glycopeptides

Question 1

Name the 2 main ones

Answer 1

vancomycin
teicoplanin

Question 2

MOA

Answer 2

bactericidal
inhibit the synthesis of bacterial cell walls by binding to the end of peptidoglycan precursor units - kill bacteria

Question 3

Teicoplanin is similar to vancomycin, but has a what is the main difference in its duration of action?

Answer 3

Teicoplanin has significantly longer duration of action, allowing once daily administration after the loading dose.

Question 4

does vancomycin penetrate into CSF

Answer 4

poorly

Question 5

spectrum of activity for vancomycin

Answer 5

NARROW
bactericidal activity against aerobic and anaerobic Gram-positive bacteria including MRSA

Question 6

can they be used for MRSA

Answer 6

yes

Question 7

True or false - there are reports of Staphylococcus aureus with reduced susceptibility to glycopeptides.

Answer 7

True

Question 8

There are increasing reports of glycopeptide-resistant …..

Answer 8

enterococci

Question 9

is vancomycin given orally

Answer 9

Vancomycin should not be given by mouth for systemic infections because it is not absorbed significantly.

only used orally for CDI infection

Question 10

CI for vancomycin with IV use

Answer 10

previous hearing loss

Question 11

cautions - vancomycin, oral use

Answer 11

it is not used by mouth for systemic infections because it is not absorbed significantly. it is used orally for CDI

with oral use
systemic absorption may be enhanced in patients with inflammatory disorders of the intestinal mucosa or with Clostridioides difficile-induced pseudomembranous colitis (increased risk of adverse reactions)

Question 12

state a common SE of vancomcyin with IV use

Answer 12

Vancomycin infusion reaction

previously known as red man sydnrome

Question 13

patient is on vancomycin. they have tinnitus. what should you do

Answer 13

discontinue

Question 14

which one is more nephrotoxic - vancomycin or teciplanin

Answer 14

vancomycin

Question 15

IV use vancomcyin - what are doses based on

Answer 15

initial doses should be based on body-weight; subsequent dose adjustments should be based on serum-vancomycin concentrations to achieve targeted therapeutic concentrations.

Question 16

who needs serum-vanocmycin conc monitoring & when is this done

Answer 16

ALL patients require serum-vancomycin measurement (on the second day of treatment, immediately before the next dose if renal function normal, earlier if renal impairment)

Question 17

when would you do serum-vancomycin conc monitoring

Answer 17

on the second day of treatment, immediately before the next dose if renal function normal, earlier if renal impairment

Question 18

vancomycin: frequency of monitoring depends on the clinical situation and response to treatment; but when is regular monitoring indicated?

Answer 18

• high-dose therapy
• longer-term use,
  esp in patients with RI, impaired hearing, or concurrent use of nephrotoxic or ototoxic drugs.

Question 19

vancomycin trough conc levels

Answer 19

pre dose (‘trough’) normally 10–20 mg/litre depending on the site of infection and the susceptibility of the pathogen

trough concentration of 15–20 mg/litre is usually recommended to cover susceptible pathogens with MIC greater than or equal to 1 mg/litre

Question 20

should you do therapeutic drug monitoring for vancomycin oral use

Answer 20

advised to monitor serum-vancomycin concentration in inflammatory intestinal disorders.

not used orally for systemic infections as inadequate absorption

but, risk of absorption in CDI-induced pseudomembranous colitis and in inflammatory conditions of intestinal mucosa = increased risk of SE

Question 21

monitoring pt parameters vancomycin IV use

Answer 21

• periodic testing of auditory function.
• blood counts, urinalysis, LFTs and RFTs periodically in all pt
• leucocyte count regularly in long erm treatment or if other drugs that may cause neutropenia or agranulocytosis
• elderly: vestibular and auditory function during and after treatment in the elderly; avoid concurrent or sequential use of other ototoxic drugs.

Question 22

monitoring pt parameters vancomycin oral use

Answer 22

serial tests of auditory function may be helpful to minimise the risk of ototoxicity in patients with an underlying hearing loss, or who are receiving concomitant therapy with other ototoxic drugs.

Question 23

hepatotoxic or nephrotoxic

Answer 23

nephrotoxic

therefore increased risk with other drugs e.g. aspirin, AGs, azoles, ACE, ARB, cephalosporins etc

Question 24

interaction with loop diuretics, vinca alkaloids, AGs, cisplatin

Answer 24

ototoxicity increased risk

Question 25

spectrum activity teicoplanin

Answer 25

NARROW
teicoplanin has bactericidal activity against aerobic and anaerobic Gram-positive bacteria including multi-resistant staphylococci.

Question 26

can teicoplanin be given orally

Answer 26

Teicoplanin should not be given by mouth for systemic infections because it is not absorbed significantly.

used orally for CDI

Question 27

teicoplanin monitoring pt parameters

Answer 27

Blood counts and liver and kidney function tests required.

Manufacturer advises monitoring for adverse reactions when doses of 12 mg/kg twice daily are administered.

Question 28

teicoplanin theapeutic drug monitoring for IV and IM use - when would you measure

Answer 28

Manufacturer advises monitor serum-teicoplanin trough concentration at steady state after completion of loading dose and during maintenance treatment—consult product literature.

Question 29

what is vancomycin infusion reaction

Answer 29

aka red man syndrome

can occur when vancomycin is administered intravenously too quickly

Question 30

signs of vancomycin infusion reaction

Answer 30

flushing, erythema, pruritus, and/or maculopapular rash usually of the upper body (i.e. face, neck, trunk, and/or upper extremities). Chest or back pain and hypotension may also occur

Question 31

electrolyte disturbance can vancomycin cause

Answer 31

hypoK and hypoMg