Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
63 Cards in this Set
- Front
- Back
- 3rd side (hint)
formulation of vanco and which is perferred
|
-iv
-po -iv, bc po is not absorbed |
|
|
moa of vancomysin
pneumonic |
-cell wall inhibitor
• Inhibits stage 2 of bacterial cell wall synthesis (peptidoglycan synthesis and assembly) by binding to the D-alanyl-D-alanine terminus of cell wall precursor units a van with + on its side is driving out of iv tubing and is going to run over a ear and hit ptg cell wall |
|
|
vanco spectrum of activity
|
all gram + (aerobic and anaerobic)
-Staph aureus (including MRSA) − Staph epidermidis (including MRSE) − Streptococcus (including PCN resistant strains) − Enterococcus (bacteriostatic, bactericidal if combined with gentamicin) − Corynebacterium spp. (diphtheroids) − Clostridium spp. (including C. difficile) |
|
|
vanco is static or cidal toward entercoccus
|
static
|
|
|
vanco +gentamicin is static or cidal toward entercoccus
|
bacteriocidal
|
|
|
synergistic + gentamicin protects vs
|
-S. aureus (MSSA and MRSA)
-Enterococcus |
|
|
oral bioavail of vanco
|
- F<5 %
-low |
|
|
when can you use po vanco
|
-to treat C.difficle colitis
|
|
|
t/f
you can use po form of vanco for systemic infections |
false, only use for c. difficle infxn
|
|
|
vanco elimination?
|
renal
|
|
|
vanco t1/2=
vano t1/2 esrd= |
t1/2= 6-7 hrs
ESRD= 7 days |
|
|
dose adjust for vanco?
when? |
renal impairment
|
|
|
during dialysis in what happens to vanco?
|
-not cleared by hemodialysis or peritoneal dialysis, dnt need to give additional dosage after dialysis
|
|
|
for vanco what concentrations are most accurate method to correlate to efficacy
|
trough
|
|
|
vanco
trough concentration should =? why |
>10 mg/ml
to prevent emrgence of vrsa/visa |
|
|
vanco
auc/mic = |
400
Newer evidence suggests that AUC/MIC is the important parameter: AUC:MIC > 400 is optimal − If the MIC is 1, a target trough of 15-20 should be targeted to try to achieve the AUC:MIC > 400 − If the MIC is 2, it is unlikely that an AUC/MIC of 400 can be achieved |
|
|
vano is con indepen or depen drug
|
both
|
|
|
vanco therapeutic indications
|
Infections due to MRSA, Staph epidermidis
• PCN-resistant Streptococci, Enterococci infections • PO Vancomycin - Clostridium difficile colitis • Patients infected with Gram + bacteria with allergy to β-lactam (PCN) • Prophylaxis − Surgical procedures involving prosthetic device or patient with recent MRSA infection − Endocarditis prophylaxis per AHA |
|
|
CDC Recommendations for Preventing the Spread of Vancomycin Resistance:
|
1. Treatment of serious infections caused by B-lactam-resistant gram-positive organisms
3. When antibiotic-associated colitis fails to respond to metronidazole therapy or is severe and potentially life-threatening 5. Prophylaxis for major surgical procedures involving implantation of prosthetic materials or devices at institutions that have a high rate of infections caused by MRSA or MRSE (one dose before surgery is sufficient, repeat one dose if the procedure lasts >6 hours, NTE 2 doses total) |
|
|
b lactam vs vanco, greater killing effect?
|
b-lactam,
vanco has slow bactericidal killing |
|
|
vanco iv admin
- how long is the usual infusion rate? - inf rate of dose >1gm |
- at least 60 min
- doses >1 gm are generally infused over 1.5-2 hrs |
|
|
doall patient population get vanco loading dose?
|
no, only with certain pop
- critically ill -bacteremia -endocarditis -meningitis -ostemyelitis, -hospital acquired pneumonia |
|
|
vanco target trough varies based on
|
-site of infection
- mic of the mrsa stain |
|
|
vanco target trough?
target for serious infections? |
target trough= 10-15 mg/L
target trough for serious infections =15-20 mg/L |
|
|
vanco peak
- max level -aim level |
- below 60 mg/ L , to avoid ototoxicity
-aim <40 mg/L |
|
|
when do you get trough level for vanco?
|
- get trough after the 4th dose (ss) in patients w/ normal renal fxn
- obtain the trough < 1 hr prior to nxt scheduled dose |
|
|
vanco trough monitoring is reco for
|
-Patients receiving aggressive dosing,
-Patients at high risk of nephrotoxicity -Unstable renal function -Prolonged courses of therapy: >3-5 days |
|
|
how frequent do you monitor trough levels for vanco?
|
- once weekly monitoring is reco for hemodynamic stable patients
- renal failure: random levels checked 3-5 days after initiating therapy |
|
|
vanco adr
|
- drug fever
- red neck syndrome -otoxicity - nephrotoxicity neph and otox like amg + red neck syndrome+ drug fever |
|
|
red neck syndrome
|
-vanco
-caused by rapid infusion and high doses - Sx: tingling and flushing of the face, neck and thorax, tachycardia, hypotension − Prevent by infusing over at least 60 minutes (antihistamine also effective) − Doses > 1 gram should be infused over 90-120 minutes − Not an allergic hypersensitivity |
|
|
t/f
red neck syndrome is an allergic hypersensitivity rxn |
false
|
|
|
is ototoxicity a main concern w/ vanco?
