Not beta lactams

Question 1

What is vancomycin?

Answer 1

Antibiotic

Useful in gram +, MRSA, penicillin-resistant enterococci and streptococci

Question 2

How is vancomycin administered?

Answer 2

Parenteral

Oral only for c diff if metronidazole doesn’t work

Question 3

What is vancomycin used for?

Answer 3

Severe infections only

Useful in gram +, MRSA, penicillin-resistant enterococci and streptococci

Also used for pseudomembranous colitis due to c diff

Question 4

What is the first choice for pseudomembranous colitis due to c diff?

Answer 4

Metronidazole

Use vancomycin only if that doesn’t work

Question 5

How is vancomycin excreted?

Answer 5

Kidneys

Question 6

What does vancomycin target?

Answer 6

Transglycosylases

Blocks connection of NAM-NAG to NAM-NAG

Question 7

What are adverse effects of vancomycin?

Answer 7

Fever, chills, shock

Redman syndrome (Histamine release, head and neck mostly)

Nephrotoxicity with inappropriate dosing

Ototoxicity - high concentrations when given with other ototoxins

Question 8

True or false: There is no resistance to vancomycin

Answer 8

False, resistance is becoming a problem in E. faecium

Question 9

What is televancin?

Answer 9

Bactericidal cell wall synthesis inhibitor, derivative of vancomycin

Question 10

What is televancin used for?

Answer 10

Used for skin and skin structure, MRSA, gram +, nosocomial pneumonia

Question 11

What is the mechanism for televancin?

Answer 11

Similar to vancomycin - inhibits cell wall synthesis

but also depolarizes bacteria by disrupting the membrane

Question 12

What are the adverse effects of televancin?

Answer 12

Nausea, vomiting, foamy urine

Decreases renal function

Redman syndrome

Taste disturbances

May interfere with clotting tests (not blood clotting itself, just the test - draw blood 23 hours after dose)

Question 13

What are the SERIOUS adverse effects of televancin?

Answer 13

Adverse fetal effects (avoid during pregnancy)
QT prolongation
Renal insufficiency

Question 14

Which agent has to be given only after a pregnancy test is done?

Answer 14

Televancin

Question 15

How does Daptomycin work?

Answer 15

Depolarizes bacteria, bacteria lose membrane potential and cell death occurs

Question 16

What is daptomycin used for?

Answer 16

Broad spectrum gram +
Vancomycin resistant bacteria
Staphylococci and streptococci

Question 17

How is daptomycin administered?

Answer 17

IV Once daily dosing

Question 18

Which agent has renal dosing?

Answer 18

Daptomycin

If CRCL is less than 30 mL/min, give dosing every 48 hours instead of every 24

Question 19

Which agent is inactivated by pulmonary surfactant?

Answer 19

Daptomycin

Question 20

What toxicities are associated with daptomycin?

Answer 20

Muscle damage, rhabdomyolsis (do not give with statins, aminoglycosides)

Question 21

Which agent can cause muscle damage/rhabdomyolsis?

Answer 21

Daptomycin

Question 22

How does fosfomycin work?

Answer 22

Blocks first step in peptidoglycan synthesis (inside the cell)

Question 23

What is fosfomycin used for?

Answer 23

Single dose therapy for uncomplicated UTI’s due to Ecoli or Enterococci faecalis

Question 24

How is fosfomycin excreted?

Answer 24

Concentrated and unchanged in the urine

Question 25

What are adverse effects of fosfomycin?

Answer 25

Diarrhea, nausea/vomiting
Vaginitis
Asthenia

Question 26

What is Bacitracin?

Answer 26

Cyclic polypeptide that blocks the lipid carrier molecule to move peptidoglycan to cell wall

Question 27

What does bacitracin target?

Answer 27

Gram + bacteria

Question 28

How is bacitratin administered?

Answer 28

Topical OTC

Often formulated with polymixin (Polysporin) or neomycin (Neosporin)

Question 29

Why can’t bacitracin be taken by mouth?

Answer 29

It’s nephrotoxic systemically