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12.16 Anti-Infective – Glycopeptide

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  1. Overview
    1. Antibacterial agents
    2. Gram-positive organisms
    3. Not absorbed orally
      1. Intravenous
      2. Long half-life
  2. Mechanism of Action
    1. Inhibit cell wall synthesis
  3. Monitoring
    1. Goal = monitor concentrations
      1. Peak levels
      2. Trough levels
      3. DISCLAIMER: In video it says to draw 30 mins after a dose, but the actual timing is 1-2 hours
  4. Types
    1. Dalbavancin
    2. Oritavancin
    3. Telavancin
    4. Vancomycin- Therapeutic range for vanc trough is10-20 mcg/mL
  5. Indications
    1. Listeria
    2. Clostridium difficile
    3. Streptococcus species
    4. Enterococcus species
    5. Staphylococcus aureus
      1. Methicillin-resistant (MRSA)
  6. Contraindications
    1. Pregnancy
      1. High toxicity risks
    2. Breastfeeding
      1. Intestinal flora
    3. Kidney disease
      1. Highly nephrotoxic
  7. Side Effects
    1. Red man syndrome
      1. Rapid infusion
      2. Itching
      3. Flushing (face/torso)
    2. Anaphylaxis
    3. Ototoxicity
    4. Hepatoxicity
    5. Nephrotoxicity
    6. QTc prolongation

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Video Transcript

Welcome back and today we are going to discuss glycopeptides.

Glycopeptides are antibacterial agents that work against gram-positive organisms. They are only in IV form and have long half-lives. So you will generally see them being given q12 or qday – unlike most antibiotics which are BID or TID.

Glycopeptides works by inhibiting cell wall synthesis – no call wall, no bacteria. They are bactericidal, meaning they destroy bacteria.

Alright, monitoring in necessary as these drugs have serious side effects. Peaks are drawn 30 mins after the dose is completed, while troughs are drawn right before the next dose. This goal is check for toxicity and decrease risk. If the levels are too high, pharmacy can lower the dose or stop administration all together. If too low, we can increase the dose to therapeutic levels. I had a patient with a toxic level of vancomycin once, all future doses were immediately discontinued.

Types of glycopeptides include the following. I want you to focus more in the endings -CIN. With vancomycin being the most used. I’ve had many patients on vancomycin, it’s a wonderful drug and works in sepsis, especially in MRSA cases. MRSA is a stubborn bug causes havoc can cause full blown sepsis.

Speaking of MRSA, indications include C. diff, listeria, enter/strep/staph and MRSA. An easy way to remember this is CLESS. Glycopeptides works on many drug-resistant organisms and is s great options for patients who infections are overwhelming their system. They are usually a last resort for many providers as they work but come with many concerns (which we will discuss later).

Contraindications include pregnancy (d/t toxicity potential), breastfeeding (d/t changing fetal intestinal flora)  and kidney disease (d/t nephrotoxicity risk). I had a patient years ago with severe sepsis who had CKD. Vancomycin was ordered and the infection was resolved but it caused profound kidney deterioration and the patient ultimately needed a kidney transplant. 

Side effects are plentiful and include red man syndrome d/t rapid infusion which presents as itching and flushing on the face. This is something you will not forget once you see it. The patient’s face is beet red! Other effects include anaphylaxis, ototoxicity, hepatotoxicity, nephrotoxicity – Basically it hits the ears, liver and kidney BIG time. And permanent damage can occur without proper monitoring.

Priority nursing concepts include infection control and pharmacology.

Let’s review. Glycopeptides are used to treat gram-positive organisms, MRSA being a big one. Monitoring in necessary in order to prevent harm and done with peak and trough blood draws at specific time frames. Types of glycopeptides end in -CIN. With indications being remembered as CLESS (C. diff, listeria, enter/strep/staph and MRSA). Side effects include red man syndrome and various toxicities (ears,liver, kidney).

Now you know all your need to know about glycopeptides. Now go out and be your best self and happy nursing.

  • Question 1 of 4

The nurse reviews a client’s vancomycin trough result prior to giving the next dose. The level is 8 mcg/mL. For which of the following reasons is the nurse concerned? Select all that apply.

  • Question 2 of 4

A client has a vancomycin trough of 22 mcg/mL. Which of the following is of primary concern to the nurse?

  • Question 3 of 4

The nurse is assigned to a client taking a glycopeptide antibiotic for MRSA. The nurse is most concerned when the client complains of which of the following?

  • Question 4 of 4

The nurse is caring for a client who is taking a glycopeptide antibiotic and monitors for signs of which adverse effect of this medication?

Module 0 – Pharmacology Course Introduction
Module 3 – Disease Specific Medications

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