staph (MRSA and MSSA)
enterococcus (only if vanc susceptible)
skin and soft tissue infections

60
Q

avoid vancin use in what

A

gram negative
gut anaerobes
atypical
BLOODSTREAM INFECTIONS

61
Q

when are the vancin’s useful?

A

when adherence is in question

one time or two time dose one week apart

62
Q

MOA of quinupristin and dalfopristin and ROA

A

inhibits bacterial protein synthesis by binding to different sites on the 50S bacterial ribosomal subunit and thereby inhibiting protein synthesis

both IV

63
Q

main uses of quinupristin and dalfopristin

A

gram positive
strep (pneumo too)
staph (MRSA MSSA)
enterococcus FAECIUM only (this is the only VRE it treats)

64
Q

ADRs of quinupristin and dalfopristin

A

poorly tolerated overall
increased bilirubin
pain at injection site (central line only)
myopathies

Therapeutics Exam 2 - antibiotics:( (7 decks)

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