EXAM 2 Vanc and Gram +

Question 1

Vancomycin MOA

Answer 1

inhibit cell wall synthesis by binding D-ala-D-ala
bactericidal

Question 2

Vancomycin MOR

Answer 2

Resistance in VRE and VRSA due to D-alanine replaced by d-lactate

Question 3

Vancomycin spectrum

Answer 3

PRSP
MSSA
MRSA
C. diff oral

Question 4

Vancomycin distribution

Answer 4

Widely distributed into body tissues
use TBW for Vd calculation
Variable penetration into CSF even in presence of meninges

Question 5

Vancomycin elimination

Answer 5

eliminated unchanged by kidneys
Elimination t 1/2 depends on renal function

Question 6

Vancomycin serum concentration monitoring

Answer 6

peak draw 60m ins after end of infusion

Question 7

Vancomycin adverse effects

Answer 7

red-man syndrome (related to rate)
Nephrotoxicity
ototoxicity

Question 8

Syncercid MOA

Answer 8

streptogramin
binds 50S subunit (bacteriostatic)

Question 9

syncercid MOR

Answer 9

alterations ribosomal binding
enzymatic inactivation

Question 10

Syncerid interactions

Answer 10

CYP 450 3A4 inhibitor

Question 11

Syncercid adverse effects

Answer 11

venous irritation
myalgias

Question 12

synercid spectrum

Answer 12

PRSP
VRE (faecium)
MSSA
MRSA

Question 13

oxazolidinones drugs

Answer 13

Linezolid and tedizolid

Question 14

oxazolidinones MOA

Answer 14

binds 50S subunit and causes inhibition of 70S complex
bacteriostatic

Question 15

oxazolidinones spectrum

Answer 15

PRSP
VRE
MRSA
MSSA

Question 16

oxazolidinones pharmacology

Answer 16

readily distributed into well-perfused tissues
some CSF penetration
Both renally and nonrenally eliminated
removed by HD

Question 17

oxazolidinones drug interactions

Answer 17

serotonin syndrome with SSRIs

Question 18

oxazolidinones adverse effects

Answer 18

optic and peripheral neuropathy
thrombocytoenia

Question 19

daptomycin MOA

Answer 19

Binds to bacterial membranes and inserts lipophilic tail into cell wall
Leaks cell contents –> inhibits protein, RNA, DNA synthesis

Question 20

daptomycin spectrum

Answer 20

PRSP
VRE
MRSA
MSSA

Question 21

daptomycin elimination

Answer 21

primarily excreted by the kidneys
dosage adjustments in renal impairment

Question 22

daptomycin adverse effects

Answer 22

myopathy and CPK elavation
eosinophilic pneumonia

Question 23

daptomycin drug interactions

Answer 23

HMG CoA-reductase inhibitors – may lead to increased incidence of myopathy

Question 24

Lipoglycopeptides drugs

Answer 24

Telavancin and oritavancin

Question 25

Lipoglycopeptides MOA

Answer 25

All 3 interfere with polymerization and cross-linking of peptidoglycan by binding to D-Ala-D-Ala terminal

Question 26

Lipoglycopeptides spectrum

Answer 26

PRSP VRE MSSA MRSA

Question 27

Lipoglycopeptides elimination

Answer 27

Telavancin excreted primarily by the kidneys Dalbavancin – 33% unchanged in urine

Question 28

Telavancin drug interactions

Answer 28

interfere with coagulation tests (PT, INR, aPTT) by binding to artificial phospholipid surfaces

Question 29

Telavancin adverse effects

Answer 29

Nephrotoxicity; QTc prolongation, taste disturbances

Question 30

Lipoglycopeptides in pregnancy

Answer 30

All are Pregnancy Category C Telavancin with black box warning on use during pregnancy; perform pregnancy test in women before use

Question 31

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

Answer 31

TRUE Vancomycin IS the drug of choice for infections due to MRSA due to extensive experience and clinical data supporting its use in a variety of infection types.

Question 32

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

Answer 32

Quinupristin-dalfopristin

Question 33

Which of the following antibiotic-adverse effect combinations is INCORRECT? Daptomycin – myopathy Synercid – nephrotoxicity Linezolid – thrombocytopenia Vancomycin – Red man syndrome Telavancin – QTc prolongation

Answer 33

Synercid – nephrotoxicity