ID drugs Flashcards
1
Q
Vancomycin MOA and coverage
A
- Glycopeptide that inhibits bacterial cell wall synthesis by binding to d-alanyl-d-alanine cell wall precursor and blocking
- Vanc only covers gram positive bacteria, including staph (MRSA), streptococci, enterococci (not VRE) and C. DIff
2
Q
When should you consider an alternative drug fro MRSA?
A
If the MIC is >=2mcg/mL
3
Q
Vanc dosing including CrCl dose adjustments
A
- IV 15-20 mg/kg q8-12 hours
- Dose is based on actual body weight
- CrCl 20-49 q24h dosing
- C.Diff
- 125-500 QID for 10 days (upper end used for severe complicated disease)
- No dose adjustment for renal impairment
4
Q
Vanco warnings, SEs, and monitoring
A
- Ototoxicity and nephrotoxicity
- PO used only for C.Diff colitis and enterocolitis not absorbed systemically
- Infusion reaction and red mans syndrome minimum rate of infusion is 1 gram/ hour
- Monitoring: renal function, trough serum concentrations at steady state generally 30 minutes before the 4th or 5th dose
- Goal trough 15-20 mcg.mL: pneumonia, endocarditis, osteomyelitis, meningitis, bacteremia
- Goal trough other infections: 10-15 mcg/mL
5
Q
Lipoglycopeptides what is the suffix and what is the MOA
A
- vancin
- Inhibit bacterial cell wall synthesis by 1) binding to D-alanyl-D-alanine portion of the cell wall, blocking polymerization and cross-linking of peptidoglycan and 2) disrupting bacterial membrane potential and changing cell permeability
- Concentration dependent
- Similar coverage as vanc but only IV and no C. DIff
6
Q
televancin: what is it approved for?
Safety and Warnings
A
- Vibativ
- Approved for complicated skin and soft tissue infections (SSTI) and hospital acquired and ventilator associated pneomonia
- Fetal risk: obtain pregnancy test prior to starting therapy, nephrotoxicity increase in mortality with pre-exisiting moderate to severe renal impairment (CrCl<=50 mL/min) when compared to vanc
- COntrainidicated: with concurrent use of IV unfractionated heparin (UFH)
- Warnings: falsely elevated coagulation tests (aPTT, PT, INR), but does not increase bleeding risk, red man syndrome: give over 30 minutes, QT prolongation
7
Q
Oritavancin contraindications and approved treatment
Dalbavancin:
A
- Orbactiv
- Approved for SSTIs
- Use of IV UFH for 120 hours (5 days) after orivancin administration due to false elevation in aPTT
- Can cause falsely elevated PT/INR for up to 12 hours and aPTT for up to 120 hours
- Orivancin: use a different antibiotic if osteomyelitis is confirmed or suspected
- Dalbavancin (Dalvance): SSTIs: Infusion reaction with rapid infusion, Increased ALT > 3 x the ULN
- Infusion site reaction for both red man, N/V/D, rash, HA
- Extremely long half life allows single dose regimen for both
8
Q
Vancomycin glycopeptide, drug interactions
A
- Risk of nephrotoxicity is increased when other nephro drugs are use (AMGs, ampho B, cisplatin, polymyxins, cyclosporine, tacrolimus, loop diuretics, NSAIDs, radiocontrast dye.
- Vanc can also increase the risk of ototoxicity when used with other ototoxic drugs (AMGs, cisplatin, loop diuretics)
9
Q
Telavancin and Oritavancin drug interactions
A
- Tele: vibativ
- Oritacancin: Orbactiv
- Avoid televancin in patients with congenital long QT syndrom, known QT prolongation or uncompensated heart failure. Caution with other meds known to cause QT prolong
- Orivancin is a weak inhibitor of 2C9 and 2C19, and a weak inducer of 3A4 and 2D6 use caution in warfarin and other drugs
10
Q
Daptomycin MOA, and coverage
Cubicin
A
- Binds to cell membrane components, causing rapid depolarization; this inhibits intracellular replication process including protein synthesis and causes cell death.
- Concentration dependent activity
- G+, Including staph (MRSA), enterococcus (bothe species of VRE) (E. Faecium and facalis)
11
Q
When shouldnt daptomycin be used?
What is it approved for?
A
For pneumonia inactivated in the lungs by surfactant
- complicated skin and soft tissue infections, S. Aureus (MRSA), bloodstream infections, including right sided endocarditis.
- Dose adjustment at 30 CrCl
12
Q
Dapto warnings, SEs, Monitoring, and Notes
A
- Eosinophilic pneumonia: generally developes 2-4 weeks after treatment
- Myopathy and rhabdo: DC in pts with S/Sx and CPK >1000 units/L (5xULN), or in asymptomatic patients with CPK>= 2000 (10xULN)
- Can falsely elevate INR/PT but does not increase bleed
- SEs: Increased CPK,
- Monitor: CPK weekly
- Cubicin: compatible with NS and LR (no dextrose)
- Cubicin RF: compatible with NS but must only use sterile or bacteriostatic water for injection,
13
Q
Dapto drug interactions only one
A
- Increase muscle toxicity when used with statins
14
Q
Oxazalidinones: wht are the drugs, the MOA, and coverage
A
- Linezolid (Zyvox), Tedizolid (Sivextro)
- Bind to 50s ribosomal subunit inhibiting translation and protein synthesis
- Coverage similar to vanc but also cover all VREs
15
Q
Linezolid dosing, contraindications, warning, SEs, monitoring and notes
A
- No renal adjustment
- IV:PO 1:1
- Do not use within 2 wks of an MAO
- Warnings: duration related myelosuppresion (thrombocytopenia, anemia, leukpenia)
- Optic neuropathy when used for longer than 28 days
- Serotonin syndrome
- hypoglycemia
- Increased BP
- SEs: decreased platelets Hgb, WBC, Increased LFTs
- Monitor: HR, BP weekly CBC
- DO not shake linezolid suspension
