Save
Busy. Please wait.
Log in with Clever
or
show password
Forgot Password?
Don't have an account?  Sign up 
Sign up using Clever
or
Username is available taken
show password


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account. Your email address is only used to allow you to reset your password. See our Privacy Policy and Terms of Service.

Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.
focusNode
Didn't know it?
click below
 
Knew it?
click below
Don't Know
Remaining cards (0)
Know
0:00
edit
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

RavLect13: Penem/Bac

Carbepenems & Monobactams

QuestionAnswer
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

 

 



Voices

Use these flashcards to help memorize information. Look at the large card and try to recall what is on the other side. Then click the card to flip it. If you knew the answer, click the green Know box. Otherwise, click the red Don't know box.

When you've placed seven or more cards in the Don't know box, click "retry" to try those cards again.

If you've accidentally put the card in the wrong box, just click on the card to take it out of the box.

You can also use your keyboard to move the cards as follows:

If you are logged in to your account, this website will remember which cards you know and don't know so that they are in the same box the next time you log in.

When you need a break, try one of the other activities listed below the flashcards like Matching, Snowman, or Hungry Bug. Although it may feel like you're playing a game, your brain is still making more connections with the information to help you out.

To see how well you know the information, try the Quiz or Test activity.

Pass complete!
"Know" box contains:
Time elapsed:
Retries:
restart all cards