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Pharmacology > Antibiotics against Gram + > Flashcards

Antibiotics against Gram + Flashcards

1
Q

What are the glycopeptides?

A 
vancomycin
teicoplanin
dalbavancin
telavancin
oritavancin
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2
Q

What 2 infections increased use of vanco?

A

MRSA

PRSP

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3
Q

What is the MOA of vanc?

A

inhibits cell wall synthesis at site DIFFERENT than beta lactams (inhibits second stage)

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4
Q

What part of cell wall precursors does vanco bind to?

A

D-alany-D-alanine (prevents further cross linking and elongation)

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5
Q

Is vanc time or conc dependent?

A

TIME (bacteriocidal)

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6
Q

What is the MOR in vanc?

A

modification of D-alanyl-D-alanine binding site of PG

3 phenoytpes (vanA, B, C)

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7
Q

What is the spectrum of activity of vanc?

A

ONLY GRAM POSITIVE (MRSA, MSSA, PRSP, C. diff, corynebacterium, bacillus, listeria, actinomyces, enterococcus)

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8
Q

Does vanc have activity against gram negatives?

A

NO

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9
Q

What is the drug that has the opposite SOA in that it only does gram neg?

A

aztreonam

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10
Q

Do you use lean mass or total body weight for dosing vanc?

A

TBW (distributes to adipose too)

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11
Q

How long does it take to distribute vanc from plasma into tissues?

A

one hour

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12
Q

What does elimination half life depend on for vanc?

A

renal function (NOT removed by hemodialysis though)

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13
Q

When do you draw a vanc peak?

A

60 min post infusion

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14
Q

When do you use oral vancomycin?

A

moderate to severse C. diff colitis

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15
Q

What is the name of the syndrome caused when patient gets flushing immediately following bolus of vanc?

A

red-man syndrome (related to RATE of infusion)

resolves spontaneously

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16
Q

What are 2 major adverse effects of vanc?

A

1) nephrotoxicity
2) ototoxicity

(also dermatologic, hematologic, thrombophlebitis, interstitial nephritis)

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17
Q

What is the second generation glycopeptide?

A

dalbavancin

18
Q

When is dalbavancin used?

A

against vanc resistant enterococcus

19
Q

When and how do you give dalbavancin?

A

1x per week (IV)

20
Q

How is dalbavancin eliminated?

A

kidney (NOT hemodialysis)

21
Q

What was developed in response to vanc resistant bugs? (VRE, MRSA, VISA)

A

oxazolidinones (linezolid)

22
Q

What is the MOA of linezolid?

A

binds to 50S subunit to inhibit prot synth (BACTERIOSTATIC)

23
Q

What is the MOR of linezolid?

A

alterations in ribosomal binding sites

24
Q

What diseases call for linezolid?

A

MRSA, MSSA, VRSA, PRSP, enterococcus faecium and faecalis

25
Q

What gram negative diseases does linezolid treat?

A

NONE

26
Q

What is special about the pharmacology of linezolid?

A

100% bioavailable regardless of route of administration (oral or IV)

27
Q

How well does linezolid penetrate the CSF?

A

30%

28
Q

Do you need to adjust linezolid for renal insufficiency?

A

NO (removed by HD)

29
Q

What is a downside of linezolid?

A

EXPENSIVE (reserve use for serious infections by RESISTANT GRAM POS)

30
Q

What is the significance of taking SSRIs before linezolid?

A

interaction (can get serotonin syndrome)

enhancement of pressor response

31
Q

What is the BIGGEST adverse effect of linezolid?

A

thrombocytopenia (after 10-14 days)

also get peripheral neuropathy and lactic acidosis

32
Q

What is Tedizolid and what is benefit of it?

A

bacterial SSSI

NO SSRI interaction

33
Q

What is the main lipopeptide?

A

daptomycin (use for resistant gram positives VRE, MRSA, VISA)

34
Q

What is the MOA of daptomycin?

A

binds to bact membrane and depolarizes it (no more prot or nuc synthesis)

35
Q

What is the MOR of daptomycin?

A

not much

36
Q

What is the spectrum of activity for daptomycin?

A

MRSA, MSSA, VRSA, PRSP, enterococcus faecium and faecalis

37
Q

Is daptomycin conc or time dependent?

A

Conc

38
Q

Do you change dapto dosing based on RI?

A

yes (renally eliminated)

39
Q

Why can you not use daptomycin in the treatment on pneumonia?

A

inactivated by surfactant

40
Q

What is the main adverse effect of daptomycin?

A

myopathy and CPK elevation

41
Q

how do quinupristin and dalfopristin function?

A

protein synth inhibitors

Pharmacology (21 decks)

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