Glycopeptides

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Glycopeptides

According to Wikipedia, Significant glycopeptide antibiotics include vancomycin, teicoplanin, telavancin, bleomycin, ramoplanin, and decaplanin.

Vancomycin HCL (VANCOCIN)

– is a glycopepticde bactericidal antibiotic used in the 50’s to treat staphylococcus infections.

 -inhibits bacterial cell wall synthesis and is active against many gram-positive microorganisms. 

-used for s. aureus-resistant infections and cardiac surgical prophylaxis in clients with penicillin allergy.  -Given orally for tx of staphylococcal enterocolitis and antibiotic-associated pseudomembranous colitis due to Clostridium difficile. 

-Vanco has become ineffective for treating enterococci.

–Given IV for severe infections d/t MRSA;septicemia; and bone, skin and lower respiratory tract infections that don’t respond or are resistant to other antibiotics. 

-Peak action is 30 minutes after the end of infusion.

-30% protein bound and has a half life of 6 hours. 

-When not given orally, it is not absorbed systemically and is excreted in the feces. 

-Serum vanco levels should be monitored as it can cause nephrotoxicity and ototoxicity.

-Intermittent doses should be diluted in 100 ml for 500 mg and 200ml for 1g of D5W, NS or RL and administered at a rate of 10mg/min or a minimum of 60 minutes. 

-side effects-chills, dizziness, fever, rashes, nausea, vomiting, thrombophlebitis.  Rapid infusion can cause red man syndrome or red neck syndrome.

-Adverse reactions include vascular collapse, ototoxicity, temporary or permanent loss of balance, permanent hearing loss, nephrotoxicity, eosinophilia, neutropenia and Stevens-Johnson syndrome, severe hypotension, thachycardia, tingling and cardiac arrest and red neck syndrome. 

Drug Interactions –when taking dimenhydrinate (Dramamine) with vanco can maks ototoxicity.  The risk of nephrotoxicity and ototoxicity may be potentiated when vanco is given with furosemide, aminoglycosides, amphotercin B, colistin, cisplatin, cyclosporine.  Vanco may inhibit methotrexate excretion and increase methotrexate toxicity.  The absorption of oral vanco may be decreased when given with cholestyramine and colestipol.

Nursing Considerations-Assess for improvement/worsening of the infection

-Record i/o, report hematuria,

-Monitor hearing function

-Monitor bp-sudden drop may indicate red man syndrome

-Monitor integumentary and respiratory systems

-Administer antihistamine if suspect red man syndrome

-Report sore throat, fatigue –could be a sign of superinfection

Teach

- take entire course of medication, must be taken at regular intervals around the clock,

Telavancin (Vibativ)

- is a semisynthetic derivative of vancomycin. 

- inhibits bacterial cell wall synthesis by binding to the D-Ala-D-Ala terminus of the peptidoglycan in the cell wall.  Also, disrupts bacterial membranes .

-used for treating gram pos skin infections and MRSA. 

-Once-daily dosing via IV administration. 

-90% protein bound, half life 9 hours

-Excretion-

76% in urine, <1% in feces

-Side Effects- nausea, vomiting, constipation, diarrhea, stomach pain, loss of appetite, chills, dizziness,  foamy appearance in urine, unusual or unpleasant taste, vaginal itching or discharge, mild skin rash or itching, redness or pain around the IV needle.

-Adverse effects –bloody diarrhea, drowsiness, confusion, mood changes, increased thirst, swelling, weight gain, feeling short of breath, oliguria, anuria, hearing loss, red neck syndrome, hives, difficult breathing; swelling of your face, lips, tongue, or throat and blood dyscrasias.

Drug Interactions - increases in the PT, INR, aPTT, and ACT

Bleomycin

-Inhibits synthesis of DNA and RNA ; derived from streptomyces verticillus

-used to tread cancer of the head, neck, penis, cervix, vulva of squamous cell origin, lymphosarcoma, Hodgkin’s and non-Hodgkin’s disease, reticulum cell sarcoma, testicular cardinoma and as a sclerosing agent for malignant pleural effusion.

-Routes- subq, IM, IV, intrapleural

-Side effects- pain at tumor site, HA, confusion, nausea, vomiting , anorexia, stomatitis, weight loss, ulceration of mouth and lips, hypotension, confusion, fever, chills, wheezing, rash, hyperkeratosis, nail changes, alopecia, pruritis, acne, striae, peeling, hyuperpigmentation, fibrosis, pneumonitis, pulmonary toxicity, raynaud’s phenomenon

-Contraindications- pregnancy, breast feeding, hypersensitivity, prior reaction.

-Preacautions –pts> 70 yo, renal, hepatic, respiratory probs.

-Half life-2h, metabolized in liver, 50% excreted in urine.

-Interactions-avoid live virus vaccines concurrently

-increase toxicity- other antineoplastics, radiation, general anesthesia

-decreases serum phenytoin levels

Nursing Considerations

-Assess –IM test dose in lymphoma 1-2 units before 1^st and second doses

-Pulmonary FunctionTests’s – 1-2 weeks prior to tx

-VS to assess for infection

-BUN and Creatinine to assess for nephrotoxicity

-for respiratory distress

-mouth for sores, ulcers, pain, dysphagia, oral bleeding

-sx anaphylaxis—rash, pruritis, urticaria, purpuric lesions, flushing, wheezing, low bp

Evaluate –size of tumor

Teach

-report changes in breathing, cough fever

-hair may be lost during tx

-avoid foods that are hot, spicy, have citric acid or a rough texture

-report mouth problems and examine daily

-Use contraception and avoid breastfeeding

-avoid vaccines during tx

References

Kee, J., Hayes, E., & McCuistion, L. (2012). Pharmacology: A Nursing Process Approach. St. Louis, Missouri: Elsevier Saunders.

Mosby. (2010). Mosby's Nursing Drug Reference, 23rd Edition. Elsevier.

Telavancin. (2014). In Wikipedia.  Retrieved from http://en.wikipedia.org/wiki/Telavancin.

Telavancin. (2014). In Rx List: The Internet Drug Index.  Retrieved from http://www.rxlist.com/vibativ-drug.htm