RavLect13: Penem/Bac Word Scramble
|
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Question | Answer |
Carbepenem drugs | Imipenem/Cilastatin (Primaxin) Meropenem (Merrem) Doripenem (Doribax) Ertapenem (Invanz) |
Monobactam drugs | Aztreonam (Azactam) |
Carbepenem MoA | bactericidal B-lactams (stable b/c C-base) Cell wall active (inhibit synthesis) bind to PBPs; inhibit wall-building enzymes Go thru porin protein channels; enter periplasmic space synergistic w/ aminoglycosides (G+/-); additive w/ quinolones (G-) |
Mech of Resistance to Carbepenems | Beta-lactamase Altered cell wall penetration PBP affinity alteration Altered porin channels for gram negatives |
Cilastin | dehydropeptidase inhibitor (not a beta lactamase inhibitor). Added to imepenem to prevent its breakdown in kidney |
Imipenem | zwitterion: better G- penetration very broad spectrum! synergistic combination |
Primaxin (Imipenem/Cilastin) SoA | ESBLs! Staph, Strep, Pneumococci, B. Fragilis, Listeria, Pseudomonas Enterococcus faecalis is ok, faecium coverage poor SPACE (covers pseudomonas, G-) Doesn't cover MRSA, VRE (faecium), C. dif, S. maltophilia, B. cepacia, atypicals, carbenemase-p |
Primaxin (Imipenem/Cilastin) ADRs | leads to overgrowth of S. maltiphilia & B. cepacia (need to be Tx'd with Septra) seen in cystic fibrosis kids Renal dysfxn (CrCl<20) -> accumulation -> seizure IM infusion irritation: give w/ Lidocaine b/c it burns N&V Cross rxn w/ pen allergy |
Imipenem PK | Cleared by kidney! Renal damage may lead to SEIZURES b/c of drug accumulation. Do NOT use in ptx with meningitis!! Concentration INdepedent (time-dependent) b/c beta-lactam |
Meropenem (Merrem) | zwitterion resistant to dehydropeptidase so it doesn't need Cilastin for stability; thus, reduced seizure risk b/c quicker clearance |
Meropenem (Merrem) SoA | Meningitis caused by: Strep. pneumonia Listeria (1st line is Septra. Meropenem is 2nd in case of septra allergy) Can treat B. cepacia (from imipenem use) More G- (pseudomonas), less Enterococcus activity than Imipenem (don't use) ESBL |
Doripenem (Doribax) SoA | close to Meropenem's SoA Most active for B. cepacia Mainly used for Pseudomonas Can treat ESBL Not used as often for meningitis as meropenem |
Doripenem (Doribax) PK | Dose adjust for Renal impairment |
Ertapenem (Invanz) SoA step down penem; more similar to 2nd/3rd Ceph b/c it doesn't cover entercoccus at all | Mainly for IAB or pelvic infections also for diabetic foot infections Can Tx UTI/pyelonephritic ESBL, but not systemic ESBL |
Ertapenem (Invanz) | empiric use in community intra-abdominal infections like acute appendix NOT for severe systemic or institutional Enterococcus & Pseudomonas infectoin |
Ertapenem (Invanz) PK | Dose adjusted in renal patients Given IM with lidocaine |
Ertapenem (Invanz) ADRs | Headache Diarrhea/Nausea fairly frequent Phlebitis Increased LFT’s low incidence but happens CNS: tremors, dyskinesias, myoclonus |
Aztreonam (Azactam) SoA | Pseudomonas Enterobacter E. coli non ESBL producing organisms NDM-1 Carbepenemase-producers Must be combined w/ AGs for effective activity Not for ESBL, or atypicals |
Aztreonam (Azactam) PK | Concentration INdependent (beta-lactam) |
Aztreonam MoA | Binds PBP like beta-lactamase Must be combined w/ AGs for effective activity (should NOT be combined with PCNs or Cephs b/c NO synergistic effect) |
Aztreonam (Azactam) ADRs | Monitor PT/INR Phlebitis Pyrexia (fever), esp in kids Good: No PCN allergy cross-over! |
Created by:
cheeoh
Popular Medical sets