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PHRM 865 > E2 Erdman Vanc and GP agents > Flashcards

E2 Erdman Vanc and GP agents Flashcards

1
Q

glycopeptide covered in lecture

A

vanc

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2
Q

streptogramins covered in lecture

A

quin-dalf (synercid)

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3
Q

Oxazolidinones covered in lecture

A

Linezolid, Tedizolid

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4
Q

Lipopeptide covered in lecture

A

daptomycin

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5
Q

Lipoglycopeptides covered in lecture

A

telavancin
dalbavancin
oritavancin

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6
Q

what stag e of cell wall synthesis does vanc inhibit

A

2nd

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7
Q

Vanc is SLOWLY (bactericidal/bacteriostatic) (time/conc) dependent

A

bactericidal
time

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8
Q

what bacteria is vanc bacteriostatic against?

A

enterococcus

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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
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10
Q

Vanc displays activity against many ________ aerobic and _______ bacteria

A

GP, anaerobic

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11
Q

3 highlighted GP bacteria for vanc

A

MRSA
PRSP
C diff (clostridium spp)

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12
Q

T or F:
Vanc has mediocre activity against select GN bacterias

A

false, nonee

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13
Q

vanc:
Absorption from GI tract is negligible after oral administration, except in patients with _______ ________

A

intense colitis

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14
Q

PD parameter for vanc

A

AUC/MIC

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15
Q

target MIC vanc

A

400-600

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16
Q

what body weight do you use for Vd calculation

A

TBW

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17
Q

T or F:
vanc has variable penetration to CSF

A

true

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18
Q

how long does it take vanc to distribute from plasma into tissue compartment

A

1 hour

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19
Q

preferred route of vanc for systemic infections

A

IV (NOT IM)

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20
Q

vanc elimination

A

unchanged in kidney

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21
Q

T or F:
half life progressively decreases as renal function decreases

A

false, increases as decreases

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22
Q

elimination half life of vanc in pts with ESRD

A

7-14 days

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23
Q

T or F:
vanco is removed by hemo

A

true

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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)
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25
Q

when should peak conc be obtain for vanc

A

one hour after end of infusion

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26
Q

vanc target peak conc

A

30-40

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27
Q

vanc target trough conc (in severe)

A

10-15

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28
Q

basically only time vanc should be used orally

A

for C diff colitis

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29
Q

4 clinical uses of vanc

A
  • MRSA/CNS
  • serious GP infections in pts allergic to b-lactams
  • PRSP
  • oral for C diff
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30
Q

unique AE for vanc

A

red man syndrome

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31
Q

T or F:
red-man syndrome is related to the rate of IV infusion

A

true

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32
Q

T or F:
red man syndrome resolves spontaneously after d/c

A

true

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33
Q

what can be done to minimize or prevent red man syndrome from vanc

A

vanc doses of 1 gram should be infused over at least one hour and larger doses should be infused over 90-120

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34
Q

2 highlighted “other” AEs for vanc

A

thrombophlebitis
interstitial nephritis

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34
Q

what were streptogramins developed in response to

A

mainly VRE

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35
Q

Synercid cidal or static

A

static

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36
Q

MOA of synercid

A

binds to 50S

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37
Q

2 mechs of resistance for synercid

A
  • alterations in ribosomal binding sites
  • enzymatic inactivation
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38
Q

synercid SoA:
GP bacteria (highlighted things)

A
  • strep pneu (including PRSP*)
  • enterococcus FAECIUM only (including VRE*)
  • MSSA
  • MRSA
  • coagulase negative staph
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39
Q

synercid SoA:
GN aerobes

A

limited against Neisseria and Moraxella BUT NOT USED HERE

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40
Q

Synercid SoA
atypical bacteria

A

not used here

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41
Q

T or F:
synercid has minimal CSF penetration

42
Q

synercid time or conc dependent

43
Q

T or F:
synercid has significant PAE against GN bacteria

44
Q

dosage form synercid

A

parenteral only

45
Q

synercid elim:
both agents are converted to active metabolites by _____ that are eliminated by ______ clearance or _______ elimination

A

CYP enzymes
hepatic
biliary

46
Q

T or F:
synercid requires dosage adjustments in renal insufficiency

A

false, hepatic

47
Q

synercid is only considered as a treatment option when?

A

vanc, linezolid, AND daptomycin cannot be used

48
Q

1 highlighted clinical use synercid

49
Q

T or F:
synercid is a CYP3A4 inhibitor

50
Q

synercid highlighted drug interactions (4)

A
  • HMG coa reductase inhibitors
  • cyclosporine
  • tacrolimus
  • carbamazepine
51
Q

4 highlighted AEs for synercid

A
  • venous irritation*
  • GI upset
  • myalgias, arthralgias* (myopathy)*
  • rash
52
Q

2 oxazolidinones

A

linezolid, tidezolid

53
Q

linezolid/tedizolid dosage forms

54
Q

linezolid/tedizolid developed in response to need for antibiotics with activity against resistant GPs _____, ______, and _____

A

VRE
MRSA
VISA

55
Q

linezolid/tedizolid MOA

A

binds to 50s and causes inhibition of 70s initiation complex, which inhibits protein synthesis

