potoski exam 1 stuff

Question 1

SOA Vancomycin?

Answer 1

Active: Gram (+) cocci, bacilli
Great for MRSA

inactive: gram negative

Question 2

dosage form of vanco

Answer 2

IV for systemic, PO for C. difficile

Question 3

how is vanco eliminated

Answer 3

renal elimination

Question 4

therapeutic drug monitoring parameters for vanco

Answer 4

nephrotoxicity– AUC:MIC ratio is 400-600
serum trough concentrations 15-20 mcg/mL for serious infections

Question 5

daptomycin dosage forms

Answer 5

IV only
not absorbed PO

Question 6

daptomycin dosing

Answer 6

once daily dosing
dose adjustment in renal insufficiency

Question 7

daptomycin cannot be used for _______, because ______

Answer 7

pneumonia, it is inactivated by lung surfactant

Question 8

daptomycin spectrum of activity

Answer 8

Primarily active against aerobic Gram (+): S. aureus (including MRSA), strep. pyogenes, enterococcus faecalis and faecium (both vanco-sensitive and vanco-resistant strains)

INACTIVE AGAINST GRAM NEGATIVE, DRUG CANNOT PENETRATE THE GRAM NEGATIVE OUTER MEMBRANE

Question 9

indications for daptomycin

Answer 9

therapy of complicated skin/skin structure infections produced by susceptible strains of gram (+) aerobes: MSSA, MRSA, strep, enterococcus faecalis

therapy of MRSA and MSSA bacteremia

other off label uses for MRSA

Question 10

adverse reactions to daptomycin

Answer 10

rhabdomyolysis

injection site reactions, GI upset, CNS

Question 11

FDA warning for daptomycin

Answer 11

eosinophilic pneumonia (therapy is cessation of drug and administration of steroids)

Question 12

how to mitigate rhabdomyolysis with daptomycin

Answer 12

monitor CPK at baseline then weekly. D/c drug if CPK> 10x ULN or symptomatic with CPK> 5x ULN

Question 13

what is the mechanism of daptomycin?

Answer 13

formation of a porin, allows for leakage of intracellular components, cell dies

Question 14

linezolid dosage forms

Answer 14

IV and PO
PO bioavailability is 100%

Question 15

linezolid is a ______

Answer 15

oxazolidinone

Question 16

linezolid penetrates ___

Answer 16

CNS

Question 17

linezolid activity

Answer 17

aerobic gram (+) bacteria: enterococcus faecium and faecalis, strep pneumoniae, viridans group strep, MRSA and MSSA, some anaerobic bacteria, mycobacteria

Question 18

linezolid indications

Answer 18

skin and skin structure infections, VRE infections, nosocomial pneumonia, CAP

Question 19

what are the side effects of linezolid?

Answer 19

thrombocytopenia, CNS, diarrhea, lactic acidosis, serotonin syndrome

Question 20

when is thrombocytopenia from linezolid highest risk

Answer 20

after 14 days

Question 21

why does serotonin syndrome happen from linezolid

Answer 21

MAO inhibitor

tedezolid doesn’t inhibit MAO, no serotonin syndrome

Question 22

what is the mechanism of linezolid

Answer 22

binds to 23S portion of 50S ribosomal subunit and distorts binding site so it can’t bind to 30S subunit, prevents formation of 70S ribosome

Question 23

telavancin dosage forms

Answer 23

IV only
not absorbed PO

Question 24

what to monitor for telavancin

Answer 24

CrCL; dosage adjustments in renal impairment

Question 25

telavancin spectrum of activity

Answer 25

MSSA and MRSA vancomycin-susceptible enterococcus faecalis strep

Question 26

indications for telavancin

Answer 26

complicated skin and skin structure infections HABP/VABP only when alternative treatments aren't available

Question 27

what is the BBW for telavancin

Answer 27

increased mortality with moderate/severe renal impairment

Question 28

what is the mechanism of action of telavancin

Answer 28

it is a derivative of vancomycin + structural modifications lipophilic side chain enhances cell wall disruptive activity phosphonic acid improves distribution and antibacterial activity

Question 29

ceftaroline dosage forms

Answer 29

IV only

Question 30

ceftaroline clinical utility

Answer 30

MRSA

Question 31

ceftaroline spectrum of activity

Answer 31

Good: strep, MSSA, MRSA, enteric GNRs moderate: acinetobacter, enterococci faecalis poor: enterococci faecium, pseudomonas, anaerobes

Question 32

what is the indication for ceftaroline

Answer 32

use in combination with daptomycin in patients that fail to clear

Question 33

what is the mechanism of ceftaroline

Answer 33

advanced generation cephalosporin with activity against MRSA because it binds to PBP 2a of MRSA that has a low affinity for other beta lactams

Question 34

there is an additional risk of nephrotoxicity if vancomycin is used concomitantly with ______

Answer 34

piperacillin/tazobactam

Question 35

vancomycin non-susceptible staphylococci include _________

Answer 35

vancomycin-intermediate staph. aureus (VISA) vancomycin-resistant staph. aureus (VRSA)

Question 36

what is the mechanism of VISA???

Answer 36

a thicker cell wall--> reduced cell wall cross linking

Question 37

what is the mechanism of VRSA?

Answer 37

D-ala D-ala changes to D-ala D-Lac

Question 38

common characteristics of VRSA

Answer 38

-co-infection/co-colonization with VRE (gets VanA gene from VRE via a transposon) -prior use of vanco -diabetes, ESRD, gangrenous wound, surgical wound

Question 39

linezolid dosing

Answer 39

fixed, not weight based 600 mg IV or PO q12h

Question 40

with linezolid, be careful with ____

Answer 40

SSRIs

Question 41

telavancin is a ______

Answer 41

semisynthetic cyclic lipoglycopeptide