Podcast
Questions and Answers
Which statement accurately contrasts the spectrum of activity between ertapenem and other carbapenems?
Which statement accurately contrasts the spectrum of activity between ertapenem and other carbapenems?
- Ertapenem is the only carbapenem that is effective against gram-positive bacteria.
- Ertapenem is the only carbapenem effective against _Acinetobacter_ infections.
- Ertapenem does not have activity against _Pseudomonas aeruginosa_, _Enterococci_, or _Acinetobacter_, unlike other carbapenems. (correct)
- Ertapenem uniquely covers _Enterococcus_ species, while other carbapenems do not.
A patient with a known penicillin allergy requires broad-spectrum antibiotic coverage. Considering the potential for cross-reactivity, which of the following is the MOST appropriate choice?
A patient with a known penicillin allergy requires broad-spectrum antibiotic coverage. Considering the potential for cross-reactivity, which of the following is the MOST appropriate choice?
- Ceftriaxone, a third-generation cephalosporin, is safe in penicillin-allergic patients.
- Aztreonam, as it is a monobactam and generally safe for use in patients with penicillin allergies. (correct)
- Meropenem, as it has a lower risk of cross-reactivity compared to penicillins.
- Imipenem-cilastatin, due to its broad-spectrum activity.
A patient with a history of seizures is prescribed a carbapenem antibiotic. Which carbapenem would pose the LOWEST risk of inducing seizures?
A patient with a history of seizures is prescribed a carbapenem antibiotic. Which carbapenem would pose the LOWEST risk of inducing seizures?
- Imipenem-cilastatin
- Ertapenem
- Doripenem
- Meropenem (correct)
A patient receiving valproic acid for seizure control develops a severe infection requiring carbapenem therapy. What is the MOST important consideration regarding this drug interaction?
A patient receiving valproic acid for seizure control develops a severe infection requiring carbapenem therapy. What is the MOST important consideration regarding this drug interaction?
Which mechanism of resistance is LEAST likely to be effective against aztreonam?
Which mechanism of resistance is LEAST likely to be effective against aztreonam?
A patient develops hemolytic anemia during prolonged aztreonam therapy. Which of the following laboratory findings would MOST likely be associated with this adverse effect?
A patient develops hemolytic anemia during prolonged aztreonam therapy. Which of the following laboratory findings would MOST likely be associated with this adverse effect?
Which of the following beta-lactamases is specifically inhibited by vaborbactam?
Which of the following beta-lactamases is specifically inhibited by vaborbactam?
Which of the following scenarios would MOST warrant the use of aztreonam over other beta-lactam antibiotics?
Which of the following scenarios would MOST warrant the use of aztreonam over other beta-lactam antibiotics?
A patient on imipenem-cilastatin develops a seizure. Which of the following factors would MOST likely contribute to this adverse effect?
A patient on imipenem-cilastatin develops a seizure. Which of the following factors would MOST likely contribute to this adverse effect?
Which of the following statements BEST describes the role of cilastatin in imipenem-cilastatin?
Which of the following statements BEST describes the role of cilastatin in imipenem-cilastatin?
Flashcards
Beta-Lactams
Beta-Lactams
A class of antibiotics including monobactams and carbapenems, susceptible to inactivation by beta-lactamases, targeting PBPs, and hindered by reduced diffusion through porin channels.
Meropenem/Vaborbactam
Meropenem/Vaborbactam
A beta-lactamase inhibitor combined with meropenem to enhance its effectiveness against certain resistant bacteria.
Carbapenems
Carbapenems
Broad-spectrum antibiotics effective against Gram-positive, Gram-negative, and anaerobic organisms, but inactivated by carbapenemases.
Carbapenemases
Carbapenemases
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Monobactam (Aztreonam)
Monobactam (Aztreonam)
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E. coli, Kleb, H. influenzae and Pseudomonas Aeruginosa
E. coli, Kleb, H. influenzae and Pseudomonas Aeruginosa
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Seizure Risk
Seizure Risk
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PEA (Pseudomonas, Enterococci, Acinetobacter).
PEA (Pseudomonas, Enterococci, Acinetobacter).
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Vaborbactam
Vaborbactam
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Study Notes
- Beta-lactams, monobactams, and carbapenems can encounter resistance through drug inactivation by β-lactamases, changes to PBP targets, or decreased diffusion via porin channels.
Carbapenems
- Carbapenems share side effects with penicillins, along with an increased risk of seizures, especially with imipenem. Meropenem poses the lowest seizure risk.
- Should be used cautiously with CNS stimulants, as carbapenems can increase the risk of seizures.
- Can decrease levels of valproic acid.
- Consist of imipenem-cilastatin, meropenem, meropenem/vaborbactam, and ertapenem.
- Exhibit a broad spectrum of activity, effective against many gram-positive, gram-negative, and anaerobic organisms, including β-lactam-producing E. coli, Klebsiella, H. influenzae, SPACE organisms, and ESBLs.
- Ertapenem is not effective against PEA (Pseudomonas, Enterococci, Acinetobacter).
- All carbapenems except ertapenem are effective against Pseudomonas aeruginosa, Enterococci, and Acinetobacter.
- Side effects include seizures, particularly in those with renal impairment or a history of seizure disorders.
- Can be inactivated by carbapenemases, which are a type of β-lactamase produced by K. pneumoniae, E. coli, E. aerogenes, and others.
- Vaborbactam is a β-lactamase inhibitor.
- Bactericidal
Monobactams
- Side effects include hypersensitivity reactions (rash, hives, dyspnea, throat swelling), nausea, vomiting, diarrhea, interstitial nephritis, a positive direct Coombs test, hemolytic anemia (with prolonged use), and seizures, especially in individuals with renal dysfunction.
- Composed of aztreonam.
- Effective solely against gram-negative organisms, including both non-β-lactam-producing and β-lactam-producing E. coli, Klebsiella, H. influenzae, and Pseudomonas aeruginosa.
- Safe for use in patients with allergies to penicillins, cephalosporins, or carbapenems.
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