Gram Positive Antibiotics Flashcards
1
Q
Vancomycin — MOA
- Glycopeptide
- inhibits cell wall ________ by binding to D-alanine - D-alanine component of ________
- ___________ (slowly)
- ________ dependent killer
A
- Glycopeptide
- inhibits cell wall SYNTHESIS by binding to D-alanine - D-alanine component of PEPTIDOGLYCAN
- BACTERICIDAL (slowly)
- TIME dependent killer
2
Q
Vancomycin — Spectrum
- Drug of choice for _______ (found in pools, locker rooms, etc.)
- Active against __________, but inferior to beta lactase
- Very ________, __________, and resource intensive
- Active against S. pneumonia but not used if _______ is only pathogen of concern
A
- Drug of choice for MRSA (found in pools, locker rooms, etc.)
- Active against MSSA, but inferior to beta lactase
- Very TIME, LABOR, and resource intensive
- Active against S. pneumonia but not used if STREP is only pathogen of concern
3
Q
Vancomycin — Kinetics
- Very large molecule, too big to be absorbed from __________
- Only given IV for ________ therapy; can use PO therapy for ________ infections
- Very ___________, very well distributed; but molecule is too large to penetrate the __________ well (high doses used)
A
- Very large molecule, too big to be absorbed from GI TRACT
- Only given IV for SYSTEMIC therapy; can use PO therapy for GI infections
- Very LIPOPHILIC, very well distributed; but molecule is too large to penetrate the BLOOD BRAIN BARRIER well (high doses used)
4
Q
Vancomycin — ADRs
- __________ eliminated
- __________ (after 7 days of therapy) – usually reversible, but can become permanent
- _________ (very rare; only occurring /c prolonged therapy)
- ” ________ syndrome” — not allergic reaction
- _________: dilute in more fluid to fix
A
- RENALLY eliminated
- NEPHROTOXIC (after 7 days of therapy) – usually reversible, but can become permanent
- OTOTOXICITY (very rare; only occurring /c prolonged therapy)
- ” RED MAN syndrome” — not allergic reaction
- PHLEBITIS: dilute in more fluid to fix
5
Q
Vancomycin — Dosing
- Unique: _________ specific and requires _______ monitoring
A
- Unique: PATIENT specific and requires INTENSE monitoring
6
Q
Vancomycin — Clinical Pearls
- PO is commercially available for ____________
A
- PO is commercially available for C. DIFF
7
Q
Daptomycin (Cubicin)
- This drug is another option for ________ & easier to administer than ___________
- A cyclic __________
- Causes cell death in gram ________ bacteria by binding to cell membrane and causing depolarization and intracellular ion loss
- The immediate loss of membrane potential inhibits protein, _______ and _______ synthesis
- __________ dependent
- ___________ (very rapid relative to other MRSA agents)
A
- This drug is another option for MRSA & easier to administer than VANCOMYCIN
- A cyclic LIPOPEPTIDE
- Causes cell death in gram POSITIVE bacteria by binding to cell membrane and causing depolarization and intracellular ion loss
- The immediate loss of membrane potential inhibits protein, DNA and RNA synthesis
- CONCENTRATION dependent
- BACTERICIDAL (very rapid relative to other MRSA agents)
8
Q
Daptomycin (Cubicin) — ADRs
- Very _______ tolerated
- Myalgias (manifested /c increased ______ levels) — recommend to hold ______ therapy during antibiotic course
- ________/________/__________ (NVD)
A
- Very WELL tolerated
- Myalgias (manifested /c increased CPK levels) — recommend to hold STATIN therapy during antibiotic course
- NAUSEA/VOMITING/DIARRHEA (NVD)
9
Q
Daptomycin (Cubicin)
- _________ is more cost effective
- Avoid for __________ (binds to lung surfactant which inactivates the drug)
A
- VANCOMYCIN is more cost effective
- Avoid for PNEUMONIA (binds to lung surfactant which inactivates the drug)
10
Q
Linezolid (Zyvox) — MOA
- Binds to 50S ribosome near the 30S interface to inhibit ______________
- ___________ (not great)
- Unique MOA results in very little, if any, ________________ /c other classes of antibiotics
A
- Binds to 50S ribosome near the 30S interface to inhibit PROTEIN SYNTHESIS
- BACTERIOSTATIC (not great)
- Unique MOA results in very little, if any, CROSS RESISTANCE /c other classes of antibiotics
11
Q
Linezolid (Zyvox) — Spectrum
- Very little gram ________ activity
- _______, ________, MRSE, MSSE
- Streptococci — ___________
- Enterococcus
A
- Very little gram NEGATIVE activity
- MRSA, MSSA, MRSE, MSSE
- Streptococci — BACTERICIDAL
- Enterococcus
12
Q
Linezolid (Zyvox) — ADRs
- _______/_________/________ (NVD)
- ___________ /c long duration of use ( >2 weeks)
A
- NAUSEA/VOMITING/DIAHRREA (NVD)
- THROMBOCYTOPENIA /c long duration of use ( >2 weeks)
13
Q
Linezolid (Zyvox)
- What is the drug interaction of LInezolid?
A
Serotonin Syndrome — avoid in combo /c serotoninergic drugs as linezolid inhibits MAO
14
Q
Linezolid (Zyvox)
- F: 1 = good ___________
- Not ________ eliminated (a niche for MRSA treatment)
- Try to use other agents _______ moving to Linezolid (Zyvox)
A
- F: 1 = good BIOAVAILABILITY
- Not RENALLY eliminated (a niche for MRSA treatment)
- Try to use other agents BEFORE moving to Linezolid (Zyvox
15
Q
Linezolid (Zyvox) — Clinical Use
- P_________
- _______________ (SSTI)
- ___________, so avoid if possible when other agents will work
A
- PNEUMONIA
- SKIN AND SOFT TISSUE (SSTI)
- BACTEREMIA, so avoid if possible when other agents will work
