Pharmacology Exam II

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Rx2013
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65256
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Pharmacology Exam II
Updated:
2011-02-09 11:44:15
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Other beta lactams
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other beta lactams
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  1. Other beta lactams
    • monobactams
    • beta-lactamase inhibitors
    • carbapenems
  2. drugs with monocyclic beta lactam rings
    monobactams
  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
    ertapenem
  29. Carbapenem tissue penetration
    • good
    • includes CSF
  30. Dosing of carbapenems
    must be renally dosed
  31. carbapenem with the longest half life
    ertapenem
  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
    ertapenem
  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
    imipenem
  40. Patients allergic to PCN
    may be allergic to carbapenems as well

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