|
-only 1-9%
- only occurs when taking other otoxic agents - when tx is >21 days |
|
|
factors associated w/ nephrotoxicity when taking vanco
|
-Trough >15
-Extended durations of therapy: > 2 weeks -Concurrent nephrotoxins -Obese patients (>101.4 kg) |
|
|
monotherapy w/ vanco will you get nephrotox?
|
uncommon
|
|
|
vanco preg cat
|
C
|
|
|
aminoglycosides (5)
|
- streptomycin
-gentamicin -tobramycin -amikacin -neomycin -netilmicin |
|
|
amg moa
|
-Inhibits bacterial protein synthesis by binding to 30 S ribosomal subunit misreading and premature
termination of translation of mRNA • Entry into the cell − Diffuse through the porin proteins in the outer membranes -bactericidal |
|
|
amg resistance mechanisms
|
1. Drug inactivation by microbial enzymes (acquired)
2. Impaired transport of drug into the cell (intrinsic) 3. Alterations in ribosomal structure (acquired) |
|
|
amg spectrum of activity
|
- aerobic, GN bacilli ****
-heaps - gram + cocci-limited - mycobacteria (streptomycin,amikacin) |
|
|
amg covers what aerobic gram - bacilli
|
- Haemophilus spp
− Enterobacteriaceae − Serratia spp: gentamicin is most active − Pseudomonas aeruginosa: tobramycin is most active − Acinetobacter spp HEAPS |
think heaps
|
|
amg are concentration indep or depen?
|
concentration dependent bactericidal activity
-higher concentation, the greater the rate of bacteria killing |
|
|
can you get pae with gram + or -?
|
get pae only with gram -
|
|
|
explain the pae of amg
|
inc dose --> inc concentation of amg
--> long pae effect |
|
|
duration of pae depends on multiple factors
|
-Type of organism
-Type of antimicrobial agent -Concentration of antimicrobial (correlates with peak and AUC) -Duration of exposure |
|
|
amg
def adaptive resitance and how to prevent this |
-initial drug concentration is subtherapeutic, bacterial uptake of drug is reduced upon 2nd exposure
resulting in slower bactericidal activity - prevent this by giving a loading dose |
|
|
amg
how do you get synergy |
Results in more than additive effect when combined with β-lactams (GN and GP)
|
|
|
Amg are active vs gram + cocci on their own?
|
no, have to be combined with cell wall active agent (B-lactam, pcn, vanco)
|
|
|
amg
which agents are vs mycobacteria |
- streptomycin
-amikacin |
|
|
amg
absorption |
-less than 1% absorbed from the gi tract
-absorption after im injection is rapid and complete -usually given iv |
think of birthday cake
tag |
|
amg distribution
- high - approx equal -low |
high: renal cortex, inner ear
approx equal: pleural, synovial, peritoneal low: bile, respiratory |
|
|
amg vs vanco dialysis
|
Dosing must be adjusted for decline in renal function
− ~50% removal in 12 hour by hemodialysis − Peritoneal dialysis less effective than hemodialysis in AG removal |
|
|
gent/tobra peak
|
5-10 mg/L
|
|
|
Amikacin peak
|
20-35 mg/L
|
|
|
for amg peak mean
|
assure efficacy
|
|
|
trough
gent/tobr amikacin |
gent= 0.5-2 (aim for less <1)
amikacin= 5-10 |
|
|
amg synergy dosing
-gentamycin -target peak |
Synergy dosing: used for GP bacteria and urinary tract infections (not pyelonephritis or urosepsis)
− Gentamicin 1.0 mg/kg Q8H − Target Peak 3-5 mg/L, Trough <1 mg/L − Goal Minimize toxicity without jeopardizing clinical cure |
|
|
extended interval dosing for amg is not reco for who?
|
-Meningitis, endocarditis, enterococcal and staphylococcal infections, neutropenic patients
− Children − Hyperkinetic patients: burn victims, spinal cord injury, pregnancy − Renal impairment: CrCL <20 ml/min, dialysis |
|
|
amg are reco for kids
|
no, pregnancy category D
|
|
|
adr of amg
a mean guy in the eigth round delivers a crushing left hook to his opponets ear, with his opponent off balance, a mean guy surges upward with a savage right hook into his left side, pulverizing his kidney (renal toxicity), the opponents drops to the floor out cold in a complete neuromuscular blockage |
- ototoxicity
- nephrotoxicity -neuromuscular paralysis |
|
|
can a pt use amg if they have myasthenia gravis
|
- no, it is a contraindication
|
|
|
amg preg cat
|
D
|
|
|
which amg is most active vs serratia
|
gentamycin
|
|
|
which amg is most active vs psa
|
tobramycin
|
|