Chapter 7 Notes

Question 1

zwitterionic nature of carbapenem

Answer 1

facilitates penetration through prin channels and increases activity against P. aeruginosa

Question 2

carbapenems are highly resistant to these BLases

Answer 2

NSBL, BSBL, ESBL, and AmpC

Question 3

carbapenems are strong inducers of

Answer 3

chromosomal BLase

Question 4

carbapenems are hydrolyzed by these c’ases producers

Answer 4

S. maltophilia, some enterobact, some P. aeruginosa

Question 5

there is modified resistance seen in these bugs to fight off carbapenems

Answer 5

G + bugs, MRSA, E. faecium, listeria, pseudomonas, acinetobacter

Question 6

G + activity of carbapenems

Answer 6

dorip and imip > mero and erta

Dori is most effective against PRSP

Question 7

G - cocci/coccobacilli activity of carbapenems

Answer 7

meropen and doripen > imipen

Question 8

enterobact activity of carbapenem

Answer 8

mero and dorip > erta > imip

Question 9

pseudomonas activity of carbapenems

Answer 9

susceptible to imipenem, merpenem, and dorpenem

Not susceptible to ertapenem

Question 10

Meropenem, imipenem, and doripenem have similar

Answer 10

Tmax, Cmax, AUC, and half life (1 hour), very low PPB

Question 11

carbapenems are removed by

Answer 11

dialysis so give supplemental doses

Question 12

increase dose interval in severe

Answer 12

renal impairment

Question 13

inactivation by hydrolysis

Answer 13

imipenem > meropenem and ertapenem

Question 14

3rd gen ceph and carbapenems have low

Answer 14

cross reactivity

Question 15

ADR

Answer 15

HSR I - IV (anaphylaxis, urticaria and angioedema, hematologic, serum sickness, intersitial nephritis)
stevens johnson syndrom
drug fever

Question 16

Non BL producers

Answer 16

Streptococci
Enterococci
Gram positive anaerobes
Bacillus, listeria, corynebacteria
Spirochetes (Treponema, borrelia)
Pasteurella
Eikenella
N. meningitides
Legionella
Proteus mirabilis *

Question 17

NSBL producer

Answer 17

staph aureus

Question 18

possible BSBL producers

Answer 18

Shigella
Salmonella
H. influenzae
N. gonorrhoeae

Use: AP+BLI, ESP+BLI, S/T/FrGC, Carbapenems

Question 19

likely BSBL producers

Answer 19

Many other Enterobacteriaceae (CEKMPrvS)
B. fragilis
M. catarrhalis
Acinetobacter
Pseudomonads
Use:
Non-Pseudomonads/Enterbacteriaceae:
AP+BLI, ESP+BLI, S/T/FrGC, Carbapenems*
Pseudomonads/Enterbacteriaceae:
ESP+BLI, T/FrGC (APCs), Carbapenems*

Question 20

AmpC producers

Answer 20

• Nosocomial versus Community
• Chromosomal (most):
o “variable” expression: Repressed, Derepressed, Inducible*
• Inhibitors: Tazobactam (not clav or sulb)
• Substrates: Pens (except pip/tazo*), cephs (variable T/FrGCs), aztr
• Potentially Effective BLs: Pip/tazo, Carbapenems (not Erta)
Bugs:
P. aeruginosa
Enterobacteriaceae (CEMSProv)

Question 21

ESBL producers

Answer 21

• Nosocomial versus Community
• Plasmid (most): transfer by conjugation
• Substrates: Pens, most cephs, Aztr
• Non-substrates: Cephamycins (?) and Carbapenems
• Inhibitors: Clav (variable)
Bugs:
E. coli
K. pneumonia
Other Enterobacteriaceae (few)

Question 22

clavulanate (oral) inhibits these BLases

Answer 22

NSBL, BSBL, ESBL

does not inhibit AmpC, iRT, c’ases

Question 23

sulbactam (IV) inhibits these BLases

Answer 23

NSBL, BSBL

does not inhibit ESBL, AmpC, iRT, c’ases

Question 24

tazobactam (IV) inhibits these BLases

Answer 24

NSBL, BSBL, AmpC

does not inhibit ESBL, iRT, c’ases

Question 25

carbapenems are effective against

Answer 25

MSSA, MSSE, PSSP, PRSP, strep, E. faecalis, Acinetobacter, moraxella, H. influ, N. gonorrhea, N. meningitidis, pasturella/eikenella, E coli, Salmonella, shigella, proteus mirabilis, klebsiella, citrobacter, morganella, providencia, enterobact, serritia, P aeruginosa, B. Fragilis, provetella, clostridium, peptostrep, propioni meropenem is effecitve against Burkholdieria

Question 26

Carbapenems are not effective against

Answer 26

MRSA, MRSE, E. faecium, listeria, stenotrophomonas maltophilia, campylobacter, legionella, yersinia pestis, franscella, h. pylori, C. dificile, atypicals