Exam 2 - Vancomycin & GP agents Flashcards
what are the two main groups Vanc has coverage for
GP aerobic and anaerobic
what target organisms does vanc cover
PSSP
PRSP
Enterococcus
MSSA
MRSA
C. diff (PO dose only)
GN coverage of Vanc
none
what is vanc THE drug of choice for
MRSA
C. diff (po dose only)
clinical uses of vanc
MRSA infections (even in the CNS)
Serious GP infections for pts allergic to penicillins
PRSP infections/resistant GP organisms
prophylaxis of high risk surgeries
GP coverage for synercid
PSSP
PRSP
Enterococcus Faecium ONLY (including VRE)
MSSA
MRSA
GN and atypical coverage for vanc
none
when to use synercid
only when vanc, linezolid, and daptomycin cannot be used
Enterococcus faecium (VRE)
GP coverage for linezolid
PSSP, PRSP
Enterococcus faecium AND faecalis (including VRE)
MSSA, MRSA, VISA, VRSA
GN and atypical coverage for linezolide
none
when to use linezolid
when vanc or b-lactams cannot be used
-VRE infections
-Nosocomial pneumonia from MRSA
what is linezolid the drug of choice for
VRE infections
GP coverage of daptomycin
PSSP, PRSP
Enterococcus Faecium AND Faecalis (including VRE)
MSSA, MRSA, VISA, VRSA, LRSA
GN coverage of daptomycin
NONE
when to use daptomycin
when vanc and linezolid cant be used
-staph aureus bacteremia and endocarditis
-MRSA or VRE
what infection should daptomycin NOT be used in
treatment of pneumonia
due to inactivation by pulmonary surfactant
what are the lipoglycopeptides
telavancin, dalbavancin, oritavancin
GP coverage for lipoglycopeptides
PSSP, PRSP
Enterococcus Faecium and Faecalis
Staph A infections
what place in therapy are lipoglycopeptides for GP bugs
last line
vanc moa
-inhibits synthesis of cell wall at different site than B-lactams
-inhibits synthesis and assembly during second stage (D-ala-D-ala)
-prevents cross linking
what kind of killers are vanc
bactericidal slooooooow killers
what is the resistance against vanc
Showed in Enterococcus (VRE) and Staph A (VRSA) due to modification of the D-ala to d-lactate
also in VISA due to thickening of cell wall
what do you target for clinical efficacy of vanc
AUC/MIC
what is the route of admin for vanc
IM and IV (preferred)
where does vanc distribute
widely distributed (adipose) AND the CNS even w/ inflamed meninges
how long does vanc take to distribute
one hour
what weight do you use to dose vanc
TBW
how is vanc eliminated
unchanged by the kidneys
what is the half life of vanc and how can it be affected
6-8 hours and increases as renal function decreases (7-14 days)
is vanc removed during dialysis
somewhat 30-40%
why should serum conc. be monitored with vanc
high concentrations can lead to nephrotoxicity
when to draw concentrations for vanc
Peak: one hour after end of infusion
Trough: just prior to dose
what should doses not exceed for vanc
2000-3000mg
what are the adverse effects of vanc
Red-Man Syndrome
Nephrotoxicity
Ototoxicity
Dermatologic
Hematologic
what can cause red-man syndrome
rate of the vanc infusion
how to mitigate red-man syndrome
vanc doses of 1g should be infused over at least 1 hour and larger doses over 90-120 minutes
what are risk factors for nephro and ototoxicity for vanc
underlying renal insufficiency
synercid moa
on the 50S subunit
what kind of killer is synercid
time dependent
bacteriostatic alone and bactericidal together
what is the resistance against synercid
alteration of ribosomal binding site by the erm gene
does synercid have a PAE
yes and allows for extended dosing
does synercid need to be adjusted for anything?
no adjustment for renal insufficiency
should adjust in hepatic insufficiency
DDIs of synercid
statins
immunosuppressors (cyclosporine and tacrolimus)
Carbamazepine
what are the AEs for synercid
vein irritation
GI
myalgias/arthralgias
rash
linezolid moa
binds to 50s subunit near the 30s to prevent 70s complex
inhibits protein synthesis
what kind of killers are linezolid
bacteriostatic
what is the resistance against linezolid
alteration of subunit target
(not erm though)
does linezolid have PAE
yes
what is the absorption for linezolid
100% oral bioavailability
what is the distribution of linezolid
readily distributes into well-perfused tissues
limited CSF access
how is linezolid eliminated
renal and hepatic
dose adjustments for linezolid
none for renal insufficiency
DDIs of linezolid
weak inhibitors of Monoamine oxidase
serotonin syndrome
can linezolid be used with SSRIs
yes, but you have to counsel patient on how to monitor for serotonin syndrome
what are the adverse effects of linezolid
GI
peripheral and optic neuropathy
thrombocytopenia and anemia
what should ALWAYS be checked before starting linezolid
SSRI use and platelets < 50,000
daptomycin moa
binds to membrane and inserts tail into cell wall
what kind of killer is daptomycin
rapid concentration dependent bactericidal activity
what is the resistance against daptomycin
altered cell-membrane (rare)
route of admin for dapto
IV only
distribution of daptomycin
fairly well into tissue
NO CNS
elimination of daptomycin
via the kidneys
dosage adjustment of daptomycin
required for renal insufficiency
DDI of daptomycin
statins
adverse effects of daptomycin
GI
Headache
Injection site reactions
Rash
Myopathy and CPK elevation
Acute eosinophilic penumonia
moa of lipoglycopeptides
interfere with d-ala-d-ala
only oritavancin and telavancin will insert the tail)
resistance against lipoglycopeptides
alteration in the D-ala to D-lactate
what kind of killers are lipoglycopeptides
concentration-dependent bactericidal activity
distribution of lipoglycopeptides
well into tissues
NO CNS
what lipoglycopeptides are removed by HD
none
what lipoglycopeptides need adjusted for renal insufficiency
telavancin and dalbavancin
what lipoglycopeptide does NOT need adjusted for renal
oritavancin
adverse effects of lipoglycopeptides
red man syndrome
nephrotoxicity
QTc - prolongation
taste disturbances
what is the risk you run with lipoglycopeptides?
if a patient experiences a bad reaction, the half-life is so long they will take a while to go away
lipoglycopeptides in pregnancy
telavancin has a black box warning for pregnancy
dalba and orita are also due to lack of studies
