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What is the primary dosing recommendation for vancomycin in treating Staph aureus bacteremia?
Which side effect is associated with long-term use of linezolid?
Which condition should be monitored for when administering linezolid with SSRIs?
What is the mechanism of action for mupriricin?
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How should vancomycin therapy be monitored in terms of lab values?
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What is a common use of mupirocin in clinical practice?
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What characteristic limitation does linezolid have regarding bacterial coverage?
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What is the desired peak concentration for Vancomycin therapy?
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Which of the following factors must be monitored during Vancomycin therapy?
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Which of these conditions is Vancomycin recommended for treating?
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Which side effect is commonly associated with Vancomycin and correlates with peak levels?
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What is the primary route of administration for Vancomycin in systemic infections?
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What is the common dosing schedule for Vancomycin in most patients?
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How should Vancomycin dosing be adjusted for patients with renal insufficiency?
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When should peak and trough levels for Vancomycin be monitored?
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What mechanism of action does Quinupristin/Dalfopristin utilize to inhibit bacterial growth?
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Which of the following is not a scenario in which Vancomycin should be avoided?
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What is the clinical significance of monitoring peaks and troughs for Vancomycin therapy?
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For which condition has Quinupristin/Dalfopristin shown effectiveness?
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What should be done if cultures for a patient on Vancomycin therapy return negative?
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What pharmacokinetic principle is essential for individualizing Vancomycin dosing?
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Vancomycin is the primary treatment for which of the following conditions?
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Study Notes
Linezolid (Zyvox)
- Unique antibiotic belonging to the oxazolidinone class.
- Mechanism: binds to 23S ribosomal RNA in the 50S ribosomal subunit.
- Available in both IV and oral forms (100% bioavailability).
- Effective against MRSA, VISA, VRE, and penicillin-resistant Streptococcus pneumoniae.
- Adverse Drug Reactions (ADRs):
- Myelosuppression leading to thrombocytopenia, especially after prolonged use (>2 weeks).
- Risk of superinfection, particularly yeast infections.
- Long courses may cause mitochondrial toxicity, resulting in peripheral or optic neuropathy.
- Monitor drug-drug interaction with Monoamine Oxidase Inhibitors to prevent serotonin syndrome, especially with SSRIs.
- Common dosing for complicated skin and soft tissue infections: 4 mg/kg daily (renal adjustment required).
- For Staph aureus and MRSA bacteremia/right-sided endocarditis: 6 mg/kg daily (renal adjustment required).
- Ineffective against pneumonia due to inactivation by pulmonary surfactant.
- Additional ADRs include rhabdomyolysis and rare eosinophilic pneumonia.
Mupirocin (Bactroban)
- Topical cream/ointment (2%) used for MRSA colonization eradication in nares.
- Controversial effectiveness for long-term eradication.
- Dosage: 0.5 grams in each nostril twice daily for 5 days.
- Also used to treat impetigo or infected wounds.
Vancomycin
- Primarily used for serious infections by beta-lactam resistant gram-positive organisms.
- Administered through IV for systemic infections; oral form used for C. difficile colitis.
- Avoid routine surgical prophylaxis and empirical therapy in febrile neutropenic patients unless there is clear evidence of gram-positive infection.
- Dosing varies based on patient factors; commonly 1-15 gm every 12 hours, needing adjustment for renal insufficiency.
- Monitoring involves measuring peak and trough levels, with the third dose taken at steady state after initiation.
- Desired peak levels: 20-40 mcg/ml; troughs: 10-20 mcg/ml, except specific indications may warrant higher troughs.
- Side effects include local reactions, nephrotoxicity, red-man syndrome, and various hematologic reactions like neutropenia and thrombocytopenia.
Spectrum and Indications of Vancomycin
- Active against various gram-positive organisms, including MRSA, C. difficile colitis, and beta-lactam resistant strains.
- Indications include serious infections in patients with a severe beta-lactam allergy and prophylaxis for major surgical procedures involving prosthetic materials.
Pharmacokinetics of Vancomycin
- Poorly absorbed from the GI tract; IV only for systemic infections.
- Distributed widely into body tissues; can penetrate the CSF during inflammation.
- Excreted mostly unchanged via glomerular filtration.
- Half-life ranges from 6-12 hours with dosing intervals based on renal function.
Additional Review Topics
- Review mechanisms of action for different antibiotic classes.
- Understand hallmark side effects associated with antibiotics.
- Familiarize with antimicrobial coverage, including gram-positive, gram-negative, anaerobes, and atypical bacteria.
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Description
This quiz covers the pharmacological details of Linezolid, including its class, mechanism of action, indications, and potential adverse reactions. Test your understanding of this important antibiotic and its role in treating resistant infections.
