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Infectous Disease > Dr. Cluck Clinical Application Gram(+) > Flashcards

Dr. Cluck Clinical Application Gram(+) Flashcards

1
Q

What is required for every patient on VNC?

A

Therapeutic Drug Monitoring
AUC or through-based monitoring

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2
Q

What are other nephrotoxic agents interacting with VNC?

A

Aminoglycosides
Pip-Tazo

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3
Q

Adverse effects of VNC

A

-possible Nephrotoxicity/Ototoxicity
-VNC Infusion Reaction (painful)

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4
Q

What is the VNC Infusion Reaction?

A

-Histamin-related reaction (rash)
-IV administered too quickly
-Normal infusion rate 1g/hr

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5
Q

What is the disadvantage of the VNC + Pip-Tazo combination?

A

-Synergistic Nephrotoxicity (both are nephrotoxic)
still a common combo

Pip-Tazo: for gram (-) coverage (also Pseudo and anaerobes)

VNC: mainly for MRSA, Gram (+) coverage

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6
Q

Which drug is appropriate to substitute with Pip-Tazo?

A

-Cefepime(4) for Gram(-) also: Pseudomonas, Gr(+), MSSA

-but no anaerobes coverage (anaerobes are often bystanders)

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7
Q

Spectrum of Activity for VNC
EXAM!!!

A

-Only Gram (+)
-MRSA
-Streptococcus (not to best option, there are better drugs -> ß-lactams work well)
-Enterococci

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8
Q

Why is VNC not the best choice for Streptococcus?

A

-ß-lactams cover Streptococcus well
-It damages the kidneys

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9
Q

How would C. diff be treated with VNC?

A

-PO (bc the absorption is weak and it works in the gut where C. Diff is present)

-IV has no activity

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10
Q

Drug Class of Zyvox

A

Linezolid

-Gram (+) coverage
-MRSA
-Streptococcus (fine for superficial, skin tissue)
-VRE
-Hepatic eliminated (metabolites can accumulate)

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11
Q

Why are Linezolids used for superficial infections rather than invasive (Bacterimia, CNS) infections?

A

It is bacteriostatic

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12
Q

MOA of Linezolids?

A

Binds to 50S and block 50S + 30S (70S) formation

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13
Q

Drug formulations of Zyvox

A

-IV and PO (2x daily)

-100% IV to PO conversion

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14
Q

Adverse effects of Linezolid

!!!

A

-Myelosuppression (bone marrow) after 14 days of use (dip in platelets)
-lactic acidosis, teeth coloring (not seen by Dr. Cluck)
-optic neuritis
-weak MOA inhibitor
! -interacts with SSRI and other drugs with serotonergic activity

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15
Q

Cubicin

!!!

A

-Daptomycin
-IV Only
-Gram (+), MRSA, Strepto, VRE - same as VNC
-cannot treat pneumonia (inactivated by pulmonary surfactant) !!!
-drug interaction with statins !!!

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16
Q

Adverse effects of Daptomycin
!!!

A

-Eosinophilic pneumonia (hypersensitivity)
-if used with statins: Myopathy
-> Monitor weekly CPK (creatine phosphate kinase) !!

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17
Q

3 big drugs for invasive Gram (+) infections

A

-VNC (DOC for MRSA)
-Linezolid (also MRSA)
-Daptomycin (also MRSA)

18
Q

What is VISA?

A

-Subpopulation that can not be treated with VNC
-treat with Daptomycin, Linezolid, or Ceftaroline(5)
-VNC intermediate Staph aureus (more often than VRSA)
(VRSA - VNC resistant Staph aureus)
-cell wall starts to thicken, tolerance to VNC

19
Q

When is Linezold preferred over VNC (Gold-standard)?

A

-MRSA-Pneumonia

-bc VNC is weight-based dosing - it doesn’t fit all

-clinical trial: it took 9 days to reach therapeutic level vs. linezolid is therapeutic right away

20
Q

Cleocin

A

-Clindamycin (MOA like erythromycin)
-IV, PO, supp., topical
-probably 1:1 IV-PO conversion, but the GI doesn’t tolerate high doses
-lincosamide antibiotic
-share MOA and MOR with macrolides

21
Q

Spectrum of activity

!!!

