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🄼 💊M2 PHARM EXAM 3 Rx > 9-10 Vancomycin/Linezolid/Daptomycin > Flashcards

9-10 Vancomycin/Linezolid/Daptomycin Flashcards

1
Q

VANCOMYCIN

  1. Concentration vs. Time-Dependent
  2. Bacteriostatic vs. BacteriCIDAL
A
  1. *TIME DEPENDENT
  2. *BacteriCIDAL that kills SLOWLY
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2
Q

VANCOMYCIN MOA

  1. Inhibits ______ [cell _____ assembly] stage
  2. How does it do this?
A
  1. Inhibits SECOND [cell wall assembly] stage
  2. Prevents [Cell Wall Cross-linking] by H-binding to DADA (D-alanyl-D alanine)
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3
Q

VANCOMYCIN

A: [Mechanism of Resistance] for [VRE and VRSA]

B: 3 phenotypes?

C: What is VISA and why is it Resistant?

A

A: [VRE and VRSA] change terminal D-alanine to D-lactate which disrupts a critical H-bonding site for Vanco

B: 3 phenotypes = vanA vs. vanB vs. vanC

C: VISA (vancomycin intermediate Stap Aureus) = thickened cell wall

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4
Q

VANCOMYCIN

A: What administration route is most used?

B: When is there an [administration route] exception?

B2: Vancomycin _____ distributes into all body areas including _____ tissue. Use ____ for dosing.

B2: Vancomycin has variable ___ penetration even with _____ meninges.

C: How long does it take to distribute from plasma into tissue? why?

D: Elimination

D2: How does this affect hemodialysis?

A

PHARMCOKINETICS - VANCOMYCIN

A: Use IV for systemic infections

A2: Due to [poor oral bioavail] use PO ONLY in patients with colitis);

B: Widely distributed, including into adipose (use TBW for dosing),

B2: variable CSF penetration even w/ inflamed meninges,

C: 1 hour to distribute from plasma into tissue because it is a VERY LARGE COMPOUND!

D: RENAL ELIMINATION: –> [Half-life] depends on renal function, watch CrCl.

D2: NOT removed by hemodialysis

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5
Q

VANCOMYCIN

A: Which [Gram (+) Bacteria] does it treat? (10)

A

VANCOMYCIN TREATS: Gram + Bacteria

  1. PRSP
  2. [Clostridium SPECIES]
  3. MSSA
  4. Corynebacterium
  5. Listeria
  6. [Actinomyces Israelii]
  7. [Strep Group A ONLY]
  8. SKETCHY
  9. [Virdans Strep]
  10. Bacillus

“learning [VANC] in PCM CLASS was VERY BORING”

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6
Q

VANCOMYCIN

A: Which [Gram negative Bacteria] does it treat?

A

NONE!

“Vancomycin is a PURPLE VAN ONLY”

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7
Q

VANCOMYCIN

A: Which [AnAerobes] does it treat?

B: Name 2 ungrouped bacteria it treats?

A

a. ONLY GRAM (+) AnAerobes

B: UNGROUPED:

  1. : Clostridium Peptococcus
    2: Peptostreptococcus
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8
Q

Why do you have to wait __ minutes to draw a peak for Vancomycin after its infusion ends?

A

draw at least 60 minutes AFTER THE INFUSIONS ENDS b/c equilibration is slow from plasma to tissues

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9
Q

Name 3 Clinical Uses for Vancomycin

A
  1. Endocarditis or certain surgery prophylaxis
  2. Serious [Gram (+) Bacteria] if pt is allergic to penicillin
  3. PO for moderate/severe [C.Diff Colitis]

“Use [VANC] to End Serious Problems!”

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10
Q

VANCOMYCIN Adverse Effects:

A: 3 Sx of [Red Man Syndrome]

A2: When do these sx first appear

B: What causes [Red Man Syndrome] exactly

B2: [Red Man Syndrome] Tx (2)

C: Other Vancomycin Adverse Effects (5)

A

A: Red Man Syndrome;

1) flushing,
2) itching
3) [red rash on face, neck, torso and arms] occurring w/in 5 to 15 min of infusion

B: due to RATE of [Vanc IV infusion] and NOT hypersensitivity

B2: Pretreat pt with antihistamines and DEC infusion rate. Vanco can be used in future;

C: Vanc Can also cause

  1. [Thrombocytopenia during prolonged therapy]
  2. Ototoxiciy
  3. Red Man Syndrome (3 sx)
  4. Neutropenia
  5. Nephrotoxicity
  6. Thrombophlebitis

“[VANC] is Toxic to TORNNT”

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11
Q

DalbaVancin has similar MOA to _______

A: Differences (2)

B: Pharmacokinetics (2)

C: Adverse Effects: (3)

A

Dalbavancin has similar MOA to Vancomycin

A: Differences:

1) Lipid moiety anchors it to the cell membrane
2) MORE POTENT than Vanc

B: IV Only and [weekly dosing]

C:

  • [INC ALT]
  • Anaphylaxis
  • Flushing with rapid infusion such as [Red Man infusion]
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12
Q

[Linezolid OxaZoliDinone]

  1. Concentration vs. Time-Dependent
  2. Bacteriostatic vs. BacteriCIDAL
  3. Which gram bacteria does [Linezolid Oxazolidinone] show Post Antibiotic Effect for?
A

[Linezolid OxaZoliDinone]

  1. -TIME DEPENDENT
  2. -Bacteriostatic
  3. -Has a Post Antibiotic Effect for Gram POSITIVE
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13
Q

[Linezolid OxaZoliDinone]

MOA

A

Inhibits [70s Ribosome Synthesis] by binding to 50s at different part (near 30s surface interface) than [macrolides/ synercid/clinda].

