ABXSH3 Vancomycin/ AG/ Quinalones Flashcards
Vancomycin
VacOO : ototoxicity and nephrotoxicity
Spectrum : MRSA and all gram positives ( DOES Not cover gram negative )
MOA: works on the cell wall.
If PCN allergy can use vanco if needed.
AUC depended killing: the longer the patient on vanco the more the abx will kill. Want AUC /MIC ratio ≥ 400. 400 to 600 for severe infections
Peak and trough: trough more important. Dont want to go to a really high dose. Have to check trough. Need to be high enough to kill the organism.
Trough depends on bacteria were trying to kill.
15-20 mg/L trough: bacteremia, endocarditis, osteomyelitis, meningitis and HAP ( from staph aureus )
Trough levels taken at steady state usually before the 4th dose.
2nd line agent for C diff ( po form ). Vanco oral not used for anything else. It’s not absorbed. Stays in GI tract. If oral vanco unavailable patient can drink IV.
Vanco loading dose
What if rapid admin vanco: what reaction? Why?
Dose adjust in REnal?
Cdiff dosing?
1 gram IV Q 12 hour.
Loading dose: 25- 30 mg/kg and maintenance dose: 15-20 mg/kg. Dose over 1 hour.
Red man syndrome with rapid IV admin. Why? Due to histamine release. ( give antihistamine Benadryl over 1 hour)
CrCl > 50 : 15-20 mg/kg /dose ( 750 -1500 mg ) Q8-12 hrs
CrCl 20-49 : 15-20 mg/ kg dose QD
CrCl < 20 determined by serum concentration.
C Diff: 125 mg PO QID 10 days
Vancomycin Side effects
Nephrotoxicity and Ototoxicity ( watch for additive effects ( • cisplatin ) )
Red man syndrome
- occurs if rapid administration causing histamine release.
- give antihistamine ( Benadryl )
- you don’t stop med just that next time they give it you give it at least over 1 hour.
Aminoglycoside
Gentamycin , Tobramycin , amikacin
Gram Negative coverage .( reality is it covers some gram positive, but SE too severe for them )
MOA: inhibits protein synthesis by binding to ribosomal subunits
Coverage: pseudomonas and other gram ( – ).
SE: nephrotoxicity / ototoxicity
If severe nephrotoxicity, try aztreonam, ( a Monobactam )
Post antibiotic effect: after you stop giving it, it continues working.
Peak or trough: the peak the higher we give the more it kills.
If kids have tubes avoid aminoglycosides
T
Avoid otic AG like cortisporin ( neomycin, ,polymyxin B& hC)
- neomycin is the part you want to avoid. It could lead to ototoxicity and hearing loss.
Peaks and troughs
Trough: is drawn immediately before the next dose
Peak is drawn after infusion
Trough: the lowest amount that you have in your body. That means im going to check right before the next dose. The peak is the highest amount in your body. Check it after you give a dose.
With AG check peak
With vanco check trough.
Gentamicin
3-5 mg/kg/day IM/IV divided q8h
Daptomycin
Cubicin INNNNN normal saline ( NS ) like Unasyn , imipenem cilastinnnn all NS
IV only hospital only: vials are single use only. Eg) if 7 day course it’s 7 vials.
Gram positive only
Daptomycin aka DayOmycin: once daily
MOA: binds bac cell membrane and causes rapid depol of membrane. Loss of membrane potential. —> inhibition of protein, dna, rna, synthesis resulting in bacterial cell death.
Used for MRSA and MSSA skin infections. ( if MRSA pneumonia daptomycin will not work. It’ll bind to surfactant of lung and be inactive ) . Unlabeled VRE use.
SE: neuropathy & myopathy ( consider holding statins ) ( check CK at baseline then weekly )
Renal
Preg B
Flouroquinolones
MOA
Coverage?
Counseling?
DDI
Which patients to avoid?
MOA: inhibit bacterial DNA gyrase
Spectrum: gram ( - )and atypicals ( mycoplasma, legionella, & chlamydia )
Clinical use : CAP, UTI, STD’s
Avoid in children pts < 18 y/o and PREGNANCY : can cause arthropathy, cartilage erosion
Counseling: quinALONE ( separate 2 hours anatacids vitamins didanosine)
DDI : ↑theophylline, and ↑warfarin
Fluoroquinolones SE:
C in cipro : CNS ( seizures, HA, dizziness), crystalluria ( nephrotoxicity crystal formations in kidneys )
O in cipro: sunshine : phototoxicity , make o in the end like a q : QT prolongation
R in cipro : RUPTURE of the tendon BBW( especially if on patient on corticosteroid )
Pseudo membranous colitis if you take multiple abs together
P in cipro: peripheral neuropathy, especially weakness in pts with Myasthenia Gravis
Tube feeding: might reduce bioavailability. Stop tube feeding 2 hour before and 4 hour after quinolones
Fluoroquinolones generations
2nd : CIPRO, ofloxacin ( comes in otic formulation , opthalmic, PO )
Cover gram ( - ) pseudomonas included ) , we can use it for UTI
* never use 2nd gen for community acquired pneumonia
3rd Gen : Levofloxacin ( MSSA, gram ( - ), atypical, CAP, can use UTI ( but too big of a gun, we should use cipro ))
4th gen: gatifloxacin, moxifloxacin ( never for UTI doesn’t get there )
Delafloxacin ( baxdela ) : ( PO/ IV ) MRSA , strep, E. coli, Klebsiella, Enterobacter, Pseudomonas
CIPRO
CIPRO XR ( once daily ) , ProQuin XR ) -comes in otic, and opthalmic
IV is 80% of the oral
Reduced in renal impairment
DDI : Cyp1A2 so can increase theophylline and
Caffeine increases too ( decrease caffeine )
QuinALONE 2 hours before and 6 hours after ( antacids , ca etc )
OATP inhibitors : orange, apple, green tea can decrease cipro
DO NOT GIVE oral suspension through feeding tube. Just crush immediate release tab and put through.
OTovel
Ciloxan
OTovel: ciproflox + fluocinolone
Ciloxan : ciprofloxacin ointment for the eye
3rd Gen Levofloxacin
Levaquin
IV/PO dose are the same
If you see levofloxacin for 28 days, you assume it’ll be for a male patient for chronic bacterial prostatitis
DDI: increases INR , and glyburide
It can give false positive opioid test.
Dose adjustment in renal impairment.
