Carbapenems

Question 1

What type of bacteria do Carbapenems target?

Answer 1

G+/G- and anaerobes

Question 2

How would one administer Imipenem w/ cilistatin?

Answer 2

IV or IM

Question 3

How do bacteria resist carbapenems?

Answer 3

They have little cross resistance as they enter G- by a different route than normal

Question 4

Side effects of cilastatin?

Answer 4

Nausea, vomiting, seizures (1.5%)

Question 5

Mechanism of cilastatin?

Answer 5

Inhibits dehydropeptidase

Question 6

What might meropenem cause?

Answer 6

Seizures (0.5%)

Question 7

How often do you take ertapenem?

Answer 7

1x/day

Question 8

When and how do you use doripenem?

Answer 8

Parenteral for complicated intra-abdominal infections & UTIs

Question 9

What should doripenem not be used for?

Answer 9

Any form of pneumonia = up risk of death and down cure rates when compared to imipenem/cilastatin

Question 10

What are the general uses for carbapenems?

Answer 10

Resistance infections including:
UTIs
Lower RTIs
Intra-abdominal & gynecological infections
Bacterial Septicemia
Bone, joint & skin infections
Carbapenem-resistant Klebsiella pneumonia (CRKP)

Question 11

What are drug class interactions with carbapenems?

Answer 11

Decreased levels of valproic acid results in increased risk of seizures

Question 12

Tell me about Aztroenam.

Answer 12

A monobactam
Mechanism: binds PBP-3 of G- Bacteria > lysis of long filamentous bacteria
IV/IM
Excreted in Urine Unchanged
Use on G- aerobes
Crosses inflamed meninges

Question 13

What is the main use for Vancomycin?

Answer 13

IV for MRSA of MSSA if allergic to beta-lactams

Oral vs pseudomembranous colitis

Question 14

What causes pseudomembranous colitis?

Answer 14

C. difficile

Question 15

What is the mechanism of Vancomycin?

Answer 15

Binds to D-ala-D-ala terminus & prevents removal of terminal D-ala

Question 16

What are the side effects of Vancomycin?

Answer 16

Red Man Syndrome
Ototoxicity
Nephrotoxicity (w/ other nephrotoxic Rxs)

Question 17

What is Red Man Syndrome?

Answer 17

Flushing of upper body & face, hypotension, tachycardia and shock.
Caused by histamine release.

Question 18

What is ototoxicity?

Answer 18

Renal failure cause by Rx accumulation (may be permanent)

Question 19

What is telavancin?

Answer 19

A semisynthetic derivative of vancomycin

An IV cidal lipoglycopeptide

Question 20

What are the uses of telavancin?

Answer 20

Complicated skin & skin structure infections; hospital-aquired & ventilator-associated pneumonia from S. aureus

Question 21

What are the mechanisms of telavancin?

Answer 21

1) binds D-ala terminus

2) disrupts membrane potential which increases membrane permeability

Question 22

What are the side effects of telavancin?

Answer 22

NVD, taste disturbance, foamy urine

Potentially teratogenic

Question 23

What is oritavancin?

Answer 23

IV lipoglycopeptide for ABSSSI, including MRSA

Question 24

What is ABSSSI?

Answer 24

Acute bacterial skin & skin structure infections

Question 25

What are the mechanisms of Orivavancin?

Answer 25

1) binds stem peptide of peptidoglycan precursors (inhibits polymerization) 2) Binds peptide bridging segments (inhibits crosslinking) 3) Disrupts membrane integrity (depolarization, up membrane permeability, cell death)

Question 26

What are the side effects of oritavancin?

Answer 26

NVD, headache, SQ abscesses

Question 27

What are some possible Rx interactions of oritavancin?

Answer 27

Wait 48 hours before giving heparin or may increase activated partial thromboplastin time (aPTT)

Question 28

What is dalbavancin?

Answer 28

semisynthetic lipoglycopeptide for ABSSSI

Question 29

What as the mechanism of dalbavancin?

Answer 29

binds D-alanyl-d-ala terminus preventing crosslinking

Question 30

What are the side effects of dalbavancin?

Answer 30

Nausea, diarrhea, headache

Question 31

What is bacitracin?

Answer 31

A cidal vs. G+ cocci and rods

Question 32

What is the mechanism of bacitracin?

Answer 32

complexes w/ P~P

Question 33

What is the side effect of bacitracin?

Answer 33

Nephrotoxic

Question 34

How can bacitracin be used topically?

Answer 34

For minor cuts and scrapes

Question 35

What ophthalmic uses are there for bacitracin?

Answer 35

Ulcerative conjunctivitis | Bacterial conjunctivitis

Question 36

What uses are there for fosfomycin?

Answer 36

For short course, uncomplicated UTIs in women

Question 37

What is the mechanism of fosfomycin?

Answer 37

Inhibits enolpyruvate transferase | Blocks adding PEP to UDP-N-acetylglucosamine

Question 38

What is the action of fosfomycin?

Answer 38

Inhibits cell wall synthesis