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Questions and Answers
Which of the following mechanisms contributes to bacterial resistance against both monobactams and carbapenems?
Which of the following mechanisms contributes to bacterial resistance against both monobactams and carbapenems?
- Drug inactivation by beta-lactamases (correct)
- Ribosomal methylation
- Efflux pump overexpression
- Modification of the bacterial cell wall structure
A patient with a known penicillin allergy requires broad-spectrum antibiotic coverage. Which of the following agents would be most appropriate, considering potential cross-reactivity and spectrum of activity?
A patient with a known penicillin allergy requires broad-spectrum antibiotic coverage. Which of the following agents would be most appropriate, considering potential cross-reactivity and spectrum of activity?
- Imipenem-cilastatin
- Ceftriaxone
- Aztreonam (correct)
- Amoxicillin-clavulanate
Which of the following carbapenems does NOT cover Enterococcus species?
Which of the following carbapenems does NOT cover Enterococcus species?
- Meropenem
- Imipenem-cilastatin
- Meropenem/vaborbactam
- Ertapenem (correct)
A patient with a history of seizures is prescribed a carbapenem antibiotic. Which agent would pose the LEAST risk of inducing a seizure?
A patient with a history of seizures is prescribed a carbapenem antibiotic. Which agent would pose the LEAST risk of inducing a seizure?
A patient is receiving valproic acid for seizure control. Concurrent administration of which carbapenem could significantly reduce valproic acid levels, potentially leading to breakthrough seizures?
A patient is receiving valproic acid for seizure control. Concurrent administration of which carbapenem could significantly reduce valproic acid levels, potentially leading to breakthrough seizures?
Which mechanism is LEAST likely to contribute to bacterial resistance against aztreonam?
Which mechanism is LEAST likely to contribute to bacterial resistance against aztreonam?
A patient develops hemolytic anemia during prolonged aztreonam therapy. Which of the following best explains the mechanism?
A patient develops hemolytic anemia during prolonged aztreonam therapy. Which of the following best explains the mechanism?
A hospital faces an outbreak of carbapenem-resistant Klebsiella pneumoniae (CRKP) producing a carbapenemase. Which carbapenem-based therapy would likely retain activity against this CRKP strain?
A hospital faces an outbreak of carbapenem-resistant Klebsiella pneumoniae (CRKP) producing a carbapenemase. Which carbapenem-based therapy would likely retain activity against this CRKP strain?
Which of the following organisms is LEAST likely to be effectively treated with aztreonam?
Which of the following organisms is LEAST likely to be effectively treated with aztreonam?
A patient with renal impairment requires treatment for a gram-negative infection. Which agent requires the MOST careful dose adjustment based on renal function to minimize the risk of seizures?
A patient with renal impairment requires treatment for a gram-negative infection. Which agent requires the MOST careful dose adjustment based on renal function to minimize the risk of seizures?
Flashcards
Beta-Lactam Resistance
Beta-Lactam Resistance
Drug inactivation by B-lactamases, altered PBP targets, and reduced diffusion through porin channels.
Carbapenems List
Carbapenems List
Imipenem-cilastatin, meropenem, meropenem/vaborbactam, and ertapenem.
Carbapenem Spectrum
Carbapenem Spectrum
Broad spectrum, active against gram-positive, gram-negative, and anaerobic organisms. Ertapenem does not work against PEA (Pseudomonas, Enterococci, Acinetobacter).
Carbapenem Side Effects
Carbapenem Side Effects
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Vaborbactam
Vaborbactam
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Monobactam Example
Monobactam Example
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Monobactam Spectrum
Monobactam Spectrum
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Monobactam Side Effects
Monobactam Side Effects
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Monobactam Allergy Use
Monobactam Allergy Use
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Study Notes
- Beta-lactams, including monobactams and carbapenems, can encounter resistance through drug inactivation by B-lactamases, altered PBP targets, and reduced diffusion via porin channels.
Carbapenems
- Carbapenems' side effects are similar to those of penicillin, but with the added risk of seizures, highest with imipenem and lowest with meropenem.
- Carbapenems can decrease levels of valproic acid and increase seizure risk when taken with CNS stimulants.
- Carbapenems include imipenem-cilastatin, meropenem, meropenem/vaborbactam, and ertapenem.
- Carbapenems have a broad spectrum of activity, effective against gram-positive, gram-negative, and anaerobic organisms, including beta-lactam-producing E. coli, Klebsiella, H. influenzae, SPACE, and ESBL.
- Ertapenem is not effective against PEA (Pseudomonas aeruginosa, Enterococci, Acinetobacter).
- All carbapenems except ertapenem are active against Pseudomonas aeruginosa, Enterococci, and Acinetobacter.
- Side effects of carbapenems include seizures, especially in patients with renal impairment or a history of seizure disorder.
- Carbapenems can be inactivated by carbapenemases (a type of beta-lactamase) produced by K. pneumoniae, E. coli, E. aerogenes, and others.
- The risk of seizures is highest with imipenem/cilastatin and lowest with meropenem.
- Vaborbactam is a beta-lactamase inhibitor.
- Carbapenems are bactericidal.
Monobactams
- Monobactams can cause hypersensitivity reactions (rash, hives, dyspnea, throat swelling), nausea, vomiting, diarrhea, interstitial nephritis, a positive Direct Coombs test, hemolytic anemia (with prolonged administration), and seizures (especially with renal dysfunction).
- Monobactam includes aztreonam.
- Monobactam is only effective against gram-negative organisms, both non-beta-lactam-producing and beta-lactam-producing E. coli, Klebsiella, H. influenzae, and Pseudomonas aeruginosa.
- Monobactam can be used in patients allergic to penicillins, cephalosporins, or carbapenems.
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