Cell wall synthesis: vanc and its derivatives

Question 1

vancomycin brand

Answer 1

vancocin

Question 2

Vanc MOA

Answer 2

blocks the cell wall synthesis by binding to D-alanine-D-alanine terminal, cross linking of peptidoglycan layers is blocked as well as elongation of NAG-NAM polymers, kills bacteria that are actively growing and synthesizing the cell wall

Question 3

Vanc cidal or static and time or conc dependent?

Answer 3

bactericidal, time-dependent

bacteriostatic against enterococcus spp (makes resistance)

Question 4

vanc structure

Answer 4

glycopeptide, large and bulky

Question 5

vanc spectrum

Answer 5

all G+, including MRSA
G+ anaerobes including c. diff
enterococci- moderate activity, increased resistance
staphlococci MIC creep - VISA/VRSA (staph starts to develop resistance)
~ used in pts to treat G+ infections with a penicillin allergy

Question 6

vanc administration

Answer 6

IV

PO: c. diff (bc needs to get into the gut)

Question 7

vanc body clearance

Answer 7

renal

Question 8

vanc infusion related effects

Answer 8

red man syndrome- histamine release, flushing, tachycrdia, hypotension
thrombophlebitis
admin over 60 mins, 10mg/min for doses > 500mg

Question 9

vanc general AE

Answer 9

infusion related effects
nephrotoxicity
ototoxicity (monitor if already has hearing loss)

Question 10

lipoglycopeptides cidal or static and conc or time

Answer 10

lipoglycopepetides are bacterial cidal and concentration dependent

Question 11

lipoglycopeptides admin

Answer 11

IV

Question 12

lipoglycopeptides drug names

Answer 12

dalbavancin, oritavancin

Question 13

t 1/2 dalbavancin and oritavancin

Answer 13

long, dosed 1x = 2 weeks worth of therapy

Question 14

clearance of lipoglycopeptides

Answer 14

renal

Question 15

spectrum of lipoglycopeptides

Answer 15

G+, including MRSA, no c. diff, vanc senstitive enterococci, oritavancin- VRE

Question 16

lipoglycopeptides infusion reaction

Answer 16

red mans syndrome

Question 17

oritavancin and telavancin tests

Answer 17

may affect coagulation tests, use non-phospholipid dependent coagulation test

Question 18

telavancin AE

Answer 18

tast disturbances (metallic), foamy urine, renal toxicity (inc mortality in patients with preexisting renal impairment, prolongs the QT interval, contraindicated in pregnancy

Question 19

daptomyocin MOA

Answer 19

membrane disrupter, causes rapid depolarization of bacterial cell membrane, affects the synthesis of DNA, RNA, and protein

Question 20

dapto structure

Answer 20

cyclic lipopeptide

Question 21

dapto admin

Answer 21

IV

Question 22

dapto spectrum

Answer 22

G+ including MRSA, G+ anaerobes except c. diff

Question 23

dapto cidal or static and conc or time

Answer 23

bacterial cidal conc dependent

Question 24

dapto interaction

Answer 24

deactivated by lung surfactants

Question 25

dapto clearance

Answer 25

renally

Question 26

dapto adverse reactions

Answer 26

peripheral neuropathy, infusion reactions, myopathy/rhabdomyolysis (monitor CK levels, use with statins to increase the risk),

Question 27

dapto is contraindicated in what patient population

Answer 27

children younger than 1, muscular/neuromuscular and/or toxicity in CNS