Exam 2 - Vancomycin & GP agents

Question 1

what are the two main groups Vanc has coverage for

Answer 1

GP aerobic and anaerobic

Question 2

what target organisms does vanc cover

Answer 2

PSSP
PRSP
Enterococcus
MSSA
MRSA
C. diff (PO dose only)

Question 3

GN coverage of Vanc

Answer 3

none

Question 4

what is vanc THE drug of choice for

Answer 4

MRSA
C. diff (po dose only)

Question 5

clinical uses of vanc

Answer 5

MRSA infections (even in the CNS)
Serious GP infections for pts allergic to penicillins
PRSP infections/resistant GP organisms
prophylaxis of high risk surgeries

Question 6

GP coverage for synercid

Answer 6

PSSP
PRSP
Enterococcus Faecium ONLY (including VRE)
MSSA
MRSA

Question 7

GN and atypical coverage for vanc

Answer 7

none

Question 8

when to use synercid

Answer 8

only when vanc, linezolid, and daptomycin cannot be used
Enterococcus faecium (VRE)

Question 9

GP coverage for linezolid

Answer 9

PSSP, PRSP
Enterococcus faecium AND faecalis (including VRE)
MSSA, MRSA, VISA, VRSA

Question 10

GN and atypical coverage for linezolide

Answer 10

none

Question 11

when to use linezolid

Answer 11

when vanc or b-lactams cannot be used
-VRE infections
-Nosocomial pneumonia from MRSA

Question 12

what is linezolid the drug of choice for

Answer 12

VRE infections

Question 13

GP coverage of daptomycin

Answer 13

PSSP, PRSP
Enterococcus Faecium AND Faecalis (including VRE)
MSSA, MRSA, VISA, VRSA, LRSA

Question 14

GN coverage of daptomycin

Answer 14

NONE

Question 15

when to use daptomycin

Answer 15

when vanc and linezolid cant be used
-staph aureus bacteremia and endocarditis
-MRSA or VRE

Question 16

what infection should daptomycin NOT be used in

Answer 16

treatment of pneumonia
due to inactivation by pulmonary surfactant

Question 17

what are the lipoglycopeptides

Answer 17

telavancin, dalbavancin, oritavancin

Question 18

GP coverage for lipoglycopeptides

Answer 18

PSSP, PRSP
Enterococcus Faecium and Faecalis
Staph A infections

Question 19

what place in therapy are lipoglycopeptides for GP bugs

Answer 19

last line

Question 20

vanc moa

Answer 20

-inhibits synthesis of cell wall at different site than B-lactams
-inhibits synthesis and assembly during second stage (D-ala-D-ala)
-prevents cross linking

Question 21

what kind of killers are vanc

Answer 21

bactericidal slooooooow killers

Question 22

what is the resistance against vanc

Answer 22

Showed in Enterococcus (VRE) and Staph A (VRSA) due to modification of the D-ala to d-lactate
also in VISA due to thickening of cell wall

Question 23

what do you target for clinical efficacy of vanc

Answer 23

AUC/MIC

Question 24

what is the route of admin for vanc

Answer 24

IM and IV (preferred)

Question 25

where does vanc distribute

Answer 25

widely distributed (adipose) AND the CNS even w/ inflamed meninges

Question 26

how long does vanc take to distribute

Answer 26

one hour

Question 27

what weight do you use to dose vanc

Answer 27

TBW

Question 28

how is vanc eliminated

Answer 28

unchanged by the kidneys

Question 29

what is the half life of vanc and how can it be affected

Answer 29

6-8 hours and increases as renal function decreases (7-14 days)

Question 30

is vanc removed during dialysis

Answer 30

somewhat 30-40%

Question 31

why should serum conc. be monitored with vanc

Answer 31

high concentrations can lead to nephrotoxicity

Question 32

when to draw concentrations for vanc

Answer 32

Peak: one hour after end of infusion Trough: just prior to dose

Question 33

what should doses not exceed for vanc

Answer 33

2000-3000mg

Question 34

what are the adverse effects of vanc

Answer 34

Red-Man Syndrome Nephrotoxicity Ototoxicity Dermatologic Hematologic

Question 35

what can cause red-man syndrome

Answer 35

rate of the vanc infusion

Question 36

how to mitigate red-man syndrome

Answer 36

vanc doses of 1g should be infused over at least 1 hour and larger doses over 90-120 minutes

