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What is the route of administration for all carbepenems?
All are IV only
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Why are Carbapenems problematic for stepdown therapy?
There are no Oral formulations
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Do carbepenems have good MRSA coverage?
No, >16
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Which antibiotics are described as the atom bomb of antibiotics?
- Carbepenems, because they have such broad spectrum
- Widest spectrum of all antibiotics
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What is the spectrum for Carbepenums?
Everything on the charts except MRSA, E faecium and fungus
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What group of antibiotics has the widest spectrum?
Carbepenems
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Do carbepeneums have cross reactivity with PCNs?
Yes, 2-10%
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What are the major uses for Carbepenums?
- ESBL (extended spectrum beta lactamase producing organisms)-producing E. coli, K. pneumoniae
- Intra-abdominal infx
- Meningitis
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What is the dose for Ertepenem?
1 gram Q24 hours IV
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What is the dose for Meropenem?
500 mg to 1 gram Q8 IV
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What is the peak level of Meropenem?
49 ug/mL (1g)
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What is the peak level of ertapenem?
154 ug/mL (1g)
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What is the t1/2 for Meropenem?
- 1 hour
- Renal insufficiency: 10 hours
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What is the t1/2 for Ertapenem?
- 4 hour
- Renal insufficiency: >4 hours
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Which Carbapenem does not treat pseudomonas?
Ertapenem
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Which Carbepenems treat pseudomonas?
Meropenem, Imipenem or Doripenem
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What is the advantage to Ertapenem?
Only carbepenem that is dosed daily
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What are the AE of carbepenems?
- Seizure with unadjusted dose in renal insufficiency
- Neutropenia/thrombocytopenia/eosinophilia
- Rash, anaphylaxis, serum sickness
- C. difficile colitis
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Why is Imipenem-cilastatin given together?
Cilastatin is used to inhibit the renal dihydropeptidase that is responsible for metabolizing imipenem. Other carbapenem – don’t have this problem
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What are the aminoglycosides?
- Gentamicin – Garamycin
- Tobramycin – Nebcin, Tobi (inhalation)
- Amikacin – Amikin
- Streptomycin
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What is the inhalation version of tobramycin?
Tobi
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What is streptomycin primarily used for?
TB
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Would you use an aminoglycoside against a G+ bug?
No
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Would you use an aminoglycoside against G – bugs?
Yes, no G + coverage
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What is the spectrum of aminoglycosides?
- G -:
- H flu
- N gon
- E. coli
- K. pneumon
- E. cloacae
- S. marcescenes
- P. aureuginosa
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What is the route of administration for aminoglycosides?
Only IV
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What type of PK/PD activity do aminoglycosides have?
Peak conc dependant acviity
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What other antibiotics are synergistic with aminoglycosides?
Beta-lactams
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What is toxicity of aminoglycosides dependent on?
Trough concentration dependent
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What are the main uses for Aminoglycosides?
- Enterococcal endocarditis
- TB tx – streptomycin, amikacin (usual resistant to other drugs)
- Option for Gm-negative infections
- Pseudomonal lung infx – tobi (inhalation)
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What route of elimination is used by aminoglycosides?
Renal
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What should you monitor for with aminoglycoside use?
- Renal (renal elimination) = BUN, SCr
- Ototoxicity
- Neuromuscular blockade
- Potentiating drugs: ampho B, cisplatinum, cyclosporine, loops, vanco, contrast dyes, NSAIDs
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What are the AEs for Aminoglycosides?
- Renal failure-leading to dialysis
- Ototxicity- 8th cranial damage/vestibular damage (irreversible)
- Neuromuscular blockade – often post-surgery
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How do you treat neuromuscular blockade by Aminoglycosides?
Give calcium IV
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What drugs potentiate the SEs of aminoglycosides?
Ampho B, cisplatinum, cyclosporine, loops, vanco, contrast dyes, NSAIDs
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What are the macrolides ?
- Erythromycin – E-mycin
- Clarithromyin – Biaxin (XL)
- Azithromycin – Zithromax (ER)
- Fidaxomicin – Dificid
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What are the PO macrolides ?
- Erythromycin
- Clarithromyin
- Azithromycin
- Fidaxomicin
- (All)
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What are the IV Macrolides (-mycin)?
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Are Macrolides (-mycin) bacteriostatic or bactericidal?
Mostly Bacteriostatic
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Do you need to adjust the dose of Macrolides (-mycin)for renal insufficiency?
No
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What is the most important PK/PD factor for Macrolides (-mycin)?
AUC/MIC
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What are macrolides (-mycin) CI in?
Pregnancy
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