ID I: ABX FOR GRAM POSITIVE INFECTIONS

Question 1

Vancomycin is a glycopeptide that inhibits bacterial cell wall synthesis by binding to…

Answer 1

D-alanyl-D-alanine cell wall precursor and blocking peptidoglycan polymerization

Question 2

Vancomycin coverage

Answer 2

Gram positive:

MRSA

Streptococci

Enterococci (not VRE obviously)

C diff (PO)

Question 3

You patient has a systemic infection, IV Vanco dosing is

Answer 3

IV 15-20mg/kg Q8H-12H

Question 4

Dosing for vancomycin is based on what weight

Answer 4

TOTAL body weight

Question 5

When CrCl is 20-49 for vancomycin, what’s the interval

Answer 5

Q24H

Question 6

Consider an alternate drug when MRSA MIC > ?

Answer 6

> 2mcg/mL

Question 7

What are warnings for vancomycin?

Answer 7

ototoxicity

nephrotoxicity

red man syndrome

Question 8

What is the vancomycin AUC/MIC ratio?

Answer 8

400-600

Question 9

Goal trough for Vancomycin?

Answer 9

15-20mcg/mL

Question 10

Vancomycin is first line for

Answer 10

MRSA

[pneumonia, meningitis, bacteremia, skin]

Question 11

What are the lipoglycopeptides?

Answer 11

Telavancin
Oritavancin
Dalbavancin

Question 12

Which lipoglycopeptide is approved for complicated skin and soft-tissue infections (SSTI) and hospital acquired and ventilator associated pneumonia?

Answer 12

telavancin

Question 13

Telavancin is infused over ___ mins to avoid infusion reactions

Answer 13

60 mins

Question 14

What are boxed warnings for lipoglycopeptides?

Answer 14

fetal risk

nephrotoxicity

Question 15

Your patient is receiving UFH, what can they NOT receive?

Answer 15

a lipoglycopeptide! contraindication with IV UFH

Question 16

What are the warnings for lipoglycopeptides?

Answer 16

can falsely INC coagulation tests (aPTT/PT/INR), does not increase bleeding risk

red man syndrome

Question 17

Oritavancin is contraindicated with

Answer 17

IV UFH - or 5 days

Question 18

What is a special note about lipoglycopeptides that is beneficial in terms of dosing?

Answer 18

extremely long half-life allows for a single dose regimen

Question 19

What is daptomycin’s MOA?

Answer 19

binds to cell membrane components, causing rapid depolarization; inhibits all intracellular replication processes, including protein synthesis and causes cell death

Question 20

What is the antibacterial activity of daptomycin?

Answer 20

concentration-dependent!

Question 21

Daptomycin coverage

Answer 21

staphylococci MRSA

and both VRE (E faecium and E faecalis)

Question 22

Brand: Cubicin

Answer 22

generic: daptomycin

Question 23

What infection do you absolutely NOT use daptomycin?

Answer 23

pneumonia!

the drug is inactivated in the lungs by surfactant

Question 24

Your patient is on daptomycin, what warnings should the healthcare team lookout for?

Answer 24

myopathy, rhabdomyolysis (D/C when CPK>1000u)

falsely increase PT/INR (no effect on bleeding)

Question 25

Your patient is receiving IV Cubicin, the nurse wants to know what it is compatible with

Answer 25

NS and LR (no dextrose)

Question 26

Daptomycin is approved for:

Answer 26

complicated SSTI MRSA bloodstream infection including right sided endocarditis

Question 27

Linezolid and tedizolid bind to the ___ subunit of the bacterial ribosome, inhibiting translation and protein synthesis

Answer 27

50S

Question 28

Linezolid coverage

Answer 28

MRSA VRE (E faecium and E faecalis)

Question 29

Brand: Zyvox

Answer 29

generic: linezolid

Question 30

The patient just received phenelizine (a MAO inhibitor) before linezolid...

Answer 30

NO!!!! do not use within 2 weeks

Question 31

Warnings for linezolid include...

Answer 31

duration-related myelosuppression (thrombocytopenia) optic neuropathy serotonin syndrome (SSRI, SNRI, TCAs!!!) hypoglycemia

Question 32

What are side effects of linezolid?

Answer 32

decrased platelets

Question 33

IV:PO linezolid

Answer 33

1: 1 * no dose adjustment in renal impairment ***do not shake

Question 34

This drug is a treptogramin

Answer 34

Synervid (Quin/Dalfo)

Question 35

Synercid binds to the ____ ribosomal subunit inhibiting protein synthesis

Answer 35

50S

Question 36

Synercid coverage

Answer 36

most gram positive: MRSA, VRE (NOT E Faecalis) approved for complicated SSTI, not well-tolerated

Question 37

Brand: synercid

Answer 37

generic: quinupristin/dalfopristin

Question 38

BIG side effects of synercid include...

Answer 38

arthralgias/myalgias infusion reactions (over 60 mins) hyperbilirubinemia

Question 39

Synercid is being administered to a patient, a nurse wants to know what it can be diluted in...

Answer 39

D5W only via central line