{"id":144,"date":"2019-09-22T17:55:56","date_gmt":"2019-09-22T21:55:56","guid":{"rendered":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/3-20-misc-antibacterials-glycopeptides\/"},"modified":"2022-12-12T16:47:11","modified_gmt":"2022-12-12T21:47:11","slug":"3-20-misc-antibacterials-glycopeptides","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/3-20-misc-antibacterials-glycopeptides\/","title":{"raw":"3.21 Miscellaneous Antibacterials: Glycopeptides","rendered":"3.21 Miscellaneous Antibacterials: Glycopeptides"},"content":{"raw":"Vancomycin is a glycopeptide commonly used to treat MRSA.\r\n\r\n<strong>Indications for Use:<\/strong> Vancomycin is a popular glycopeptide that is active against gram-positive bacteria. Vancomycin is commonly used to treat serious or severe infections when other antibiotics are ineffective or contraindicated, including those caused by MRSA.\r\n\r\n<strong>Mechanism of Action:<\/strong> Glycopeptides are a class of medications that inhibit bacterial cell wall synthesis.\r\n\r\n<strong>Special Administration Considerations:<\/strong> It is poorly absorbed from the GI tract, so it must be given by IV to treat a systemic infection. Oral vancomycin, on the other hand, is used to treat antibiotic-associated clostridium difficile (C-diff). Vancomycin poses a significant risk to kidney function and hearing; therefore, clients' trough levels must be monitored carefully for effective IV dosing to avoid complications. Clients receiving IV vancomycin may also experience a complication known as \"red man syndrome\" in which they experience a flushing of the skin and a reddish rash on the upper body when the infusion is administered too rapidly.\r\n\r\n<strong>Client Teaching\/Education: <\/strong>Clients should be counselled to take medications as directed for the full course of antibacterial therapy.\u00a0 They should monitor for side effects such as hypersensitivity, tinnitus, hearing loss, and vertigo.\u00a0 Clients should promptly follow up with their healthcare provider if no improvement in symptoms is identified.[footnote]uCentral from Unbound Medicine. <a href=\"https:\/\/www.unboundmedicine.com\/ucentral\"  rel=\"noopener noreferrer\">https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote][footnote]UpToDate (2021). <em>Vancomycin<\/em>. <a href=\"https:\/\/www.uptodate.com\/contents\/search\">https:\/\/www.uptodate.com\/contents\/search<\/a>[\/footnote]\r\n<h1>Vancomycin Medication Card<\/h1>\r\nNow let's take a closer look at the medication card on vancomycin.[footnote]Daily Med, <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm\"  rel=\"noopener noreferrer\">https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm<\/a>, used for hyperlinked medications in this module. Retrieved June 27, 2019[\/footnote] Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.\r\n<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">\u00a0Medication Card 3.21.1: Miscellaneous Antibacterials: Glycopeptides (<a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/search.cfm?labeltype=all&amp;query=VANCOMYCIN\">Vancomycin<\/a>)<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n<strong>Class: <\/strong>Miscellaneous Antibacterials: Glycopeptides\r\n\r\n<strong>Prototypes: <\/strong>Vancomycin\r\n<h3>Therapeutic Effects<\/h3>\r\n<ul>\r\n \t<li>Monitor for systemic signs of infection:\r\n<ul>\r\n \t<li>WBC<\/li>\r\n \t<li>Temperature<\/li>\r\n \t<li>Culture results<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Monitor site of infection for improvement<\/li>\r\n \t<li>Monitor and report trough levels for targeted dosing<\/li>\r\n<\/ul>\r\n<strong>Administration<\/strong>\r\n<ul>\r\n \t<li>IV only (except for C. diff, PO)<\/li>\r\n \t<li>SE can be minimized if infusion rate is slowed<\/li>\r\n \t<li>Dosage adjustment is required for renal impairment<\/li>\r\n \t<li>Monitor trough levels<\/li>\r\n \t<li>IV should be administered in a diluted solution over a period of 60 minutes or more to avoid rapid-infusion-related reactions<\/li>\r\n<\/ul>\r\n<h3>Indications<\/h3>\r\n<ul>\r\n \t<li>Generally only used for serious staphylococcal infections<\/li>\r\n \t<li>Effective against Gram +<\/li>\r\n \t<li>MRSA<\/li>\r\n \t<li>VRE<\/li>\r\n \t<li>C-diff<\/li>\r\n \t<li>Bone infection<\/li>\r\n \t<li>Blood