E2 Erdman Vanc and GP agents Flashcards
1
Q
glycopeptide covered in lecture
A
vanc
2
Q
streptogramins covered in lecture
A
quin-dalf (synercid)
3
Q
Oxazolidinones covered in lecture
A
Linezolid, Tedizolid
4
Q
Lipopeptide covered in lecture
A
daptomycin
5
Q
Lipoglycopeptides covered in lecture
A
telavancin
dalbavancin
oritavancin
6
Q
what stag e of cell wall synthesis does vanc inhibit
A
2nd
7
Q
Vanc is SLOWLY (bactericidal/bacteriostatic) (time/conc) dependent
A
bactericidal
time
8
Q
what bacteria is vanc bacteriostatic against?
A
enterococcus
9
Q
Resistance in VRE and VRSA is due to modification of D-alanyl-D-alanine binding site of peptidoglycan
- Terminal D-alanine replaced by _______
- Loss of critical _______ bond
- Loss of _________activity
- Several phenotypes - vanA, vanB, vanC, etc
A
- D-lactate
-hydrogen
-antibacterial
10
Q
Vanc displays activity against many ________ aerobic and _______ bacteria
A
GP, anaerobic
11
Q
3 highlighted GP bacteria for vanc
A
MRSA
PRSP
C diff (clostridium spp)
12
Q
T or F:
Vanc has mediocre activity against select GN bacterias
A
false, nonee
13
Q
vanc:
Absorption from GI tract is negligible after oral administration, except in patients with _______ ________
A
intense colitis
14
Q
PD parameter for vanc
A
AUC/MIC
15
Q
target MIC vanc
A
400-600
16
Q
what body weight do you use for Vd calculation
A
TBW
17
Q
T or F:
vanc has variable penetration to CSF
A
true
18
Q
how long does it take vanc to distribute from plasma into tissue compartment
A
1 hour
19
Q
preferred route of vanc for systemic infections
A
IV (NOT IM)
20
Q
vanc elimination
A
unchanged in kidney
21
Q
T or F:
half life progressively decreases as renal function decreases
A
false, increases as decreases
22
Q
elimination half life of vanc in pts with ESRD
A
7-14 days
23
Q
T or F:
vanco is removed by hemo
A
true
24
Q
4 things where serum conc monitoring is recommended for vanc
A
- pts with MRSA infections
- Pts at risk for nephrotox
- pts with renal dysfxn
- pts receiving prolonged courses (3-5 days)
25
when should peak conc be obtain for vanc
one hour after end of infusion
26
vanc target peak conc
30-40
27
vanc target trough conc (in severe)
10-15
28
basically only time vanc should be used orally
for C diff colitis
29
4 clinical uses of vanc
- MRSA/CNS
- serious GP infections in pts allergic to b-lactams
- PRSP
- oral for C diff
30
unique AE for vanc
red man syndrome
31
T or F:
red-man syndrome is related to the rate of IV infusion
true
32
T or F:
red man syndrome resolves spontaneously after d/c
true
33
what can be done to minimize or prevent red man syndrome from vanc
vanc doses of 1 gram should be infused over at least one hour and larger doses should be infused over 90-120
34
2 highlighted "other" AEs for vanc
thrombophlebitis
interstitial nephritis
34
what were streptogramins developed in response to
mainly VRE
35
Synercid cidal or static
static
36
MOA of synercid
binds to 50S
37
2 mechs of resistance for synercid
- alterations in ribosomal binding sites
- enzymatic inactivation
38
synercid SoA:
GP bacteria (highlighted things)
- strep pneu (including PRSP*)
- enterococcus FAECIUM only (including VRE*)
- MSSA
- MRSA
- coagulase negative staph
39
synercid SoA:
GN aerobes
limited against Neisseria and Moraxella BUT NOT USED HERE
40
Synercid SoA
atypical bacteria
not used here
41
T or F:
synercid has minimal CSF penetration
true
42
synercid time or conc dependent
time
43
T or F:
synercid has significant PAE against GN bacteria
false, GP
44
dosage form synercid
parenteral only
45
synercid elim:
both agents are converted to active metabolites by _____ that are eliminated by ______ clearance or _______ elimination
CYP enzymes
hepatic
biliary
46
T or F:
synercid requires dosage adjustments in renal insufficiency
false, hepatic
47
synercid is only considered as a treatment option when?
vanc, linezolid, AND daptomycin cannot be used
48
1 highlighted clinical use synercid
VRE
49
T or F:
synercid is a CYP3A4 inhibitor
true
50
synercid highlighted drug interactions (4)
- HMG coa reductase inhibitors
- cyclosporine
- tacrolimus
- carbamazepine
51
4 highlighted AEs for synercid
- venous irritation*
- GI upset
- myalgias, arthralgias* (myopathy)*
- rash
52
2 oxazolidinones
linezolid, tidezolid
53
linezolid/tedizolid dosage forms
po and IV
54
linezolid/tedizolid developed in response to need for antibiotics with activity against resistant GPs _____, ______, and _____
VRE
MRSA
VISA
55
linezolid/tedizolid MOA
binds to 50s and causes inhibition of 70s initiation complex, which inhibits protein synthesis
56
linezolid/tedizolid cidal or static
static, cidal against some but i dont care
57
2 mechs of resistance for linezolid/tedizolid
- alterations in ribosomal binding sites - rare
- cross resistance with other protein synthesis inhibitors is UNLIKELY
58
linezolid/tedizolid SoA:
highlighted GP bacteria
- strep pneu (PRSP)
- Enterococcus faecium AND faecalis (including VRE*)
- MS, MR, VI, VR
59
linezolid/tedizolid SoA for GN and atypicals
dont care
60
T or F:
PAE exists for linezolid/tedizolid
true, in GP organisms
61
linezolid/tedizolid absorption
linezolid is rapidly and completely absorbed after oral admin with 100% F, tedizolid is 91% F
62
linezolid/tedizolid distribution:
CSF penetration ~30%
A. linezolid
B. tedizolid
A
63
T or F:
linezolid/tedizolid requires dose adjustment in renal insufficiency
false
64
use of linezolid/tedizolid reserved for ?
