ID I: ABX FOR GRAM POSITIVE INFECTIONS Flashcards
Vancomycin is a glycopeptide that inhibits bacterial cell wall synthesis by binding to…
D-alanyl-D-alanine cell wall precursor and blocking peptidoglycan polymerization
Vancomycin coverage
Gram positive:
MRSA
Streptococci
Enterococci (not VRE obviously)
C diff (PO)
You patient has a systemic infection, IV Vanco dosing is
IV 15-20mg/kg Q8H-12H
Dosing for vancomycin is based on what weight
TOTAL body weight
When CrCl is 20-49 for vancomycin, what’s the interval
Q24H
Consider an alternate drug when MRSA MIC > ?
> 2mcg/mL
What are warnings for vancomycin?
ototoxicity
nephrotoxicity
red man syndrome
What is the vancomycin AUC/MIC ratio?
400-600
Goal trough for Vancomycin?
15-20mcg/mL
Vancomycin is first line for
MRSA
[pneumonia, meningitis, bacteremia, skin]
What are the lipoglycopeptides?
Telavancin
Oritavancin
Dalbavancin
Which lipoglycopeptide is approved for complicated skin and soft-tissue infections (SSTI) and hospital acquired and ventilator associated pneumonia?
telavancin
Telavancin is infused over ___ mins to avoid infusion reactions
60 mins
What are boxed warnings for lipoglycopeptides?
fetal risk
nephrotoxicity
Your patient is receiving UFH, what can they NOT receive?
a lipoglycopeptide! contraindication with IV UFH
What are the warnings for lipoglycopeptides?
can falsely INC coagulation tests (aPTT/PT/INR), does not increase bleeding risk
red man syndrome
Oritavancin is contraindicated with
IV UFH - or 5 days
What is a special note about lipoglycopeptides that is beneficial in terms of dosing?
extremely long half-life allows for a single dose regimen
What is daptomycin’s MOA?
binds to cell membrane components, causing rapid depolarization; inhibits all intracellular replication processes, including protein synthesis and causes cell death
What is the antibacterial activity of daptomycin?
concentration-dependent!
Daptomycin coverage
staphylococci MRSA
and both VRE (E faecium and E faecalis)
Brand: Cubicin
generic: daptomycin
What infection do you absolutely NOT use daptomycin?
pneumonia!
the drug is inactivated in the lungs by surfactant
Your patient is on daptomycin, what warnings should the healthcare team lookout for?
myopathy, rhabdomyolysis (D/C when CPK>1000u)
falsely increase PT/INR (no effect on bleeding)
Your patient is receiving IV Cubicin, the nurse wants to know what it is compatible with
NS and LR (no dextrose)
Daptomycin is approved for:
complicated SSTI
MRSA bloodstream infection including right sided endocarditis
Linezolid and tedizolid bind to the ___ subunit of the bacterial ribosome, inhibiting translation and protein synthesis
50S
Linezolid coverage
MRSA
VRE (E faecium and E faecalis)
Brand: Zyvox
generic: linezolid
The patient just received phenelizine (a MAO inhibitor) before linezolid…
NO!!!! do not use within 2 weeks
Warnings for linezolid include…
duration-related myelosuppression (thrombocytopenia)
optic neuropathy
serotonin syndrome (SSRI, SNRI, TCAs!!!)
hypoglycemia
What are side effects of linezolid?
decrased platelets
IV:PO linezolid
1: 1
* no dose adjustment in renal impairment
***do not shake
This drug is a treptogramin
Synervid (Quin/Dalfo)
Synercid binds to the ____ ribosomal subunit inhibiting protein synthesis
50S
Synercid coverage
most gram positive: MRSA, VRE (NOT E Faecalis)
approved for complicated SSTI, not well-tolerated
Brand: synercid
generic: quinupristin/dalfopristin
BIG side effects of synercid include…
arthralgias/myalgias
infusion reactions (over 60 mins)
hyperbilirubinemia
Synercid is being administered to a patient, a nurse wants to know what it can be diluted in…
D5W only
via central line
