EXAM 2 Vanc and Gram + Flashcards
Vancomycin MOA
inhibit cell wall synthesis by binding D-ala-D-ala
bactericidal
Vancomycin MOR
Resistance in VRE and VRSA due to D-alanine replaced by d-lactate
Vancomycin spectrum
PRSP
MSSA
MRSA
C. diff oral
Vancomycin distribution
Widely distributed into body tissues
use TBW for Vd calculation
Variable penetration into CSF even in presence of meninges
Vancomycin elimination
eliminated unchanged by kidneys
Elimination t 1/2 depends on renal function
Vancomycin serum concentration monitoring
peak draw 60m ins after end of infusion
Vancomycin adverse effects
red-man syndrome (related to rate)
Nephrotoxicity
ototoxicity
Syncercid MOA
streptogramin
binds 50S subunit (bacteriostatic)
syncercid MOR
alterations ribosomal binding
enzymatic inactivation
Syncerid interactions
CYP 450 3A4 inhibitor
Syncercid adverse effects
venous irritation
myalgias
synercid spectrum
PRSP
VRE (faecium)
MSSA
MRSA
oxazolidinones drugs
Linezolid and tedizolid
oxazolidinones MOA
binds 50S subunit and causes inhibition of 70S complex
bacteriostatic
oxazolidinones spectrum
PRSP
VRE
MRSA
MSSA
oxazolidinones pharmacology
readily distributed into well-perfused tissues
some CSF penetration
Both renally and nonrenally eliminated
removed by HD
oxazolidinones drug interactions
serotonin syndrome with SSRIs
oxazolidinones adverse effects
optic and peripheral neuropathy
thrombocytoenia
daptomycin MOA
Binds to bacterial membranes and inserts lipophilic tail into cell wall
Leaks cell contents –> inhibits protein, RNA, DNA synthesis
daptomycin spectrum
PRSP
VRE
MRSA
MSSA
daptomycin elimination
primarily excreted by the kidneys
dosage adjustments in renal impairment
daptomycin adverse effects
myopathy and CPK elavation
eosinophilic pneumonia
daptomycin drug interactions
HMG CoA-reductase inhibitors – may lead to increased incidence of myopathy
Lipoglycopeptides drugs
Telavancin and oritavancin
Lipoglycopeptides MOA
All 3 interfere with polymerization and cross-linking of peptidoglycan by binding to D-Ala-D-Ala terminal
Lipoglycopeptides spectrum
PRSP
VRE
MSSA
MRSA
Lipoglycopeptides elimination
Telavancin excreted primarily by the kidneys
Dalbavancin – 33% unchanged in urine
Telavancin drug interactions
interfere with coagulation tests (PT, INR, aPTT) by binding to artificial phospholipid surfaces
Telavancin adverse effects
Nephrotoxicity; QTc prolongation, taste disturbances
Lipoglycopeptides in pregnancy
All are Pregnancy Category C
Telavancin with black box warning on use during pregnancy; perform pregnancy test in women before use
True/False: Vancomycin is the drug of choice for infections due to MRSA.
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.
Which antibiotic does NOT have activity against vancomycin-resistant Enterococcus faecalis (VRE)?
A. Quinupristin-dalfopristin
B. Linezolid
C. Daptomycin
D. Tedizolid
E. Oritavancin
Quinupristin-dalfopristin
Which of the following antibiotic-adverse effect combinations is INCORRECT?
Daptomycin – myopathy
Synercid – nephrotoxicity
Linezolid – thrombocytopenia
Vancomycin – Red man syndrome
Telavancin – QTc prolongation
Synercid – nephrotoxicity
