Monobactams/Carbapenems/Glycopeptides Flashcards Preview

Clinical Pharmacology > Monobactams/Carbapenems/Glycopeptides > Flashcards

Flashcards in Monobactams/Carbapenems/Glycopeptides Deck (25)
Loading flashcards...
1

Monobactams

Aztreonam

OK to use inpatient with anaphylactic rxn to PCN, unless the reaction is to ceftazidime

MOA and ADRs the same as other B lactams

2

Monobactam microbial coverage

Resistant aerobic GNBs (pseudomonas)

No gram + or anaerobes covered

3

Monobactam clinical indications

Mostly nosocomial infections

4

Pseudomonal carbapenems

Imipenem
Meropenem***
Doripenem

MOA/ADRs the same as other B lactams

5

Non-pseudomonal carbapenems

Ertapenem

MOA/ADRs same as other Beta lactams

6

Carbapenems microbial coverage

-Typically used for complicated infections caused by resistant GNB, MDR GNB, or ESBL GNB including Pseudomonas

-Extremely broad spectrum (G+, G-, anaerobes)

7

What organisms do carbapenems NOT cover?

MRSA
VRE
CRE
C diff

8

Carbapenems indications

Mostly nosocomial infections

9

Glycopeptides

VANCOMYCIN

MOA: cell wall synthesis inhibition

MOR: alteration in the binding site

10

Glycopeptide pharmacology

-overlapping toxicity with nephrotoxic agents (AG, contrast dye)
-renal excretion
-Time and concentration-dependent killing
-No oral absorption of PO formulation
-Bactericidal

***Slow the infusion (>60 min) to prevent Red Man Syndrome

11

Glycopeptide ADRs

Red man syndrome >>nephrotoxicity>>ototoxicity

12

Glycopeptide microbial coverage

Oral: C diff

IV/PAR: MRSA, MSSA, various streptococcal species, enterococci infections in PCN allergic pt

13

Cyclic lipopeptides

Daptomycin

-MOA: Binds to components of cell membrane --> rapid depolarization and inhibition of DNA/RNA production

14

Cyclic lipopeptide pharmacology

-may have overlapping toxicity profile with statins/fibrates (myalgias)
-D/c lipid agent while on abx

-renal excretion
-concentration-dependent bacterial killing

15

What is a pearl about cyclic lipopeptides and pneumonia?

-inactivated by surfactant --> Don't use!!!

16

Cyclic lipopeptides ADRs

Myopathy

Use with caution in pts receiving other myopathy inducing drugs (statins)

17

Cyclic lipopeptides microbial coverage

-use for MRSA and VRE
-use for MSSA, various streptococcal species, enterococci in PCN allergic pt

18

Cyclic lipopeptides indications

MRSA and VRE infections mostly

19

Lipoglycopeptides

1st gen
-Telavancin (Don't use!)

2nd gen
-Dalbavancin
-Oritavancin

20

Lipoglycopeptides MOA

Dual

-inhibit bacterial cell wall production
-disrupts the bacterial cell membrane function

21

Lipoglycopeptide interactions

Telavancin: QTc prolongation
Oritavancin: don't use UFH within 48 hours --> aPTT may be falsely elevated

22

Lipoglycopeptide pharm

-concentration-dependent killing
-renal excretion
-Infuse slowly to prevent Red Man syndrome

23

Lipoglycopeptide CI/precautions

-QT interval issues
-Women of childbearing age should have a serum pregnancy test prior to taking abx*** (BBW)

24

Lipoglyclopeptide ADRs

1st gen (Don't use)
-Telavancin causes foamy urine, taste disturbance, QTc prolongation, renal dysfunction

2nd gen
-Dalbavancin/oritavancin --> N/V/D, hypersensitivity rxn

25

Lipoglycopeptides microbial coverage

SSTI's caused by susceptible G+ bacteria including MRSA, VISA, VRSA, some VRE

Use as alternatives to vanco, Linezolid/tedizolid, daptomycin, tigecycline, ceftaroline