Antibiotics against Gram +

Question 1

What are the glycopeptides?

Answer 1

vancomycin
teicoplanin
dalbavancin
telavancin
oritavancin

Question 2

What 2 infections increased use of vanco?

Answer 2

MRSA

PRSP

Question 3

What is the MOA of vanc?

Answer 3

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

Question 4

What part of cell wall precursors does vanco bind to?

Answer 4

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

Question 5

Is vanc time or conc dependent?

Answer 5

TIME (bacteriocidal)

Question 6

What is the MOR in vanc?

Answer 6

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

3 phenoytpes (vanA, B, C)

Question 7

What is the spectrum of activity of vanc?

Answer 7

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

Question 8

Does vanc have activity against gram negatives?

Answer 8

NO

Question 9

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

Answer 9

aztreonam

Question 10

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

Answer 10

TBW (distributes to adipose too)

Question 11

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

Answer 11

one hour

Question 12

What does elimination half life depend on for vanc?

Answer 12

renal function (NOT removed by hemodialysis though)

Question 13

When do you draw a vanc peak?

Answer 13

60 min post infusion

Question 14

When do you use oral vancomycin?

Answer 14

moderate to severse C. diff colitis

Question 15

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

Answer 15

red-man syndrome (related to RATE of infusion)

resolves spontaneously

Question 16

What are 2 major adverse effects of vanc?

Answer 16

1) nephrotoxicity
2) ototoxicity

(also dermatologic, hematologic, thrombophlebitis, interstitial nephritis)

Question 17

What is the second generation glycopeptide?

Answer 17

dalbavancin

Question 18

When is dalbavancin used?

Answer 18

against vanc resistant enterococcus

Question 19

When and how do you give dalbavancin?

Answer 19

1x per week (IV)

Question 20

How is dalbavancin eliminated?

Answer 20

kidney (NOT hemodialysis)

Question 21

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

Answer 21

oxazolidinones (linezolid)

Question 22

What is the MOA of linezolid?

Answer 22

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

Question 23

What is the MOR of linezolid?

Answer 23

alterations in ribosomal binding sites

Question 24

What diseases call for linezolid?

Answer 24

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

Question 25

What gram negative diseases does linezolid treat?

Answer 25

NONE

Question 26

What is special about the pharmacology of linezolid?

Answer 26

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

Question 27

How well does linezolid penetrate the CSF?

Answer 27

30%

Question 28

Do you need to adjust linezolid for renal insufficiency?

Answer 28

NO (removed by HD)

Question 29

What is a downside of linezolid?

Answer 29

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

Question 30

What is the significance of taking SSRIs before linezolid?

Answer 30

interaction (can get serotonin syndrome) | enhancement of pressor response

Question 31

What is the BIGGEST adverse effect of linezolid?

Answer 31

thrombocytopenia (after 10-14 days) also get peripheral neuropathy and lactic acidosis

Question 32

What is Tedizolid and what is benefit of it?

Answer 32

bacterial SSSI NO SSRI interaction

Question 33

What is the main lipopeptide?

Answer 33

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

Question 34

What is the MOA of daptomycin?

Answer 34

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

Question 35

What is the MOR of daptomycin?

Answer 35

not much

Question 36

What is the spectrum of activity for daptomycin?

Answer 36

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

Question 37

Is daptomycin conc or time dependent?

Answer 37

Conc

Question 38

Do you change dapto dosing based on RI?

Answer 38

yes (renally eliminated)

Question 39

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

Answer 39

inactivated by surfactant

Question 40

What is the main adverse effect of daptomycin?

Answer 40

myopathy and CPK elevation

Question 41

how do quinupristin and dalfopristin function?

Answer 41

protein synth inhibitors