Infectious Diseases I: Gram + infections

Question 1

Vancomycin MOA

Answer 1

Glycopeptide antibiotic

inhibits bacterial cell wall synthesis

Question 2

Vancomycin coverage

Answer 2

Staph (includ MRSA)
Strep
Entercoccus
C. difficle

Question 3

Vancomycin starting dose for systemic infections

Answer 3

15-20 mg/kg

Question 4

Vancomycin dose for C. diff colitis

Answer 4

125-500 mg PO QID x10-14 days

Question 5

Vancomycin goal trough concertrations

Answer 5

Severe infections (osteo, endo, pneumonia): 15-20 mcg/ml
Other infections: 10-15 mcg/ml

Question 6

Serious concerns about Vancomycin

Answer 6

nephrotoxicity
ototoxicity
Red man syndrome (infuse slowly; over 1-2 hrs)

Question 7

Drugs that should be used with caution with Vancomycin due to incr risk of nephrotoxicity and ototoxicity

Answer 7

AG's
amphotericin B
Loop diuretics
NSAIDs
tracolimus
Cisplatin

Question 8

Available Lipoglycopeptides:

Answer 8

Telavancin
oritavancin
Dalbavancin

Question 9

Lipoglycopeptide MOA

Answer 9

inhibit bacterial cell wall synthesis

Conc dependent killing

Question 10

Lipoglycopeptides have similar coverage when compared to this antibiotic

Answer 10

Vancomycin

Question 11

Telavancin brand and warnings

Answer 11

Vibativ

Fetal risk - obtain pregnancy test before starting
Nephrotoxicity (adjust dose for CrCl < 50)
Cannot be used with IV heparin
Red man syndrome (infuse over 60 mins or longer)
QT prolongation

Question 12

Telavancin does increase bleeding risk (t/f)

Answer 12

FALSE

However, it does falsely incr PT/INR results

Question 13

Telavancin side effects

Answer 13

Metallic taste
n/v
Incr SCr

Question 14

Telavancin approved indications

Answer 14

Complicated SSTI

HAP/VAP

Question 15

Oritavancin brand and warnings

Answer 15

Orbactiv

cannot be used with heparin bc it interferes with aPTT labs for up to 120 hrs
May incr bleed risk with warfarin due to weak 2C9 inhibition

Question 16

Oritavancin indications

Answer 16

SSTI
long t1/2: given 1200 mg IV x1 dose
infused over 3 hrs

Question 17

Dalbavancin brand and warnings

Answer 17

Dalvance

Red man syndrome with fast infusions
can incr ALT

Question 18

Dalbavancin indications

Answer 18

SSTI

1500 mg IV x1 or 1000 mg x1 and 500 mg 1 wk later
infuse over 30 mins

Question 19

Oritavancin/Dalbavancin side effects

Answer 19

n/v/d
HA
rash
infusion reaction

Question 20

Daptomycin MOA

Answer 20

cyclic lipopeptide

depolarizes bacterial cell membrane

conc dependent killing

Question 21

Daptomycin coverage

Answer 21

Most Gram + bacteria

including MRSA and VRE

Question 22

Daptomycin indications

Answer 22

complicated SSTI

MRSA bacteremia/right-sided endocarditis

Question 23

Daptomycin dosing

Answer 23

4 mg/kg daily (SSTI)

6 mg/kg daily (bacteremia/endo)

Question 24

Daptomycin brand and warnings

Answer 24

Cubicin

Myopathy and rhabdo (incr risk with statin use and renal impairment)
Falsely elevated INR
Peripheral neuropathy

Question 25

Daptomycin side effects

Answer 25

incr CPK (monitor weekly or more frequently)
abd pain
pruritus
hypertension, chest pain

Question 26

Daptomycin is compatible with which diluent?

Answer 26

NS

Question 27

MOA of linezolid/tedizolid

Answer 27

oxazolidinone

binds to 50s subunit of ribosome and inhibits protein synthesis

Question 28

Linezolid brand and warnings

Answer 28

Zyvox

Do not use w/in 2 weeks of MAO inhibitor
Duration related myelosupression (> 28 days)
peripheral and optic neuropathy
serotonin syndrome 
hypoglycemia

Question 29

Linezolid side effects

Answer 29

decr platelets, WBCs
HA
nausea, diarrhea
neuropathy

Question 30

Linezolid dosage forms

Answer 30

tab, oral suspension (do NOT shake), injection
600 mg q12h
IV:PO = 1:1

Question 31

Tedizolid brand and warings

Answer 31

Sivextro

Do not use in pts with neutropenia
Less GI and myelosuppression when compared with linezolid

Question 32

Tedizolid approved indications

Answer 32

SSTI

Question 33

Tedizolid dosing

Answer 33

200 mg IV/PO daily x 6 days

Infuse over 1 hr

Question 34

BOTH tedizolid and linezolid are reversible MAO inhibitors (t/f)

Answer 34

TRUE

Question 35

Quinupristin/dalfopristin MOA

Answer 35

binds to 50S ribosome and inhibits protein synthesis

Question 36

Quinupristin/dalfopristin coverage

Answer 36

Most Gram +:
Staph (including MRSA)
entercoccus faecium (includ VRE) NOT E. faecalis

Question 37

Quinupristin/dalfopristin indications

Answer 37

SSTI

usually reserved for VRE infections

Question 38

Quinupristin/dalfopristin brand

Answer 38

Synercid

Not very well tolerated:
arthralgias/myalgias
edema 
pain
GI  upset
Phlebitis

Question 39

Tigecycline MOA

Answer 39

Glycylcycline class (related to tetracyclines)

binds to 30S ribosome and inhibits protein synthesis

Question 40

Tigecycline coverage

Answer 40

Very broad
MRSA
VRE
Gram - anerobes
atypicals

Does NOT cover:
Pseudomonas
Proteus
Providencia

Question 41

Tigecycline approved indications

Answer 41

SSTI
iintra-abdominal infections
CAP

Question 42

Tigecycline brand and side effects

Answer 42

Tygacil

n/v/d
HA, dizziness
incr LFTs
rash/severe skin reactions (SJS)

Question 43

Tigecycline boxed warning

Answer 43

Increased risk of death

HHMMMMMKAYYY

Question 44

Why should tigecycline not be used in bloodstream infections?

Answer 44

does not achieve adequate conc in the blood

due to high lipophilicity

Question 45

Tigecycline requires both renal and hepatic dose adjustments (t/f)

Answer 45

FALSE

only adjustment for hepatic inpairment