Question 37

what are risk factors for nephro and ototoxicity for vanc

Answer 37

underlying renal insufficiency

Question 38

synercid moa

Answer 38

on the 50S subunit

Question 39

what kind of killer is synercid

Answer 39

time dependent bacteriostatic alone and bactericidal together

Question 40

what is the resistance against synercid

Answer 40

alteration of ribosomal binding site by the erm gene

Question 41

does synercid have a PAE

Answer 41

yes and allows for extended dosing

Question 42

does synercid need to be adjusted for anything?

Answer 42

no adjustment for renal insufficiency should adjust in hepatic insufficiency

Question 43

DDIs of synercid

Answer 43

statins immunosuppressors (cyclosporine and tacrolimus) Carbamazepine

Question 44

what are the AEs for synercid

Answer 44

vein irritation GI myalgias/arthralgias rash

Question 45

linezolid moa

Answer 45

binds to 50s subunit near the 30s to prevent 70s complex inhibits protein synthesis

Question 46

what kind of killers are linezolid

Answer 46

bacteriostatic

Question 47

what is the resistance against linezolid

Answer 47

alteration of subunit target (not erm though)

Question 48

does linezolid have PAE

Answer 48

yes

Question 49

what is the absorption for linezolid

Answer 49

100% oral bioavailability

Question 50

what is the distribution of linezolid

Answer 50

readily distributes into well-perfused tissues limited CSF access

Question 51

how is linezolid eliminated

Answer 51

renal and hepatic

Question 52

dose adjustments for linezolid

Answer 52

none for renal insufficiency

Question 53

DDIs of linezolid

Answer 53

weak inhibitors of Monoamine oxidase serotonin syndrome

Question 54

can linezolid be used with SSRIs

Answer 54

yes, but you have to counsel patient on how to monitor for serotonin syndrome

Question 55

what are the adverse effects of linezolid

Answer 55

GI peripheral and optic neuropathy thrombocytopenia and anemia

Question 56

what should ALWAYS be checked before starting linezolid

Answer 56

SSRI use and platelets < 50,000

Question 57

daptomycin moa

Answer 57

binds to membrane and inserts tail into cell wall

Question 58

what kind of killer is daptomycin

Answer 58

rapid concentration dependent bactericidal activity

Question 59

what is the resistance against daptomycin

Answer 59

altered cell-membrane (rare)

Question 60

route of admin for dapto

Answer 60

IV only

Question 61

distribution of daptomycin

Answer 61

fairly well into tissue NO CNS

Question 62

elimination of daptomycin

Answer 62

via the kidneys

Question 63

dosage adjustment of daptomycin

Answer 63

required for renal insufficiency

Question 64

DDI of daptomycin

Answer 64

statins

Question 65

adverse effects of daptomycin

Answer 65

GI Headache Injection site reactions Rash Myopathy and CPK elevation Acute eosinophilic penumonia

Question 66

moa of lipoglycopeptides

Answer 66

interfere with d-ala-d-ala *only oritavancin and telavancin will insert the tail)*

Question 67

resistance against lipoglycopeptides

Answer 67

alteration in the D-ala to D-lactate

Question 68

what kind of killers are lipoglycopeptides

Answer 68

concentration-dependent bactericidal activity

Question 69

distribution of lipoglycopeptides

Answer 69

well into tissues NO CNS

Question 70

what lipoglycopeptides are removed by HD

Answer 70

none

Question 71

what lipoglycopeptides need adjusted for renal insufficiency

Answer 71

telavancin and dalbavancin

Question 72

what lipoglycopeptide does NOT need adjusted for renal

Answer 72

oritavancin

Question 73

adverse effects of lipoglycopeptides

Answer 73

red man syndrome nephrotoxicity QTc - prolongation taste disturbances

Question 74

what is the risk you run with lipoglycopeptides?

Answer 74

if a patient experiences a bad reaction, the half-life is so long they will take a while to go away

Question 75

lipoglycopeptides in pregnancy

Answer 75

telavancin has a black box warning for pregnancy dalba and orita are also due to lack of studies