c dif and vanco

Question 1

c diff is a ____ disease

Answer 1

toxin-mediated intestinal

Question 2

classification of c diff bacteria

Answer 2

gram (+) anaerobic, spore-forming bacilli

Question 3

c diff transmission

Answer 3

most common is fecal-oral

Question 4

c diff is the primary pathogen responsible for _____

Answer 4

antibiotic-associated colitis

Question 5

why is c diff the most common cause of infectious diarrhea in the healthcare setting

Answer 5

disruption of gut flora due to antibiotics, passing spores to others (exposed)

Question 6

what is the scary c diff strain called

Answer 6

NAP1/B1/027

Question 7

what does strain NAP1/B1/027 cause

Answer 7

more severe and more effective transmission, refractory, toxic megacolon, leukemoid reactions (inc WBC), hypoalbuminemia, colectomy, shock, death, complications in elderly due to loss of fluids and electrolytes

Question 8

symptoms of c diff

Answer 8

profuse, watery, malodorous diarrhea multiple times per day interfering with normal activities, abdominal pain, fever, leukocytosis, hypoalbuminemia, abdominal cramps/pain

Question 9

c diff endoscopy findings

Answer 9

widely disseminated, punctuate, yellow plaques, ranging from pinhead sized to confluent pseudomembranes

Question 10

c diff risk factors

Answer 10

exposure to antibiotics (all, but especially clindamycin, cephalosporins, and fluoroquinolones), previous infxn/known exposure, age 65+, weakened immune system, recent hospitalizations, PPIs or H2 blockers

Question 11

avoid ____ with c diff

Answer 11

antiperistaltics, including narcotics and loperamide

Question 12

treatment for first episode c diff

Answer 12

pref: fidaxomicin 200 mg po bid x 10d. alt: vancomycin 125 mg po qid x 10d

Question 13

alternative for first episode c diff if you can’t give fdx or van

Answer 13

metronidazole 500 mg tid x 10-14d

Question 14

treatment for first recurrence c diff

Answer 14

pref: fidaxomicin 200 mg bid x 10d OR bid x 5d followed by qod x 20d. alt: vanco in a tapered or pulsed regimen OR vanco 125 mg qid x 10d

Question 15

what is an adjunctive treatment for recurrence of CDI during standard of care

Answer 15

bezlotoxumab

Question 16

what class is fidaxomicin

Answer 16

macrolide

Question 17

what is the mechanism of fidaxomicin

Answer 17

inhibits protein synthesis via RNA polymerase

Question 18

fidaxomicin pk

Answer 18

minimal systemic absorption/nonabsorbed: stays in GI tract

Question 19

fidaxomicin ade

Answer 19

n/v, abdominal pain. rare: GI hemorrhage, bowel obstruction, anemia, neutropenia

Question 20

treatment for second or subsequent CDI recurrence

Answer 20

FDX 200 mg BID x 10 or BID x 5 then qod x 20. Vanco tapered and pulsed, or 125 qid x 10 then rifaximin 400 mg tid x 20. fecal microbiota transplant. adjuncts to SOC abx: bezlotoxumab

Question 21

when is FMT indicated

Answer 21

3 CDI episodes

Question 22

definition of fulminant CDI

Answer 22

hypotension or shock, ileus, megacolon

Question 23

treatment for fulminant CDI

Answer 23

vancomycin 500 mg po qid, rectal vancomycin, IV metronidazole 500 mg q8h

Question 24

stop FMT recipient’s anti-c diff antibiotics at least __ days before

Answer 24

5

Question 25

bezlotoxumab indication

Answer 25

reduce the recurrence of c diff in patients 18+. NOT for treatment or for monotherapy. must be used with standard of care antibiotics

Question 26

bezlotoxumab dose

Answer 26

single dose: 10 mg/kg IV given over 1 hour

Question 27

bezlotoxumab precaution

Answer 27

heart failure

Question 28

vancomycin structure

Answer 28

cyclic glycopeptide

Question 29

vancomycin MOA

Answer 29

binds to D-ala D-ala via hydrogen bonds, covers the substrate for cell wall transamidase (transpeptidase) preventing the cross linkage and causing osmotically defective cell walls

Question 30

vancomycin spectrum

Answer 30

gram + only: MRSA, MSSA, staph, strep, enterococcal, c diff. no gram - activity

Question 31

vancomycin absorption

Answer 31

not absorbed systemically when given PO. oral vanco is for c diff. IV vanco is for systemic infections

Question 32

vanco elimination

Answer 32

renal: dose adjustments are necessary

Question 33

what is the risk with vancomycin

Answer 33

nephrotoxicity: mitigated by exposure AUC: MIC 400-600

Question 34

vancomycin infusion reaction (“redman’s syndrome)

Answer 34

a histamine-induced reaction when IV administration is too rapid causing hypotension, flushing, erythematous rash

Question 35

treatment for vancomycin infusion reaction

Answer 35

po antihistamines or iv corticosteroids

Question 36

other ade for vancomycin

Answer 36

eosinophilia, thrombocytopenia, neutropenia, ototoxicity from 8th cranial nerve damage