infection<\/li>\r\n<\/ul>\r\n<h3>Side Effects<\/h3>\r\n<ul>\r\n \t<li>Nausea<\/li>\r\n \t<li>Ototoxicity<\/li>\r\n \t<li>Nephrotoxicity<\/li>\r\n \t<li>Neutropenia<\/li>\r\n \t<li>Blood disorders<\/li>\r\n \t<li>\u201cRed man syndrome\u201d [not harmful] Flushing, redness, itchiness upper trunk, face, head, neck<\/li>\r\n<\/ul>\r\n<h3>Nursing Considerations<\/h3>\r\n<ul>\r\n \t<li>Contraindicated in:\r\n<ul>\r\n \t<li>o Neuromuscular blockers<\/li>\r\n \t<li>o Hearing problem<\/li>\r\n \t<li>o Kidney dysfxn<\/li>\r\n \t<li>o Neonates<\/li>\r\n \t<li>o Geriatrics<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>maintain hydration<\/li>\r\n \t<li>monitor urine output<\/li>\r\n \t<li>v low dose = no effect, high = toxic<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<div class=\"textbox textbox--key-takeaways\" style=\"text-align: left;\"><header class=\"textbox__header\">Clinical Reasoning and Decision-Making Activity 3.20<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n<strong>Using the above information, consider the following clinical scenario question:<\/strong>\r\n\r\nA nurse is caring for a client who was prescribed vancomycin IV for a MRSA infection. The dose of medication is due now, but a trough level is not yet available in the chart. What is the nurse's next best response?\r\n\r\nNote: Answers to the activities can be found in the \"<a href=\"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/chapter-3\/\">Answer Key<\/a>\" sections at the end of the book.\r\n\r\n<\/div>\r\n<\/div>","rendered":"<p>Vancomycin is a glycopeptide commonly used to treat MRSA.<\/p>\n<p><strong>Indications for Use:<\/strong> Vancomycin is a popular glycopeptide that is active against gram-positive bacteria. Vancomycin is commonly used to treat serious or severe infections when other antibiotics are ineffective or contraindicated, including those caused by MRSA.<\/p>\n<p><strong>Mechanism of Action:<\/strong> Glycopeptides are a class of medications that inhibit bacterial cell wall synthesis.<\/p>\n<p><strong>Special Administration Considerations:<\/strong> It is poorly absorbed from the GI tract, so it must be given by IV to treat a systemic infection. Oral vancomycin, on the other hand, is used to treat antibiotic-associated clostridium difficile (C-diff). Vancomycin poses a significant risk to kidney function and hearing; therefore, clients&#8217; trough levels must be monitored carefully for effective IV dosing to avoid complications. Clients receiving IV vancomycin may also experience a complication known as &#8220;red man syndrome&#8221; in which they experience a flushing of the skin and a reddish rash on the upper body when the infusion is administered too rapidly.<\/p>\n<p><strong>Client Teaching\/Education: <\/strong>Clients should be counselled to take medications as directed for the full course of antibacterial therapy.\u00a0 They should monitor for side effects such as hypersensitivity, tinnitus, hearing loss, and vertigo.\u00a0 Clients should promptly follow up with their healthcare provider if no improvement in symptoms is identified.<a class=\"footnote\" title=\"uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral\" id=\"return-footnote-144-1\" href=\"#footnote-144-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><a class=\"footnote\" title=\"UpToDate (2021). Vancomycin. https:\/\/www.uptodate.com\/contents\/search\" id=\"return-footnote-144-2\" href=\"#footnote-144-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><\/p>\n<h1>Vancomycin Medication Card<\/h1>\n<p>Now let&#8217;s take a closer look at the medication card on vancomycin.<a class=\"footnote\" title=\"Daily Med, https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm, used for hyperlinked medications in this module. Retrieved June 27, 2019\" id=\"return-footnote-144-3\" href=\"#footnote-144-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a> Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.