Gram Positive Agents Flashcards
glycopeptides
vancomycin
streptogramins
quinupristin:dalfopristin
oxazolidinones
linezolid
tedezolid
lipopeptides
daptomycin
lipoglycopeptides
telavancin
oritavancin
dalbovancin
vancomycin MOA
inhibits 2nd stage of cell wall synthesis by binding to the D-Ala-D-Ala cell wall precursors
vancomycin cidal or static, time or conc dependent
bactericidal, slow
mechanism of resistance vancomycin
modification of the D-Ala-D-Ala vancomycin binding site
spectrum of activity vancomycin
gram positives
anaerobes
target organisms vancomycin
PRSP
MSSA
MRSA
C. diff (po only)
which is drug of choice for MRSA
vancomycin
when should we measure serum
1 hour after end of infusion
does vanc penetrate CSF
no
how is vanc eliminated? dose adjust?
excreted by kidney, requires dose adjustments based on CrCl
which gram positive agent can be used for c. diff?
vancomycin orally
adverse events of vancomycin
red man syndrome
neohrotoxicity, ototoxicity
interstitial phlebitis
risk factors for nephro and ototoxicity
high doses
prolonged therapy
use of other agents causing nephro or ototox like chemo or pressors
how does red man syndrome happen
related to rate of infusion, happens if given fast
if red man syndrome happens, can you give vancomycin again
can give it again but prolong the infusion or give pretreatment with antihistamines or corticosteroids
mechanism of action quinupristin/dalfopristin
inhibits protein synthesis by binding to 50S ribosomal subunits
quinupristin:dalfopristan cidal or static, conc or time dependent
static, time dependent
linezolid, tedizolid MOA
inhibits protein synthesis by binding to the 50S ribosomal subunit near 30S interface
linezolid, tedizolid static or cidal, time or conc
static
time dependent (linezolid)
conc dependent (tedizolid)
mechanism of action daptomycin
causes membrane depolarization by inserting lipophillic tail in cell wall to form transmembrane channel, inhibits DNA synthesis
daptomycin, cidal or static, time or conc dependent
cidal
concentration dependent
telavancin, oritavancin, dalbavancin MOA
inhibits cell wall synthesis by binding to D-Ala-D-Ala cell wall precursors AND causes cell membrane depolarization by inserting lipophilic tail in cell wall
telavancin, oritavancin, dalbavacin cidal or static, time or con
cidal
concentration dependent
Synercid mechanism of resistance
alteration in ribosomal binding site, enzymatic inactivation
linezolid, tedizolid mechanism of resistance
alteration in ribosomal binding site (rare)
daptomycin mechanism of resistance
rarely reported, altered cell wall membrane binding through loss of membrane protein
telavancin, oritavancin, dalbovancin mechanism of resistance
modification of the D-Ala-D-Ala vancomycin binding site
spectrum of activity Synercid (quinupristin, dalfopristin)
gram positives only
anaerobes
spectrum of activity linezolid, tedizolid
gram positive only
anaerobes
spectrum of activity daptomycin
gram positives only
anaerobes
spectrum of activity telavancin, oritavancin, dalbovancin
gram positives only
anaerobes
target organisms for gram positive agents
PRSP
MRSA
MSSA
VRE (except quinupristin: dalfopristin)
gram positive agents covering VISA and VRSA
linezolid, tidezolid
daptomycin
telavancin, oritavancin, dalbovancin
which gram positve agents have CSF penetration?
linezolid
which gram positives require renal dose adjustments
daptomycin
telavancin
dalbavancin
which gram positive requires hepatic dose adjustments
Synercid
side effects of Synercid (quinupristin, dalfopristin)
phlebitis
myalgias
arthralgias
linezolid side effects
optic and peripheral neuropathy
thrombocytopenia, anemia
daptomycin side effects
myopathy and CPK elevation
acute eosinophillic pneumonia
telavancin, oritavancin, dalbovancin side effects
nephrotoxicity
QT prolongation
taste werd
infusion site reactions
which drug has risk of serotonin syndrome?
linezolid
which drug has interaction with HmgCoa reductase?
daptomycin, hold the statin
which drug has CYP3a4 interaction
Synercid
what drugs should you avoid with Synercid
3A4s
cyclosporine
statins
tacrolimus
carbamezepine
which drug interacts with aPTT tests
oritavancin, dalbovancin, telavancin
which gram positive should we avoid in pregnancy
dalbavancin, oritavancin, telavancin
which drugs preferred for VRE
linezolid
daptomycin
