Antimicrobials: Glycopeptides aka Vancomycin

Question 1

Glycopeptide antibiotic drug

Answer 1

vancomycin

Question 2

Vancomycin’s two forms

Answer 2

PO: only for C diff
IV: bacteremias, etc.

they are used for different reasons, might as well be separate drugs.

Question 3

MoA of Vanco, a glycopeptide

Answer 3

binds to the D-alanyl-D-alanine terminal residue in the growing peptidoglycan chain, inhibiting cell wall synthesis.

Question 4

Non-Beta lactam but cell wall active glycopeptide

Answer 4

vancomycin

Question 5

is vancomycin bacteriostatic or bacteriocidal?

Answer 5

bacteriocidal

Question 6

monitoring IV vanco

Answer 6

random and trough

Question 7

what organisms have become resistant to vancomycin? (2)

Answer 7

• VRE

- enterococcus has developed some resistance

Question 8

what organisms are killed by vancomycin?

Answer 8

staphylococcal (MSSA, MRSA, MSSE, MRSE)
streptococcal
enterococcal

Question 9

what organisms does vancomycin have no activity against?

Answer 9

gram negatives

Question 10

what is the only anaerobe that vancomycin has activity against?

Answer 10

C diff (PO only)

Question 11

What are the adverse events of vancomycin?

Answer 11

Red man’s
Neutropenia c long term use
Ototoxicity
Nephrotoxicity (additively)

Question 12

red man’s syndrome

Answer 12

infusion related, not allergic

Question 13

preventing red man’s

Answer 13

every gram is infused over 60 min

every 250 mg over 1 gram = 15 min added to infusion time

Question 14

distribution of glycopeptides (vancomycin)

Answer 14

everywhere including CSF for meningitis

Question 15

half life of vancomycin

Answer 15

can vary dramatically between 5 hours to many days, depending on kidney function. this is why we get troughs.

Question 16

goal vancomycin trough (per Dr. Carey) for patients with mild-mod infections

Answer 16

12-15

Question 17

goal vancomycin trough (per Dr. Carey) for a more severe infection

Answer 17

15-20

Question 18

Trough (per Dr Carey) is done when

Answer 18

half hour before 4th dose

Question 19

general monitoring for penems, monos, and glycos

Answer 19

C&S
CBC/diff
RFTs
Trough* vancomycin

Question 20

Pregnancy category of penems

Answer 20

B except imipenem (C)

Question 21

pregnancy category of monos and glycopeptides

Answer 21

B

Question 22

breast milk consideration for penems, monos, and glycos

Answer 22

all excreted in low concentrations into breast milk

Question 23

geriatric considerations for penems, monos, and glycos

Answer 23

dose reduce based on GFR

Question 24

renal impairment and vancomycin

Answer 24

watch for accumulation (trough)

Question 25

vancomycin dosing for obesity

Answer 25

actual body weight

*but monitor RFTs

Question 26

even though vanco does have activity against MSSA, why shouldn’t we use it for that?

Answer 26

because it is a much broader spectrum antibiotic than other, narrower, antibiotics which are effective against MSSA. antimicrobial stewardship.