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PC2 > Lipoglycopeptides > Flashcards

Lipoglycopeptides Flashcards

1
Q

What is Telavancin

A

semi-synthetic derivative of vancomycin

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2
Q

Telavancin MOA

A

dual:

  • interferes with cell wall synthesis by binding to the d-ala-d-ala terminus of peptidoglycan precursors
  • binding to cell membranes causing membrane depolarization and increased membrane permeability
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3
Q

Telavancin spectrum coverage

A

ONLY GRAM +
dark purple: streptococcus, s. pneumoniae, viridans, MSSA, MRSA, E. faecalis, E. faecium
light purple: VRE
anaerobes: gram +

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4
Q

Dalbavancin spectrum coverage

A

ONLY GRAM +
dark purple: streptococcus, s. pneumoniae, viridans, MSSA, MRSA, E. faecalis, E. faecium
light purple: VRE
anaerobes: gram +

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5
Q

Oritavancin spectrum coverage

A

ONLY GRAM +
dark purple: streptococcus, s. pneumoniae, viridans, MSSA, MRSA, E. faecalis, E. faecium
light purple: VRE
anaerobes: gram +

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6
Q

Lipoglycopeptides have poor activity against

A

enterococcus species with VanA

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7
Q

Telavancin oral absorption

A

poor, IV only

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8
Q

Telavancin 1/2 life

A

6-8 hours; long

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9
Q

Telavancin elimination

A

64-76% renal

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10
Q

Telavancin dosing

A

usually 24-48 hours depending on CrCl

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11
Q

Telavancin adverse effects

A

*taste disturbance
*nausea
*vomiting
*foamy urine
renal
rigors
infusion-related
*red man syndrome
*QT prolongation
*contraindicated in pregnancy
clinicians are also cautioned to consider renal function

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12
Q

Telavancin is okay/not okay for pregnancy

A

NOT OKAY

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13
Q

Telavancin drug interactions

A

phospholipid agents used in measuring activated partial thromboplastin time, prothrombin time, and coag-based factor X assays

co-administration with heparin is contraindicated

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14
Q

Long acting lipoglycopeptides

A

Dalbavancin, ortivancin

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15
Q

Long acting lipoglycopeptide MOA

A

binds to d-ala-d-ala terminus of lipid II in peptidoglycan chain

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16
Q

Dalbavancin is a _____ lipoglycopeptide

A

semi-synthetic

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17
Q

Dalbavancin has enhanced ____activity

A

gram +

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18
Q

Dalbavancin has ___MICs compared to vancomycin to s. aureus

A

lower

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19
Q

Dalbavancin is active/inactive against enterococcus with vanB and vanC

A

active; potent

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20
Q

Dalbavancin is active/inactive against enterococcus with vanA

A

inactive

21
Q

Dalbavancin oral absorption

A

poor, IV only

22
Q

Dalbavancin 1/2 life

A

long 8.5 hours

23
Q

Dalbavancin elimination

A

33% renal

24
Q

PK/PD parameter used for glycopeptides and lipoglycopeptides

A

AUC:MIC

25
Q

Dalbavancin is/is not dialyzable

A

is not

26
Q

Dalbavancin is dosed

A

single or two-dose regimens; administer over 30 min

27
Q

Dalbavancin reconstitutes with

A

sterile water or 5% dextrose

28
Q

Dalbavancin adverse reactions

A

rapid infusion can cause red man syndrome
nausea
headache
diarrhea

29
Q

Dalbavancin drug interactions

A

minimal

30
Q

Oritavancin is a ____lipoglycopeptide

A

synthetic

31
Q

Oritavancin has improved activity over

A

VSE and VRE

32
Q

Oritavancin also have improved

A

anchoring to cell membrane and longer 1/2 life

33
Q

Oritavancin is potent against

A

MSSA, MRSA, VRE, VSE, streptococcus

remains active against Van A VRE

34
Q

Oritavancin oral absorption

A

poor, IV only

35
Q

Oritavancin 1/2 life

A

245 hours REALLY LONG

36
Q

Oritavancin elimination

A

very slow renal, <5%

37
Q

Can Oritavancin be dialyzable?

A

no

38
Q

Oritavancin PK/PD parameters

A

AUC:MIC and Cmax: MIC

39
Q

Oritavancin dosing

A

1200mg administered over 3 HOURS

40
Q

Oritavancin reconstitutes with

A

D5W, incompatible with NS

41
Q

Oritavancin renal adjustment

A

no

42
Q

What can happen if infusion is less than 3 hours for Oritavancin?

A

infusion-related reactions such as flushing, urticaria, pruritus, and rash

43
Q

Oritavancin drug interactions

A

contraindicated with heparin
can prolong prothrombin time and international normalized ratio for up to 12 hours
(monitoring of warfarin is unreliable for up to 12 hours after dose)

44
Q

Oritavancin adverse effects

A

nausea
vomiting
headache
more cases of osteomyelitis than in vancomycin

45
Q

Indications for long acting lipoglycopeptides

A

avoidance of hospitalization
minimize extended hospitalization/early discharge
prevent need for IV therapy in select patient populations (non compliance or inability to maintain IV access)

46
Q

Which of the following past medical history should be considered prior to administration of oritavancin?

a. DVT
b. Congestive heart failure
c. asthma
d. hypothyroidism

A

b since you have to reconstitute with 1000ml D5W

47
Q

Telavancin has dual mechanism of action in that it acts at the:

a. cell membrane and ribosome
b. cell membrane and cell wall
c. cell wall and ribosome
d. ribosome and DNA gyrase

A

b

48
Q

Which medication would you recommend for a homeless patient who has a history of 1 week cellulitis?

A

Dalbavancin bc can be given as a single dose and doesn’t need to be hospitalized/afford that kind of care

49
Q

Lipoglycopeptides are bactericidal/bacteriostatic

A

bactericidal

PC2 (18 decks)

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