Pharmacotherapy II Block 1 Misc Gram + Antibiotics
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38 terms
Terms | Definitions |
|---|---|
 Why will Vancomycin not cross Gram - bacterial membrane? | Too large - glycoprotein that weighs 1500 d |
| What is Vancomycin's spectrum of coverage? | MSSA, MRSA (breakpoint </= 2 mg/L), Streptococci (PCN-R Strep), Enterococci, Listeria, C. difficile (PO only) |
| What is Vancomycin's MOA? | binds to the d-Ala-d-Ala tail, preventing cross linking of peptidoglycan layers - bactericidal - AUC to MIC is key, so large dose less often |
| What two compartments will Vancomycin not get into well? | CSF (unless inflammed, though still not great) and Lungs (at a 1:6 lung to serum concentration ratio) |
| What is the typical dosing for Vancomycin? | 15-20 mg/kg ABW |
| What is Vancomycin the DOC for? | MRSA and Enterococci resistant to Ampicillin |
| What should you use Vancomycin empirically to cover? | HCAP, Meningitis, GPC bacteremia, Moderate to severe SSTI, C. difficile diarrhea, and Endocarditis |
| What are the key AE of Vancomycin use? | Red Man Syndrome, Ototoxicity, Nephrotoxicity and potentially Thrombocytopenia |
| What is the monitoring parameters for Vancomycin? | Trough level at 10-20 mg/L, taken after SS is achieved (usually after 4th or 5th dose) |
| What are the dosing interval guidelines for Vancomycin? | ClCr > 80 mL/min: Q8-Q12H ClCr 80-60 mL/min: Q12H ClCr 60-40 mL/min: Q24H ClCr < 40 mL/min: Q36H or pulse dosing |
| What is the maximum infusion rate for Vancomycin? | 1 gram per hour |
| What is Televancin's MOA? | Similar to Vanc, but has a hydrophobic side chain that improves d-Ala-d-Ala binding affinity, making it more rapid bactericidal / also depolarizes the bacterial cell-membrane |
| What is Televancin's spectrum of coverage? | S. aureus (MSSA, MRSA, and VISA), Enterococcus, Streptococcus, C. perfringes and C. difficile |
| What are the indications for Televancin use? | SSTI and Pneumonia |
| What are the AE associated with Televancin use? | Altered taste, foamy urine, N/V, QTc prolongation, Nephrotoxicity |
| What pregnancy category is Televancin? | Pregnancy Category C - so only use if benefit > risk - have to be registered to dispense |
| What is Linezolid's MOA? | binds to the 23s subunit of the 30s ribosome to inhibit protein production - bacteriostatic |
| How does Linezolid's PO dosing compare to its IV dosing? | 100% orally bioavailable so they compare 1:1 |
| Should Linezolid be renally adjusted? | No - only 30% renal elimination |
| What is Linezolid's spectrum of coverage? | MSSA, MRSA, VRE, PCN-R Strep |
| What are the indications for Linezolid use? | HCAP/CAP, VRE infections including bacteremia and SSTI |
| What are AE associated with Linezolid? | Weak MAO-I (so don't use with antidepressants), Optic/Peripheral Neuropathy, and Hematologic issues (mild, reversible, time-dependent myelosuppression) |
| What can be done if a patient is on antidepressants and needs to start Linezolid? | Hold the antidepressant med 2 weeks prior to linezolid OR 5 weeks if they are on Fluoxetine. Restart 24H after Linezolid DC |
| What is Linezolid's place in empiric therapy? | Linezolid should NOT be used empirically - only until you know they have bacteremia |
| What is Daptomycin's MOA? | lipopeptide that inserts itself into the cell membrane of the bacteria (Ca-dependent process), punches a hole in the membrane causing a loss of ion gradient and the cell dies (But does not lyse so no release of endotoxins) - bactericidal |
| What is Daptomycin's spectrum of coverage? | MSSA, MRSA, E. faecalis and E. faecium, PCN-R Strep, but no Gram - due to inability to penetrate outer membrane |
| What are the indications for Daptomycin use? | MRSA/MSSA bacteremia, R-sided Endocarditis, SSTI |
| What is a specific indication that Daptomycin cannot be used for and why? | Pneumonia - binds to surfactant in the lung and cannot get to the bacteria |
| What are some potential AE with Daptomycin use? | CPK elevations/Myalsia and False INR elevations |
| What drug class is contraindicated with Daptomycin? | Statins |
| What is the main thing to know about Quinupristin/Dalfopristin? | works against MRSA, but is rarely used |
| What is Rifampin's MOA? | interrupts RNA transcription on RNA polymerases |
| How is Rifampin excreted? | 60% biliary excretion so no renal adjustment |
| What is Rifampin's spectrum? | GPC (MRSA) and Mycobacterium |
| What should be watched for with Rifampin monotherapy? | Resistance can develop in 1-2 days |
| What are some uses for Rifampin? | M. tuberculosis, S. aureus (Osteo, Prosthetic valve Endocarditis, Hardware infxs), N. meningitidis chemophylaxis |
| What are some AE associated with Rifampin? | If using daily: GI, skin rash, LFT/bilirubin elevations, and Hepatitis If using for TB: Flu symptoms, ARF and Hemolytic Anemia |
| What is the main thing to know about interactions with Rifampin? | Induces both CYP3A4 and P-gp so look up everything that the patient is on |
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