Vancomycin
Pharmacology Guide!
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NAPLEX STUDY GUIDE PHARMACOLOGY
Vancomycin
Pharmacology Guide!
February 3rd, 2020
Vancomycin Pharmacology
Made Easy
Vancomycin ( Vancocin ; FIRST-
Vancomycin ) is a drug used in the
treatment of bacterial infections, often
severe. It belongs to the glycopeptide
drug class and has proved to be one of
the most effective drugs in the
treatment of many different infections.
Vancomycin is used in the treatment of severe
Gram-positive infections, including:
Endocarditis
Osteomyelitis
Abdominal infections
Skin and soft tissue infections
MRSA
Pseudomembranous colitis caused
by C. difficile
Treatment of Gram-positive
infections in patients who are
allergic to penicillins
Surgical prophylaxis where there is
a risk of MRSA or MRSE
Vancomycin may also be used for other clinical
purposes not listed in this guide, as determined
by the prescriber.
Mechanism of Action
In terms of vancomycin pharmacology, the drug
works by inhibiting cell wall synthesis of
Gram-positive bacteria.
It achieves this by inhibiting the growth and
cross-linkage of peptidoglycan strands.
Therefore, vancomycin specifically targets
Gram-positive organisms and is inactive
against most Gram-negative bacteria – whose
cell wall structure contains lipopolysaccharides.
However, resistance is on the rise.
One of the most common resistance methods
by bacteria is to modify the structure of the cell
wall to prevent vancomycin binding.
Side Effects of Vancomycin
Vancomycin is associated with the following
range of side effects:
Thrombophlebitis – if administered by
infusion. For this reason, vancomycin
should not be administered too rapidly
otherwise serious infusion reactions can
take place.
“ Red man syndrome
syndrome”” – is the name
given to one of these anaphylactoid
reactions. As the name suggests, it causes
upper body erythema – as well as pruritis.
This reaction can, in some cases, descend
to the lower extremities, too. Hypotension
and bronchospasm may also present.
Nephrotoxicity – particularly with IV
use.
Ototoxicity – again, with IV use. Hearing
loss can, in some cases, be permanent.
Bone marrow suppression –
neutropenia, leucopenia.
Of course, the risk of nephrotoxicity and
ototoxicity is low, though this risk increases if
taken with other drugs – such as
aminoglycosides – that also have the potential to
cause these effects.
Clinical Factors
In terms of the clinical pharmacology of
vancomycin, here are some important factors to
consider:
That, as we have learned above, the risk
of ototoxicity and nephrotoxicity is
enhanced if taken with other drugs – for
either one of these side effects – that are
also associated with hearing loss and
kidney damage. Macrolides, at high doses,
for example, can cause ototoxicity. Loop
diuretics and platinum chemotherapy also
increase the risk of hearing loss.
As a large hydrophilic molecule,
vancomycin is not absorbed by the
gastrointestinal tract
tract. It either works
locally in the intestine – such as in
pseudomembranous colitis – or it must be
administered IV for systemic use.
To reduce thrombophlebitis and injection
pain, vancomycin should be administered
in a dilute solution, slowly, over (at
least) a 1-hour period
period. Infusing
vancomycin over a long period also helps
prevent red man syndrome.
Vancomycin requires therapeutic drug
monitoring (TDM) to avoid toxicity. Dose
adjustments should be made accordingly.
Patients with extant renal disease may
warrant a dose reduction. Elderly patients
are at an increased risk of hearing loss, too,
and may require dose reduction. Plasma
concentrations should ideally be above
10mg/L but below 15mg/L to avoid
toxicity
toxicity.
That completes our review of vancomycin
pharmacology.
If you would like to test your knowledge
of vancomycin and every other
antibacterial drug, register to become a
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