Term
| Vancomycin is effective against which Gram POSITIVE pathogens? |
|
Definition
MSSA
MRSA
PCN resistant S. pneumoniae
Enterococci
Listeria
C. dificile |
|
|
Term
| What is the ONLY Gram POSITIVE pathogen for which ORAL Vancomycin is used? |
|
Definition
| Clostridium dificile (diarrhea) |
|
|
Term
|
Definition
MINIMAL absorption
NEGLIGIBLE metabolism
RENAL excretion (80-90% unchanged)
T1/2= ~SIX HOURS
(in normal renal function) |
|
|
Term
| Vancomycin penetrates all body compartments well EXCEPT for... |
|
Definition
|
|
Term
| Vancomycin is the DRUG OF CHOICE for... |
|
Definition
MRSA infections
Enterococci resistant to Ampicillin |
|
|
Term
| Usual dosing for Vancomycin is... |
|
Definition
15-20 mg/kg (ABW) q 8-24 h |
|
|
Term
| Vancomycin Empiric Treatment |
|
Definition
HCAP
Meningitis
GPC bacteremia
Moderate-Severe SSTIs
C. dificile diarrhea
Endocarditis |
|
|
Term
Vancomycin Adverse Effects |
|
Definition
Red Man Syndrome
(Histamine mediated-rash on neck/trunk/arms)
Ototoxicity
(↑ concentrations in ESRD pts)
Nephrotoxicity
(Incidence LOW for mono-therapy at conventional doses)
Thrombocytopenia?? |
|
|
Term
Brand: Vibativ
Generic: Televancin |
|
Definition
Lipoglycopeptide
Hydrophobic side chain improves
D-Ala-D-Ala binding affinity & is additional MOA
Hydrophilic group ↑ urinary excretion |
|
|
Term
|
Definition
Binds D-Ala-D-Ala
Cell membrane specific depolarization
Quicker bacterioCIDAL action than Vanc |
|
|
Term
|
Definition
S. aureus (MSSA, MRSA, VISA)
Enterococcus
Streptococcus (pneumoniae, agalactiae, pyogenes)
Clostridium (perfringens, dificile) |
|
|
Term
| Telavancin Kinetics & Dosing |
|
Definition
T1/2= ~7.5-8 HOURS
70% RENAL elimination
93% protein bound
Usual Dose: 10 mg/kg IV (over 1 h) q 24 h
↓ Efficacy vs Vanc if CrCl <50 ml/min |
|
|
Term
Telavancin FDA Indications |
|
Definition
SSTI (2009)
Pneumonia (PENDING) |
|
|
Term
Telavancin has ↑ incidence of what
side effects vs. Vancomycin? |
|
Definition
Altered taste (metallic or soapy)
Foamy urine
Nausea/vomiting
QTc interval ↑
Nephrotoxicity (no level monitoring req'd) |
|
|
Term
Telavancin is considered as Pregnancy Category... |
|
Definition
C
Test for pregnancy before treatment
Only give if benefits > risk |
|
|
Term
Brand: Zyvox
Generic: Linezolid |
|
Definition
Classification: Oxazolidinone
BacterioSTATIC
Usual Dose: 600 mg IV/PO q 12 h
100% Bioavailability
30% RENAL elimination (no adj. req'd) |
|
|
Term
|
Definition
GRAM POSITIVE COCCI
-MSSA
-MRSA
-VR Enterococci
-PCN Resistant Strep |
|
|
Term
|
Definition
HCAP/CAP
VRE infections (including bacteremia)
SSTI |
|
|
Term
Linezolid Adverse Effects |
|
Definition
WEAK MAO inhibitor
(separate admin. by 2 WEEKS)
(avoid tyramine rich foods-red wines, cheeses)
OPTIC/PERIPHERAL NEUROPATHY
(Duration > 28 days)
RESISTANCE & COST
($100-150/day) |
|
|
Term
Brand: Cubicin
Generic: Daptomycin |
|
Definition
Classification: Lipopeptide with lipophilic tail
BacterioCIDAL
MOA: Binds to cell membrane causing rapid depolarization of membrane potential & cell death WITHOUT cell lysis
|
|
|
Term
|
Definition
GRAM POSITIVE COCCI
-MSSA
-MRSA
-E. faecalis & faecium (VRE)
-PCN Resistant Strep
Does NOT cover Gram NEGATIVE--inability to penetrate outer membrane |
|
|
Term
|
Definition
MRSA & MSSA Bacteremia
MRSA & MSSA Endocarditis--
bacteria that grow slowly (in biofilm)
SSTI
NOT Pneumonia |
|
|
Term
|
Definition
90% protein bound (small Vd)
Minimal HEPATIC metabolism
52% unchanged drug RENALLY eliminated
T1/2= 8-9 h |
|
|
Term
|
Definition
SSTI: 4 mg/kg IV q 24 h
Bacteremia: 6 mg/kg IV q 24 h
MRSA CRBSI: 6-8 mg/kg IV q 24 h
***If CrCl is <30 ml/min change to q 48 h
|
|
|
Term
Daptomycin Adverse Effects & Interactions |
|
Definition
-CPK elevations/myalgia
(monitor CPK WEEKLY, d/c if CPK >1000)
-false INR elevations
INTERACTION → STATINS |
|
|
Term
Brand: Synercid
Generic: Quinupristin/Dalfopristin |
|
Definition
Classification: 30:70 ratio of B & A Streptogramins
MOA: Inhibition of protein synthesis by binding to TWO spots on 50 S ribosome
BacterioCIDAL |
|
|
Term
Synercid Dosing & Spectrum |
|
Definition
Dosing: 7.5 mg/kg IV q 8-12 h
Spectrum:
MRSA
VRE (E. faecium only) |
|
|
Term
Synercid Uses & Adverse Effects |
|
Definition
MRSA SSTI (Clindamycin Sensitive v Resistant)
VRE faecium infections
**INCOMPATIBLE in Normal Saline!!!
AEs: Myalgia, arthralgia, ↑ conjugated bilirubin, CYP 3A4 inhibition, peripheral vein phlebitis |
|
|
Term
|
Definition
Classification: Rifamycin
Spectrum
MRSA
Mycobacteria
*Resistance in 1-2 DAYS as MONOTHERAPY
|
|
|
Term
|
Definition
M. tuberculosis
Prosthetic valve, bone, and hardware
infections caused by S. aureus
N. meningitidis prophylaxis |
|
|
Term
|
Definition
60% BILIARY excretion
HIGH metabolism
(80% HEPATIC via 3A4)
(20% intestinal wall)
LARGE Vd
T1/2= 1.5-5 h
80% protein bound, HIGHLY lipophilic
|
|
|
Term
|
Definition
10 mg/kg up to:
300 mg PO/IV q 8 h for MRSA Endocarditis
600 mg PO BID to 2 times weekly for Tuberculosis
300 mg PO/IV q 12 h for S. aureus infections |
|
|
Term
|
Definition
Daily Dosing Infrequent Dosing
-GI -Flu symptoms
-Skin rash -ARF
-LFT/Bilirubin ↑ -Hemolytic Anemia
-Hepatitis |
|
|
