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potoski exam 1 stuff Flashcards

1
Q

SOA Vancomycin?

A

Active: Gram (+) cocci, bacilli
Great for MRSA

inactive: gram negative

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2
Q

dosage form of vanco

A

IV for systemic, PO for C. difficile

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3
Q

how is vanco eliminated

A

renal elimination

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4
Q

therapeutic drug monitoring parameters for vanco

A

nephrotoxicity– AUC:MIC ratio is 400-600
serum trough concentrations 15-20 mcg/mL for serious infections

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5
Q

daptomycin dosage forms

A

IV only
not absorbed PO

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6
Q

daptomycin dosing

A

once daily dosing
dose adjustment in renal insufficiency

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7
Q

daptomycin cannot be used for _______, because ______

A

pneumonia, it is inactivated by lung surfactant

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8
Q

daptomycin spectrum of activity

A

Primarily active against aerobic Gram (+): S. aureus (including MRSA), strep. pyogenes, enterococcus faecalis and faecium (both vanco-sensitive and vanco-resistant strains)

INACTIVE AGAINST GRAM NEGATIVE, DRUG CANNOT PENETRATE THE GRAM NEGATIVE OUTER MEMBRANE

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9
Q

indications for daptomycin

A

therapy of complicated skin/skin structure infections produced by susceptible strains of gram (+) aerobes: MSSA, MRSA, strep, enterococcus faecalis

therapy of MRSA and MSSA bacteremia

other off label uses for MRSA

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10
Q

adverse reactions to daptomycin

A

rhabdomyolysis

injection site reactions, GI upset, CNS

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11
Q

FDA warning for daptomycin

A

eosinophilic pneumonia (therapy is cessation of drug and administration of steroids)

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12
Q

how to mitigate rhabdomyolysis with daptomycin

A

monitor CPK at baseline then weekly. D/c drug if CPK> 10x ULN or symptomatic with CPK> 5x ULN

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13
Q

what is the mechanism of daptomycin?

A

formation of a porin, allows for leakage of intracellular components, cell dies

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14
Q

linezolid dosage forms

A

IV and PO
PO bioavailability is 100%

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15
Q

linezolid is a ______

A

oxazolidinone

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16
Q

linezolid penetrates ___

A

CNS

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17
Q

linezolid activity

A

aerobic gram (+) bacteria: enterococcus faecium and faecalis, strep pneumoniae, viridans group strep, MRSA and MSSA, some anaerobic bacteria, mycobacteria

18
Q

linezolid indications

A

skin and skin structure infections, VRE infections, nosocomial pneumonia, CAP

19
Q

what are the side effects of linezolid?

A

thrombocytopenia, CNS, diarrhea, lactic acidosis, serotonin syndrome

20
Q

when is thrombocytopenia from linezolid highest risk

A

after 14 days

21
Q

why does serotonin syndrome happen from linezolid

A

MAO inhibitor

tedezolid doesn’t inhibit MAO, no serotonin syndrome

22
Q

what is the mechanism of linezolid

A

binds to 23S portion of 50S ribosomal subunit and distorts binding site so it can’t bind to 30S subunit, prevents formation of 70S ribosome

23
Q

telavancin dosage forms

A

IV only
not absorbed PO

24
Q

what to monitor for telavancin

A

CrCL; dosage adjustments in renal impairment

25
Q

telavancin spectrum of activity

A

MSSA and MRSA
vancomycin-susceptible enterococcus faecalis
strep

26
Q

indications for telavancin

A

complicated skin and skin structure infections

HABP/VABP only when alternative treatments aren’t available

27
Q

what is the BBW for telavancin

A

increased mortality with moderate/severe renal impairment

28
Q

what is the mechanism of action of telavancin

A

it is a derivative of vancomycin + structural modifications

lipophilic side chain enhances cell wall disruptive activity

phosphonic acid improves distribution and antibacterial activity

29
Q

ceftaroline dosage forms

30
Q

ceftaroline clinical utility

31
Q

ceftaroline spectrum of activity

A

Good: strep, MSSA, MRSA, enteric GNRs
moderate: acinetobacter, enterococci faecalis
poor: enterococci faecium, pseudomonas, anaerobes

32
Q

what is the indication for ceftaroline

A

use in combination with daptomycin in patients that fail to clear

33
Q

what is the mechanism of ceftaroline

A

advanced generation cephalosporin with activity against MRSA because it binds to PBP 2a of MRSA that has a low affinity for other beta lactams

34
Q

there is an additional risk of nephrotoxicity if vancomycin is used concomitantly with ______

A

piperacillin/tazobactam

35
Q

vancomycin non-susceptible staphylococci include _________

A

vancomycin-intermediate staph. aureus (VISA)
vancomycin-resistant staph. aureus (VRSA)

36
Q

what is the mechanism of VISA???

A

a thicker cell wall–> reduced cell wall cross linking

37
Q

what is the mechanism of VRSA?

A

D-ala D-ala changes to D-ala D-Lac

38
Q

common characteristics of VRSA

A

-co-infection/co-colonization with VRE (gets VanA gene from VRE via a transposon)
-prior use of vanco
-diabetes, ESRD, gangrenous wound, surgical wound

39
Q

linezolid dosing

A

fixed, not weight based
600 mg IV or PO q12h

40
Q

with linezolid, be careful with ____

41
Q

telavancin is a ______

A

semisynthetic cyclic lipoglycopeptide

ID2 (13 decks)

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