serious/complicated infections caused by resistant GP bacteria
(mostly VRE and MRSA)
65
can linezolid/tedizolid be used for nosocomial pneumonia due to MRSA?
yes
66
linezolid/tedizolid drug interactions:
weak inhibitor of _______ _______
monoamine oxidase
67
linezolid/tedizolid drug interactions:
risk of _______ _________
serotonin syndrome
68
3 highlighted AEs for linezolid/tedizolid drug interactions:
GI upset
CNS (optic and peripheral neuropathy)
thrombocytopenia or anemia
69
daptomycin is a lipopeptide developed to help with activity against what 3 things
VRE
MRSA
VISA
70
daptomycin MOA
Binds to bacterial membranes and inserts lipophilic tail into cell wall to form trans-membrane channel leakage of cellular contents and rapid depolarization of the membrane potential, which causes inhibition of protein, DNA, and RNA synthesis
71
Daptomycin (time/conc) dependent with (static/cidal) activity
conc
cidal
72
1 mech of resistance for daptomycin
rare but altered cell membrane binding
73
Dapto SoA:
GP bacteria
PRSP
enterococcus faecium AND faecalis (VRE*)
MSSA / MRSA
VRSA
74
daptomycin excreted primarily by ?
kidneys
75
T or F:
daptomycin requires dose adjustment in pts with RI
true
76
T or F:
daptomycin is removed by hemo
false
77
daptomycin usually reserved for ?
serious/complicated infections caused by resistant bacteria
78
T or F:
daptomycin is the drug of choice in the treatment of pneumonia
FALSE -> DONT USE
79
why should daptomycin not be used for pneumonia
compound is inactivated by pulmonary surfactant
80
other random clinical use that i forgot about for daptomycin
staph aureus bacteremia and endocarditis
81
one listed drug interaction with dapto
statins
82
2 not obvious highlighted AEs for daptomycin
- myopathy and CPK elevation
- acute eosinophilic pneumonia
83
MOA of each lipoglycopeptide
interfere with polymerization and cross-linking of peptidoglycan by binding to D-Ala-D-Ala terminal
84
1 mech of resistance for telavancin/oritavancin/dalbavancin
alteration in peptidoglycan terminus (orita still maintains activity tho)
85
telavancin/oritavancin/dalbavancin SoA:
GP bacteria
- enterococcus faecium AND faecalis (VRE)
- MSSA
- MRSA
- VRSA
86
some VRE strains do NOT display resistance to which of the following:
A.telavancin
B. oritavancin
C. dalbavancin
B
87
telavancin elimination
excreted primarily by kidneys
requires dose adjustments in RI
88
dalbavancin elimination
33% unchanged in urine, requires dose adjustment in RI
89
oritavancin elim
unknown route
no adjustment needed in RI
90
all lipoglycopeptides are (time/conc) and (cidal/static)
conc, cidal
91
telavancin/oritavancin/dalbavancin all have poor CSF pen
thanks
92
telavancin/oritavancin/dalbavancin are all removed by hemo
no they arent idiot
93
T or F:
telavancin/oritavancin/dalbavancin should only be used in adults
true ig
94
when should telavancin/oritavancin/dalbavancin be used (not infection related)
if vanc, synercid, and dapto cannot be used
95
does NOT interfere with coagulation tests (PT, INR, aPTT)
A.telavancin
B. oritavancin
C. dalbavancin
C, other two do by binding to artificial phospholipid surfaces
96
AE of nephrotoxicity
A.telavancin
B. oritavancin
C. dalbavancin
A
97
AE of QTc prolongation
A.telavancin
B. oritavancin
C. dalbavancin
A
98
AE of taste disturbances
A.telavancin
B. oritavancin
C. dalbavancin
A
99
AE of infusion-related reactions (red man syndrome)
A.telavancin
B. oritavancin
C. dalbavancin
ALL
100
pregnancy category C
A.telavancin
B. oritavancin
C. dalbavancin
ALL (have a black box warning for this)
101
True/False: Vancomycin is the drug of choice for infections due to MRSA.
true
102
Which antibiotic does NOT have activity against vancomycin-resistant Enterococcus faecalis (VRE)?
A. Quinupristin-dalfopristin
B. Linezolid
C. Daptomycin
D. Tedizolid
E. Oritavancin
A (FAECIUM ONLY)****
103
Which of the following antibiotic-adverse effect combinations is INCORRECT?
A. Daptomycin – myopathy
B. Synercid – nephrotoxicity
C. Linezolid –thrombocytopenia
D. Vancomycin – Red man syndrome
E. Telavancin – QTc prolongation
B
