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What enzyme do B-lactams inhibit (primarily)?
Dipeptidase
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What is the MOA of Vancomycin?
Inhibits transglycosylases that creates linear chains (pre-crosslinking) by inhibiting D-alanyl-D-alanyl linking in the cell wall ( cell wall synthesis inhibitor)
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What are the glycopeptide antibiotics?
Vancomycin and telavancin ( a derivative of vanco)
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Glycopeptide antibiotics only treat what?
G+
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Is Vancomycin narrow or broad spectrum?
Narrow
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Does Vancomycin treat aerobic or anaerobic bacteria?
Both
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Can Vancomycin treat MRSA?
Yes
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What are the main groups of bacteria that Vancomycin can treat?
Staph aureus, Strep, Enterococci and C. diff
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Is Vanco a small or large molecule?
Large
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Why does Vancomycin only treat G+?
Too big to get through G- porins
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Is Vancomycin cidal or static?
Bacteriocidal
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What would be the advantage of using nafcillin (2nd gen penicillin) over vancomycin?
Nafcillin is more rapid, Vanco is slower
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When treating what organism would you consider using aminoglycosides with Vancomycin for the synergistic effects?
Enterococci
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Is vanco a time dependent drug?
Yes
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Is Vancomycin absorbed orally?
No, but is active orally for GI infections, only IV for systemic use
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Why is Vancomycin not given IM?
Causes too much pain
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What % of Vancomycin is bound to plasma proteins?
30%
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Under what conditions can Vancomycin enter the CNS?
When meninges are inflamed
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How is Vancomycin excreted?
Largely unchanged via the kidney (small amount is metabolized)
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Does resistance to Vancomycin occur rapidly or slowly?
Slowly
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How does some enterococci resistance to Vancomycin occur?
Produces PBPs that compete for D-ala-D-ala or may change D-ala-D-ala to something else
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What are the adverse effect sof Vancomycin?
Hypersensitivity/Red man syndrome (IV to quickly causes cells to release histamine), shock, thrombophlebitis, ototoxicity (could be permanent) and nephrotoxicity
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What should you do if a patient is experiencing Red man syndrome with Vancomycin?
Slow the IV and give an antihistamine
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When is ototoxicity most common with vancomycin?
High doses
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What symptom is related to older formulation of vancomycin?
Nephrotoxicity
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What are the main indications for Vancomycin?
Strep, MRSA, meningitis due to Strep, enterococci and antibiotic associated colitis (C. diff)
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When you give vancomycin for strep pneumonia caused meningitis, what might you give it with?
Cephalosporin (Not Ceptazadine, b/c doesn't treat G+) + or - rifampin
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When you are treating an enterococci with Vancomycin, why would you use aminoglycosides in combination?
To prevent vancomycin resistant enterococci
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What should you give with vancomycin when treating Enterococci?
Aminoglycosides
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What symptom should you be wary of when treating an enterococci infection with aminoglycosides and vancomycin?
Ototoxicity, since both can cause this issue
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What is the main use of Telavancin?
Treat strains that have become resistant to Vancomycin
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What is the MOA of Telavancin?
Blocks cell wall synthesis like vancomycin and disrupts cell membrane potential and increases permeability
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