A

-Excellent anaerobic
-mouth and respiratory tract (except CNS)
-good Gram (+) except Entercocci
-Clinically used for MRSA (Peds) !!
-cause C. Diff !!

22
Q

Thumb of Rule for Action site of Clindamycin

A

above the diaphragm use Clindamycin
below the diaphragm use metronidazole

kind of TRUE

23
Q

Rifadin (Rifampin)

A

-Rifamycin derivative
-IV and PO, 1:1 conversion, but high doses are not well tolerated, so given in 2 doses
-check for DDI: CYP induction !!
-red dye of fluids !! (like metronidazole) !!
Don’t use it as MONOTHERAPY: adjunct ONLY: bc resistance develops quickly !!

24
Q

Why should Rifampin be used with caution?

A

-check for DDI: CYP induction: drugs are getting way more effectively cleared by CYP enzymes (there are more enzymes, channels, and transporters affected) !!!

25
Q

Why does Rifampin work against infections on prosthetic devices?

A

Because it also works when the bacteria slows replication down (which they do in biofilms)

26
Q

Dalbavancin
IV ONLY

A

-semisynthetic glycopeptide (lipoglycopeptide)
-interferes with peptidoglycan cross-linking in the cell wall by binding to D-Ala-D-Ala of stem peptides, like VNC

-lacks the secondary mechanism seen in other lipoglycopeptides
-require renal adjustment in severe impairment OR don’t adjust and give lower dose

Adverse effects: GI irritation and headache
-no drug interactions

27
Q

At what points does Dalbavancin outperform VNC?

A

-Longer half-life
-1 dose of Dalbavancin = 14 days of VNC

28
Q

What does Dalbavancin and Oritavancin have in common?

EXAM !!!

A

-Both are only FDA-approved for skin soft tissues

-so anything else than skin soft tissue infection, a single dose would NOT be sufficient !!!
would need more than one dose (grey area)

29
Q

Difference between Dalbavancin and Oritavancin?
!!!

A

Oritavancin covers VRE and Enterococci; Dalbavancin does not!!

30
Q

Spectrum of Activity Dalbavancin

A

-only Gram (+)
-NO activity against VREnterococci carrying vanAgene(1-3)
-no drug interactions

31
Q

Oritavancin

A

-Orbactiv/Kimyrsa
-Lipoglycopeptide
-in phase 3 for soft skin tissue infection (ABSSSI)
-covers VRE (unlike Dalbavancin)
-MOA is different
-IV only

32
Q

Difference between the trade names of Oritavancin

A

Orbactiv (3hr infusion in dextrose solution)

Kimyrsa -> changed formulation: shorter infusion (1hr) stable in saline, but more expensive

33
Q

What is the MOA for

A
  1. Inhibition of Transpeptidation
  2. Inhibition of Transglycolysation
  3. Disruption of the cell wall
34
Q

When to use Oritavanvin?

A

-Skin soft tissue infection
-avoid a PICK line infusion

35
Q

Telavancin (Vibativ)

A

A mix of Daptomycin and VNC
-VNC derivative (10x activity)
-similar to Oritavancin in regards to antimicrobial profile
-daily administration needed
-IV only

36
Q

Adverse effects of Telavancin

A

-increased serum creatinine
-prolonged QT interval

37
Q

Analogy “Vancins” and DAPTOMYCIN-VNC MIX

A

-“Vancins” are lipopeptide
-Daptomycin (cyclic lipopeptide) and VNC (Glycopeptide)

38
Q

Why might Telavancin be inconvenient for patients?

A

Requires daily dosing

39
Q

What is the intended use of Telavancin?

A

-FDA approved for MRSA HAP/VAP (hospital and ventilator-acquired pneumonia + cSSSSI (complicated skin and skin structure infection)

-included in guidelines for complicated MRSA bacteremia/endocarditis (C-III)

40
Q

Tedizolid (Sivextro)

A

-congener of linezolid (same category), similar MOA
-marketed as the better version of Linezolid (but it wasn’t)
-> once daily instead of twice daily, no Myelosuppression (but possibly due to lower dosing), no SSRI interaction

-but very expensive
-IV and PO
-active against Gram (+) aerobic and anaerobes; skin soft tissue infections

Infectous Disease (29 decks)

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