Lipoglycopeptides

Question 1

What is Telavancin

Answer 1

semi-synthetic derivative of vancomycin

Question 2

Telavancin MOA

Answer 2

dual:

• interferes with cell wall synthesis by binding to the d-ala-d-ala terminus of peptidoglycan precursors
• binding to cell membranes causing membrane depolarization and increased membrane permeability

Question 3

Telavancin spectrum coverage

Answer 3

ONLY GRAM +
dark purple: streptococcus, s. pneumoniae, viridans, MSSA, MRSA, E. faecalis, E. faecium
light purple: VRE
anaerobes: gram +

Question 4

Dalbavancin spectrum coverage

Answer 4

ONLY GRAM +
dark purple: streptococcus, s. pneumoniae, viridans, MSSA, MRSA, E. faecalis, E. faecium
light purple: VRE
anaerobes: gram +

Question 5

Oritavancin spectrum coverage

Answer 5

ONLY GRAM +
dark purple: streptococcus, s. pneumoniae, viridans, MSSA, MRSA, E. faecalis, E. faecium
light purple: VRE
anaerobes: gram +

Question 6

Lipoglycopeptides have poor activity against

Answer 6

enterococcus species with VanA

Question 7

Telavancin oral absorption

Answer 7

poor, IV only

Question 8

Telavancin 1/2 life

Answer 8

6-8 hours; long

Question 9

Telavancin elimination

Answer 9

64-76% renal

Question 10

Telavancin dosing

Answer 10

usually 24-48 hours depending on CrCl

Question 11

Telavancin adverse effects

Answer 11

*taste disturbance
*nausea
*vomiting
*foamy urine
renal
rigors
infusion-related
*red man syndrome
*QT prolongation
*contraindicated in pregnancy
clinicians are also cautioned to consider renal function

Question 12

Telavancin is okay/not okay for pregnancy

Answer 12

NOT OKAY

Question 13

Telavancin drug interactions

Answer 13

phospholipid agents used in measuring activated partial thromboplastin time, prothrombin time, and coag-based factor X assays

co-administration with heparin is contraindicated

Question 14

Long acting lipoglycopeptides

Answer 14

Dalbavancin, ortivancin

Question 15

Long acting lipoglycopeptide MOA

Answer 15

binds to d-ala-d-ala terminus of lipid II in peptidoglycan chain

Question 16

Dalbavancin is a _____ lipoglycopeptide

Answer 16

semi-synthetic

Question 17

Dalbavancin has enhanced ____activity

Answer 17

gram +

Question 18

Dalbavancin has ___MICs compared to vancomycin to s. aureus

Answer 18

lower

Question 19

Dalbavancin is active/inactive against enterococcus with vanB and vanC

Answer 19

active; potent

Question 20

Dalbavancin is active/inactive against enterococcus with vanA

Answer 20

inactive

Question 21

Dalbavancin oral absorption

Answer 21

poor, IV only

Question 22

Dalbavancin 1/2 life

Answer 22

long 8.5 hours

Question 23

Dalbavancin elimination

Answer 23

33% renal

Question 24

PK/PD parameter used for glycopeptides and lipoglycopeptides

Answer 24

AUC:MIC

Question 25

Dalbavancin is/is not dialyzable

Answer 25

is not

Question 26

Dalbavancin is dosed

Answer 26

single or two-dose regimens; administer over 30 min

Question 27

Dalbavancin reconstitutes with

Answer 27

sterile water or 5% dextrose

Question 28

Dalbavancin adverse reactions

Answer 28

rapid infusion can cause red man syndrome nausea headache diarrhea

Question 29

Dalbavancin drug interactions

Answer 29

minimal

Question 30

Oritavancin is a ____lipoglycopeptide

Answer 30

synthetic

Question 31

Oritavancin has improved activity over

Answer 31

VSE and VRE

Question 32

Oritavancin also have improved

Answer 32

anchoring to cell membrane and longer 1/2 life

Question 33

Oritavancin is potent against

Answer 33

MSSA, MRSA, VRE, VSE, streptococcus | remains active against Van A VRE

Question 34

Oritavancin oral absorption

Answer 34

poor, IV only

Question 35

Oritavancin 1/2 life

Answer 35

245 hours REALLY LONG

Question 36

Oritavancin elimination

Answer 36

very slow renal, <5%

Question 37

Can Oritavancin be dialyzable?

Answer 37

no

Question 38

Oritavancin PK/PD parameters

Answer 38

AUC:MIC and Cmax: MIC

Question 39

Oritavancin dosing

Answer 39

1200mg administered over 3 HOURS

Question 40

Oritavancin reconstitutes with

Answer 40

D5W, incompatible with NS

Question 41

Oritavancin renal adjustment

Answer 41

no

Question 42

What can happen if infusion is less than 3 hours for Oritavancin?

Answer 42

infusion-related reactions such as flushing, urticaria, pruritus, and rash

Question 43

Oritavancin drug interactions

Answer 43

contraindicated with heparin can prolong prothrombin time and international normalized ratio for up to 12 hours (monitoring of warfarin is unreliable for up to 12 hours after dose)

Question 44

Oritavancin adverse effects

Answer 44

nausea vomiting headache more cases of osteomyelitis than in vancomycin

Question 45

Indications for long acting lipoglycopeptides

Answer 45

avoidance of hospitalization minimize extended hospitalization/early discharge prevent need for IV therapy in select patient populations (non compliance or inability to maintain IV access)

Question 46

Which of the following past medical history should be considered prior to administration of oritavancin? a. DVT b. Congestive heart failure c. asthma d. hypothyroidism

Answer 46

b since you have to reconstitute with 1000ml D5W

Question 47

Telavancin has dual mechanism of action in that it acts at the: a. cell membrane and ribosome b. cell membrane and cell wall c. cell wall and ribosome d. ribosome and DNA gyrase

Answer 47

b

Question 48

Which medication would you recommend for a homeless patient who has a history of 1 week cellulitis?

Answer 48

Dalbavancin bc can be given as a single dose and doesn't need to be hospitalized/afford that kind of care

Question 49

Lipoglycopeptides are bactericidal/bacteriostatic

Answer 49

bactericidal