Oxazolidinone, Daptomycin, Lefamulin, Chloramphenicol

Question 1

Linezolid
- Resistance Mechanism

Answer 1

• Mutation to 23s ribosome to prevent binding
• Methylation of ribosome
• Other binding site modifications
• Efflux

Question 2

Linezolid
- Adverse Effects

Answer 2

Optic Neuropathy (Reversible early)
Peripheral Neuropathy (Poorly reversible)

Blood Dyscrasias

Lactic Acidosis

Serotonin Syndrome

Question 3

Tedizolid
- Adverse Effects

Answer 3

Same as linezolid just less frequently

Question 4

Linezolid
- Counseling

Answer 4

No need for renal adjustment

100% bioavailable, is rapidly absorbed

Question 5

Daptomycin
- Resistance Mechanism

Answer 5

Cell membrane modification

Question 6

Daptomycin
- Adverse Effects

Answer 6

Increased CPK
Rhabdomyolysis

Question 7

Daptomycin
- Counseling

Answer 7

May have to discontinue statin

Question 8

Lefamulin
- Resistance Mechanism

Answer 8

23s ribosome changes

Question 9

Lefamulin
- Adverse Effects

Answer 9

GI
Hypokalemia

Question 10

Lefamulin
- Counseling

Answer 10

CYP 3A4 metabolized

No need for renal adjustment

Question 11

Chloramphenicol
- Resistance Mechanism

Answer 11

• Cell impermeability to chloramphenicol
• Enzyme production to acetylate chloramphenicol

Question 12

Chloramphenicol
- Adverse Effects

Answer 12

Bone Marrow Related (Anemia, Thrombocytopenia)
- Reversible

Idiosyncratic A[lastic Anemia

Grey Baby Syndrome

Optic Neuritis

Question 13

Chloramphenicol
- Counseling

Answer 13

Absorbed well in adults but not pediatrics or hepatic failure patients (they lack liver enzymes)

Inhibits CYP enzymes
- Warfarin, Phenytoin, Tolbutamide, Chlorpropamide