Glycopeptides Flashcards
What are the 4 glycopeptides that are clinically in use?
- Vancomycin
- Telavancin
- Dalbavancin
- Oritavancin
(T/F) - Vancomycin has activity against all gram (+) organisms
TRUE
(T/F) - Vancomycin has become resistant to many enterococci especially E. faecium
TRUE
What is another name of vancomycin resistant to enterococci?
Vancomycin-resistant enterococci (VRE)
(T/F) - Streptococci has learned to become resistant to vancomycin
FALSE - not streptococci but staphylococci has but is rare
Which glycopeptides are long-acting glycopeptides that can be taken once IV for a 2-week course but is very expensive?
- Dalbavancin
- Oritavancin
What is the MOA of glycopeptides?
- Inhibits cell wall synthesis binding to the D-alanine-D-alanine residues of peptide cell wall precursors
- Bactericidal against nearly all gram (+) bacteria
Vancomycin should be used in combination with which other medication against enterococci?
Aminoglycosides because of its bacteriostatic effect
What is the mechanism of resistance of glycopeptides?
Mutation of D-alanine-D-alanine binding site such that vancomycin cannot bind to the cell wall precursors
Which glycopeptide can be given IV and PO?
Vancomycin
Glycopeptides have a good spectrum in which bacteria?
- MRSA
- MSSA
- Streptococci
- C. difficile
Which glycopeptide can only be given for C. difficile?
Vancomycin PO
What adverse events can occur with vancomycin?
- Ototoxicity
- Nephrotoxicity
- Red man syndrome
How can nephrotoxicity occur with vancomycin?
By giving the patient high doses
What are symptoms of red man syndrome with the use of vancomycin?
- Warmth
- Flushed
- Hypotensive may occur
How can red man syndrome be prevented with the use of vancomycin?
- Slow the infusion rate AND/OR
- Antihistamine given prior to infusion
(T/F) - Red man syndrome is a true allergy
FALSE - it’s not
What adverse events can occur with telavancin?
- Nephrotoxicity
- Foamy urine
- Taste disturbance
- Red man syndrome
- QT prolongation
Telavancin is contraindicated in which patients?
Pregnant patients
What adverse events can occur with dalbavancin?
- Infusion reactions
- AST elevations
- nausea, HA, diarrhea
What adverse events can occur with oritavancin?
- Infusion reactions
- HA
- N/V/D
- Limb and SQ abscesses
What drug can interact with oritavancin?
Warfarin; warfarin can increase by oritavancin falsely prolonging aPTT for up to 48 hours and PT/INR for up 24 hrs
How can you determine that glycopeptides are not being eliminated too quickly?
By checking trough levels
(T/F) - IV vancomycin can also be used for C. difficile but it’s best to use PO vancomycin
FALSE - only PO vancomycin is used for C. difficile; IV vancomycin cannot reach the colon
(T/F) - Vancomycin can kill MSSA infections as quickly as beta-lactams
FALSE - Vancomycin cannot kill MSSA infections as quickly as beta-lactams; use nafcillin/oxacillin or cefazolin for MSSA infections
What is the DOC for vancomycin?
- MRSA infections
- Empiric use of MRSA infections (such as nosocomial infections)
Vancomycin is also utilized for what other indications?
- Gram (+) infections when a patient has a severe beta-lactam allergy
What is telavancin FDA-approved of?
- Complicated skin/skin structure infections
- Hospital acquired pneumonia
What is dalbavancin and oritavancin mainly utilized for?
- Acute bacterial skin/skin structure infections
(T/F) - These drugs are active against VRE
FALSE - they are not active against VRE
What should you always make sure when monitoring vancomycin?
That the trough concentration was drawn correctly
