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Pharma 2nd semester > C.17. Glycopetides. Fusidans, Lipopetides. Bacitracin. Mupirocin. Pharmacotherapy of skin and soft tissue infection. > Flashcards

C.17. Glycopetides. Fusidans, Lipopetides. Bacitracin. Mupirocin. Pharmacotherapy of skin and soft tissue infection. Flashcards

1
Q

what is the mechanism of action of Glycopeptides Ab?

A
  1. Bactericidal effect
  2. interfere with cross-linking. GP’s Binds at the D-ala-D-ala terminal –> inhibits the elongation of peptidoglycan chains
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2
Q

list the Glycopeptide antibiotics

A

Vancomycin
Teicoplanin
Oritavancin
Mupirocin

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3
Q

how are vancomycin, teicoplanin and Oritavancin given?

A

Parenterally

*not absorbed orally –> benefit in bacterial colitis treatment

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4
Q

what strains are resistant to Vancomycin, teicoplanin and Oritavancin. what is the mechanism of resistance?

A

VRSA -vancomycin-resistant S. aureus
VISA- vancomycin intermediate S.aureus
VRE-vancomycin resistant Enterococci
most β-lactamases

alteration of the terminal D-ala to D-lactate

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5
Q

what is the spectrum and clinical uses of Vancomycin and Teicoplanin? (6)

A

Narrow spectrum:

  1. gram + bacteria
  2. MRSA and PRSP
  3. Clostridium difficile (2nd line)
  4. empiric treatment: endocarditis, meningitis (with 3 gen’ cephalosporins)
  5. osteomyelitis
  6. prosthetic joint infection
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6
Q

what is the spectrum and clinical uses of Oritavancin?

A

narrow spectrum:

  1. gram + bacteria, anerobic and aerobic
  2. severe skin infection
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7
Q

what is the T1/2 of Vancomycin and teicoplanin?

A

6 hours

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8
Q

do vancomycin and Teicoplanin require monitoring of drugs plasma concentrations?

A

yes, have a narrow therapeutic index

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9
Q

adverse effects of Vancomycin and Teicoplanin?

A

chills, fever
injection site phlebitis
ototoxicity
nephrotoxicity (when given with aminoglycosides)
DRESS syndrome
diffuse flushing–>’red man syndrome’ when given rapid IV administration due to histamine release

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10
Q

how do we avoid ‘red man syndrome’ when giving Vancomycin and Teicoplanin?

A

slow injection

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11
Q

what is more toxic- vancomycin or Teicoplanin?

A

vancomycin

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12
Q

side effects of Oritavancin?

A

GI symptoms
elevated liver enzymes
elevated CK

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13
Q

what is the mechanism of Mupirocin

A

inhibits bacterial protein synthesis by selectively binding to isoleucyl-tRNA synthetase

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14
Q

when do we give Mupirocin?

A
  1. gram +cocci
  2. impetigo caused by staph (MRSA), S.pyogenes
  3. nasal carriage of S. Aureus (intranasal ointment)
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15
Q

who do we give intranasal ointment Mupirocin for S. aureus nasal carriage?

A

medical workers

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16
Q

how do we give Mupirocin?

A

topically (not absorbed)

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17
Q

side effects of Mupirocin

A

local itching and burning

rash, erythema, contact dermatitis

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18
Q

what is Daptomycin?

A

Lipopeptide Ab

depolarization agent

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19
Q

what is the mechanism of action of Daptomycin

A

Bactericidal effect

enters the cytoplasmic membrane (irreversibly)–> disrupts ionic gradients and membrane depolarization

20
Q

what has a more rapid effect- daptomycin or vancomycin?

A

daptomycin

21
Q

what is the spectrum of daptomycin?

A

narrow
gram +
MRSA,VRSA ,VRE

22
Q

How is daptomycin given?

A

parenterally

23
Q

how is daptomycin eliminated in the body?

A

renal

24
Q

what inhibits daptomycin and when it shouldn’t be given?

A

pulmonary surfactant

cannot be used to treat pneumonia

25
Q

side effects of daptomycin

A

myopathy (additive with statins)–> monitor creatine phosphokinase
Rhabdomyolysis (rare)
pneumonitis (therapy >2 w’)

26
Q

what Ab are polypeptides?

A

bacitracin and fusidic acid

27
Q

is Bacitracin bacteriostatic or bactericidal?

A

both (depends on the concentration)

28
Q

how is Bacitracin given?

A

topically (wounds)

too toxic for systemic use –> nephrotoxicity

29
Q

what does bacitracin do?

A

inhibits the precursor translocation across the bacterial membrane

30
Q

what is Neomycin-Bacitracin- Polymyxin B?

A

ointment preparation, over the counter drug (Neosporin)

prevent and treat minor skin infection

31
Q

how is fusidic acid given?

A

topical/parenteral

32
Q

when do we give systemic fusidic acid (fusidans)?

A

MRSA infection

33
Q

when do we give topical fusidic acid?

A

skin infection (cellulitis, impetigo), conjunctivitis

34
Q

what other indications are there for fusidic acids, other than skin infections are MRSA?

A

gram +
aerobes and anaerobes
corynebacterium endocarditis

35
Q

what is the mechanism of fusidic acids (fusidans)?

A

bacteriostatic effect

inhibitor of bacterial protein synthesis (inhibits translocations-elongation factor G)

36
Q

what side effect does fusidic acid cause in systemic use?

A

hepatotoxicity

37
Q

what is the 1st line topical treatment for Cellulitis &impetigo?

A

fusidic acid
Mupirocin
Polymyxin E (colistin)

38
Q

what is the 1st line treatment for Cellulitis &impetigo in case of staphylococcal or streptococcal infection?

A

Nafcillin IV or Oxacillin IV

39
Q

what is the alternative treatment for Cellulitis &impetigo in case of staphylococcal or streptococcal infection?

A

Cefazolin IV or

Ampicillin/Sulbactam IV

40
Q

what is the 1st line treatment for Cellulitis &impetigo in case of MRSA infection?

A

vancomycin IV

41
Q

what is the alternative treatment for Cellulitis &impetigo in case of MRSA infection?

A

Linezolid IV

42
Q

what is the 1st line treatment for Necrotizing fasciitis?

A

Clindamycin IV and Penicillin-G IV

43
Q

what is the 1st line treatment for gas gangrene (C.perfringes)?

A

Clindamycin IV and Penicillin-G IV

44
Q

what is the alternative treatment for Necrotizing fasciitis?

A

Clindamycin IV and Cephalosporin IV

45
Q

what is the alternative treatment for gas gangrene (C.perfringes)?

A

Clindamycin IV and Cefoxitin IV

Pharma 2nd semester (49 decks)

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