Pharmacology Exam II

  1. Other beta lactams
    • monobactams
    • beta-lactamase inhibitors
    • carbapenems
  2. drugs with monocyclic beta lactam rings
  3. Activity of monobactams
    • limited to aerobic gram negative rods including pseudomonas
    • no activity against gram + or anaerobes
  4. Monobactam drug
    • aztreonam
    • only monobactam available in the US
  5. Aztreonam is stable against many lactamases except
    • AmpC lactamase
    • extended spectrum B lactamase
  6. Aztreonam gram negative specturm is similar to
    3rd generation cephalosporins
  7. Monobactam Aztreonam penetrates CSF?

    A. True
    B. False
    A. True
  8. Aztreonam half life
    • 1-2 hours
    • prolonged in pt with renal failure
  9. Aztreonam ADRs
    • usually fine in pt with PCN allergy
    • occasional skin rash
    • elevations of serum aminotransferases (no toxicity)
    • may be used in pt with alaphylaxis to PCN if treating a serious gram negative infection
  10. Beta lactamase inhibitors
    • clavulanic acid
    • sulbactam
    • tazobactam
  11. B-lactamase inhibitors are most active against
    Ambler class A beta lactamases (plasmid encoded)
  12. B-lactamase inhibitors are not good inhibitors for
    • class C B-lactamases (chromosomally encoded)
    • produced in enterobacter, citrobacter, serratia and pseudomonas
  13. B-lactamase inhbititors are available only as
    fixed combinations with specific penicillins
  14. the spectrum of activity of B-lactamase inhibitors is determined by
    the PCN that it is acompanied by
  15. Uses for B-lactamase inhibitor
    treatment of mixed aerobic and anaerobic infections such as intra-abdominal infections
  16. Dosing of beta-lactamase inhibitor
    • doses are the same as used for a single agent
    • adjusting for renal function are made based on the PCN component
  17. Carbapenems
    • doripenem
    • ertapenem
    • imipenem
    • meropenem
  18. Imipenem
    • intraveous b-lactam antibiotic
    • wide spectrum
  19. Imipenem has good activity against
    • gram negative rods (pseudomonas)
    • gram positive organisms
    • anaerobes
  20. Imipenem is resistant to most b-lactamases except
    metallo-beta lactamase
  21. imipenem is inactivated by
    • dehydropeptidases in renal tubules
    • results in low urinary concentrations
  22. imipenem is administered with
    cilastatin which inhibits renal dehydropeptidase
  23. Doripenem
    carbapenem also known as doribax
  24. Meropenem
    • carbapenem
    • ultra broad spectrum
    • meningitis
    • pneumonia
  25. Ertapenem
    • carbapenem
    • also called Invanz
  26. Doripenem and meropenem are similar to ______ but have ______ activity against gram negative aerobes and _______ activity against gram positive organisms.
    • imipenem
    • higher
    • less
  27. Doripenem, meropenem and ertapenem differ from imipenem in that they
    do not require a renal dehydropeptidase inhibitor
  28. Least active carbapenem against pseudomonas and acinetobacter
  29. Carbapenem tissue penetration
    • good
    • includes CSF
  30. Dosing of carbapenems
    must be renally dosed
  31. carbapenem with the longest half life
  32. IM ertapenem is administered with
    1% lidocaine to reduce irritation
  33. Carbapenems are useful in treating
    • pseudomonas
    • mixed aerobic and anaerobic infections
    • highly PCN resistant pneumococci
  34. Carbapenem beta lactam antibiotics are the drug of choice in treating __ & ___ because they are resistant to the beta lactamase produced by these organisms.
    • enterobacter infections
    • extended spectrum B-lactamase producing gram netagive organisms
  35. effective treatment for febile neutropenic patients
    • imipenem
    • meropenem
    • with or without aminoglycosides
  36. Resistant to carbapenems
    • enterococcus faecium
    • MRSA
    • clostridium defficile
    • burkholderia cepacia
    • stenotrophomonas
  37. Only carbapenem that is not sufficient for treatment of pseudomonas
  38. Most common ADRs with carbapenems
    • N/V/D
    • skin rash
    • reactions at infusion sites
    • more common with imipenem
  39. Most likely carbapenem to cause seizures
  40. Patients allergic to PCN
    may be allergic to carbapenems as well
Card Set
Pharmacology Exam II
other beta lactams