56
Q

linezolid/tedizolid cidal or static

A

static, cidal against some but i dont care

57
Q

2 mechs of resistance for linezolid/tedizolid

A
  • alterations in ribosomal binding sites - rare
  • cross resistance with other protein synthesis inhibitors is UNLIKELY
58
Q

linezolid/tedizolid SoA:
highlighted GP bacteria

A
  • strep pneu (PRSP)
  • Enterococcus faecium AND faecalis (including VRE*)
  • MS, MR, VI, VR
59
Q

linezolid/tedizolid SoA for GN and atypicals

60
Q

T or F:
PAE exists for linezolid/tedizolid

A

true, in GP organisms

61
Q

linezolid/tedizolid absorption

A

linezolid is rapidly and completely absorbed after oral admin with 100% F, tedizolid is 91% F

62
Q

linezolid/tedizolid distribution:
CSF penetration ~30%
A. linezolid
B. tedizolid

63
Q

T or F:
linezolid/tedizolid requires dose adjustment in renal insufficiency

64
Q

use of linezolid/tedizolid reserved for ?

A

serious/complicated infections caused by resistant GP bacteria
(mostly VRE and MRSA)

65
Q

can linezolid/tedizolid be used for nosocomial pneumonia due to MRSA?

66
Q

linezolid/tedizolid drug interactions:
weak inhibitor of _______ _______

A

monoamine oxidase

67
Q

linezolid/tedizolid drug interactions:
risk of _______ _________

A

serotonin syndrome

68
Q

3 highlighted AEs for linezolid/tedizolid drug interactions:

A

GI upset
CNS (optic and peripheral neuropathy)
thrombocytopenia or anemia

69
Q

daptomycin is a lipopeptide developed to help with activity against what 3 things

A

VRE
MRSA
VISA

70
Q

daptomycin MOA

A

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
Q

Daptomycin (time/conc) dependent with (static/cidal) activity

72
Q

1 mech of resistance for daptomycin

A

rare but altered cell membrane binding

73
Q

Dapto SoA:
GP bacteria

A

PRSP
enterococcus faecium AND faecalis (VRE*)
MSSA / MRSA
VRSA

74
Q

daptomycin excreted primarily by ?

75
Q

T or F:
daptomycin requires dose adjustment in pts with RI

76
Q

T or F:
daptomycin is removed by hemo

77
Q

daptomycin usually reserved for ?

A

serious/complicated infections caused by resistant bacteria

78
Q

T or F:
daptomycin is the drug of choice in the treatment of pneumonia

A

FALSE -> DONT USE

79
Q

why should daptomycin not be used for pneumonia

A

compound is inactivated by pulmonary surfactant

80
Q

other random clinical use that i forgot about for daptomycin

A

staph aureus bacteremia and endocarditis

81
Q

one listed drug interaction with dapto

82
Q

2 not obvious highlighted AEs for daptomycin

A
  • myopathy and CPK elevation
  • acute eosinophilic pneumonia
83
Q

MOA of each lipoglycopeptide

A

interfere with polymerization and cross-linking of peptidoglycan by binding to D-Ala-D-Ala terminal

84
Q

1 mech of resistance for telavancin/oritavancin/dalbavancin

A

alteration in peptidoglycan terminus (orita still maintains activity tho)

85
Q

telavancin/oritavancin/dalbavancin SoA:
GP bacteria

A
  • enterococcus faecium AND faecalis (VRE)
  • MSSA
  • MRSA
  • VRSA
86
Q

some VRE strains do NOT display resistance to which of the following:
A.telavancin
B. oritavancin
C. dalbavancin

87
Q

telavancin elimination

A

excreted primarily by kidneys
requires dose adjustments in RI

88
Q

dalbavancin elimination

A

33% unchanged in urine, requires dose adjustment in RI

89
Q

oritavancin elim

A

unknown route
no adjustment needed in RI

90
Q

all lipoglycopeptides are (time/conc) and (cidal/static)

A

conc, cidal

91
Q

telavancin/oritavancin/dalbavancin all have poor CSF pen

92
Q

telavancin/oritavancin/dalbavancin are all removed by hemo

A

no they arent idiot

93
Q

T or F:
telavancin/oritavancin/dalbavancin should only be used in adults

94
Q

when should telavancin/oritavancin/dalbavancin be used (not infection related)

A

if vanc, synercid, and dapto cannot be used

95
Q

does NOT interfere with coagulation tests (PT, INR, aPTT)
A.telavancin
B. oritavancin
C. dalbavancin

A

C, other two do by binding to artificial phospholipid surfaces

96
Q

AE of nephrotoxicity
A.telavancin
B. oritavancin
C. dalbavancin

97
Q

AE of QTc prolongation
A.telavancin
B. oritavancin
C. dalbavancin

98
Q

AE of taste disturbances
A.telavancin
B. oritavancin
C. dalbavancin

99
Q

AE of infusion-related reactions (red man syndrome)
A.telavancin
B. oritavancin
C. dalbavancin

100
Q

pregnancy category C
A.telavancin
B. oritavancin
C. dalbavancin

A

ALL (have a black box warning for this)

101
Q

True/False:Vancomycin is the drug of choice for infections due to MRSA.

102
Q

Which antibiotic does NOT have activity against vancomycin-resistant Enterococcus faecalis (VRE)?
A. Quinupristin-dalfopristin
B. Linezolid
C. Daptomycin
D. Tedizolid
E. Oritavancin

A

A (FAECIUM ONLY)**

103
Q

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

PHRM 865 (16 decks)

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