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14
Q

[Linezolid OxaZoliDinone]

[Mechanism of Resistance] (2)

A
  1. RARE Alteration in [50s Ribosome binding site]
  2. RARELY has interactions with other [ribosome binding drugs] = low cross-resistance
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15
Q

[Linezolid OxaZoliDinone]

A: [Gram POSITIVE Bacteria] (4)

B: What bacteria does it NOT TREAT?

A
  1. [GROUP STREP (including PRSP)]
  2. MRSA
  3. VRSA
  4. MSSA

B: NOT C. DIFF

—————————————————————————–

“Linae POSITIVELY Gave Many VoiceMails”

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16
Q

[Linezolid OxaZoliDinone]

A: Which [Gram negative Bacteria] does it treat?

A

NONE

17
Q

[Linezolid OxaZoliDinone]

A: Which [AnAerobes] does it treat?

A

Atypical bacteria such as Mycobacteria

18
Q

[Linezolid OxaZoliDinone]

A. Clinical Uses (2)

B. What SHOULDN’T you use it for?

A

A: clinical Uses:

  1. Serious/Complicated infections from RESISTANT [Gram (+) Bacteria] such as:
    - [VRE bacteremia]
    - Nosocomial PNA or infection 2º to MRSA

B. DO NOT USE FOR UTI - IT IS EXPENSIVE!

19
Q

[Linezolid Oxazolidinone]

A: Adverse Effects: (4)

B: What is an alternative to this Rx and why?

A

[Linezolid OxaZoliDinone]

A: Adverse Effects:

“Linae’s Toxicity can L A S T for 2 weeks”

1) [Lactic Acidosis]
2) Anemia
3) [Serotonin Syndrome] when used with SSRI or MAO —-> Hyperpyrexia or coma with required 2 week washout
4) Thrombocytopenia

B: Tedizolid is a new OxaZoliDinone that has NO SSRI interaction

20
Q

[Daptomycin Lipopeptide]

  1. Concentration vs. Time-Dependent
  2. Bacteriostatic vs. BacteriCIDAL
  3. Small or Large Molecular Wt?
A
  1. CONCENTRATION DEPENDENT
  2. BacteriCIDAL
  3. [Large molecular wt]
21
Q

[Daptomycin Lipopeptide]

Organisms it treats (3)

A
  1. VRE
  2. MRSA
  3. VISA

“Give her DAP for Verifying My VISA”

22
Q

[Daptomycin Lipopeptide]

A: MOA

B: [Mechanism of Resistance] (2)

A

A: binds to bacterial membrane and causes depolarization and inhibition of protein, DNA and RNA synthesis

B: [Mechanism of Resistance] = RARELY REPORTED RESISTANCE but did occur in VRE and MRSA due to altered cell membrane binding

23
Q

[Daptomycin Lipopeptide]

A: [Gram (+) Bacteria] (5)

B: [Gram negative Bacteria]

A

[Gram (+) Bacteria]:

  1. Strep Pneumoniae (including PRSP)
  2. MRSA and MSSA
  3. VRE + VRSA + VISA
  4. Enterococcus (INCLUDING VRE)

“DAP = S1 / M2 / V3 and E”

B: DOES NOT TREAT GRAM NEGATIVE BACTERIA

24
Q

[Daptomycin Lipopeptide]

B: [Daptomycin Lipopeptide] is contraindicated in what 2 situations?

A

B: [Daptomycin Lipopeptide] SHOULD NOT BE USED FOR

  • PNA Tx
  • When pt is taking [HMG CoA-reductase inhibitors]

—————————————————————————— [DAPTOMYCIN LIPOPEPTIDE] IS VERY EXPENSIVE!!

25
Q

[Daptomycin Lipopeptide] Adverse Effects: (2)

A

(x) Myopathy
(x) [CPK elevation]

26
Q

A: [Synercid + Dalfopristin] are both _______ —> together are _______!

B: Cleared by _______

C: Adverse Effect

D: MOA together

A

A: [Synercid + Dalfopristin] are both BacterioSTATICS —> together are BacteriCIDAL!

B: Cleared by Liver

C: Adverse Effect = SEVERE GI iNTOLERANCE

D: Both are [Protein synthesis inhibitors] but Dalfopristin INC binding of Synercid

27
Q
A

[GFAP-Glial Fibrillary Acid Proteins]

🄼 💊M2 PHARM EXAM 3 Rx (8 decks)

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