<\/p>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\">\u00a0Medication Card 3.21.1: Miscellaneous Antibacterials: Glycopeptides (<a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/search.cfm?labeltype=all&amp;query=VANCOMYCIN\">Vancomycin<\/a>)<\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p><strong>Class: <\/strong>Miscellaneous Antibacterials: Glycopeptides<\/p>\n<p><strong>Prototypes: <\/strong>Vancomycin<\/p>\n<h3>Therapeutic Effects<\/h3>\n<ul>\n<li>Monitor for systemic signs of infection:\n<ul>\n<li>WBC<\/li>\n<li>Temperature<\/li>\n<li>Culture results<\/li>\n<\/ul>\n<\/li>\n<li>Monitor site of infection for improvement<\/li>\n<li>Monitor and report trough levels for targeted dosing<\/li>\n<\/ul>\n<p><strong>Administration<\/strong><\/p>\n<ul>\n<li>IV only (except for C. diff, PO)<\/li>\n<li>SE can be minimized if infusion rate is slowed<\/li>\n<li>Dosage adjustment is required for renal impairment<\/li>\n<li>Monitor trough levels<\/li>\n<li>IV should be administered in a diluted solution over a period of 60 minutes or more to avoid rapid-infusion-related reactions<\/li>\n<\/ul>\n<h3>Indications<\/h3>\n<ul>\n<li>Generally only used for serious staphylococcal infections<\/li>\n<li>Effective against Gram +<\/li>\n<li>MRSA<\/li>\n<li>VRE<\/li>\n<li>C-diff<\/li>\n<li>Bone infection<\/li>\n<li>Blood infection<\/li>\n<\/ul>\n<h3>Side Effects<\/h3>\n<ul>\n<li>Nausea<\/li>\n<li>Ototoxicity<\/li>\n<li>Nephrotoxicity<\/li>\n<li>Neutropenia<\/li>\n<li>Blood disorders<\/li>\n<li>\u201cRed man syndrome\u201d [not harmful] Flushing, redness, itchiness upper trunk, face, head, neck<\/li>\n<\/ul>\n<h3>Nursing Considerations<\/h3>\n<ul>\n<li>Contraindicated in:\n<ul>\n<li>o Neuromuscular blockers<\/li>\n<li>o Hearing problem<\/li>\n<li>o Kidney dysfxn<\/li>\n<li>o Neonates<\/li>\n<li>o Geriatrics<\/li>\n<\/ul>\n<\/li>\n<li>maintain hydration<\/li>\n<li>monitor urine output<\/li>\n<li>v low dose = no effect, high = toxic<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--key-takeaways\" style=\"text-align: left;\">\n<header class=\"textbox__header\">Clinical Reasoning and Decision-Making Activity 3.20<\/header>\n<div class=\"textbox__content\">\n<p><strong>Using the above information, consider the following clinical scenario question:<\/strong><\/p>\n<p>A nurse is caring for a client who was prescribed vancomycin IV for a MRSA infection. The dose of medication is due now, but a trough level is not yet available in the chart. What is the nurse&#8217;s next best response?<\/p>\n<p>Note: Answers to the activities can be found in the &#8220;<a href=\"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/chapter-3\/\">Answer Key<\/a>&#8221; sections at the end of the book.<\/p>\n<\/div>\n<\/div>\n<hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-144-1\">uCentral from Unbound Medicine. <a href=\"https:\/\/www.unboundmedicine.com\/ucentral\" rel=\"noopener noreferrer\">https:\/\/www.unboundmedicine.com\/ucentral<\/a> <a href=\"#return-footnote-144-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-144-2\">UpToDate (2021). <em>Vancomycin<\/em>. <a href=\"https:\/\/www.uptodate.com\/contents\/search\">https:\/\/www.uptodate.com\/contents\/search<\/a> <a href=\"#return-footnote-144-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-144-3\">Daily Med, <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm\" rel=\"noopener noreferrer\">https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm<\/a>, used for hyperlinked medications in this module. Retrieved June 27, 2019 <a href=\"#return-footnote-144-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":90,"menu_order":21,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[50],"contributor":[],"license":[],"class_list":["post-144","chapter","type-chapter","status-publish","hentry","chapter-type-numberless"],"part":70,"_links":{"self":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/144","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/users\/90"}],"version-history":[{"count":7,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/144\/revisions"}],"predecessor-version":[{"id":1430,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/144\/revisions\/1430"}],"part":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/parts\/70"}],"metadata":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/144\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/media?parent=144"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapter-type?post=144"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/contributor?post=144"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/license?post=144"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}