Vancomycin, Depression, Enterococcus discussed on Real Life Pharmacology - Pharmacology Education for Health Care Professionals


Hey, all thanks for listening today or christianson here, host of the real life pharmacology podcast. I am a pharmacist and people have certainly asked how to contact me reach out to me with questions or sponsorships or other things. Like that linked in as a great way to track me down so air christianson farm DU contract me down there as well. As through the website real-life, pharmacology dot com. So that's probably the easiest way to get in touch. With me. Thank you to all those who have left a rating and review if you like the podcast, I would strongly encourage you to do. So that helps us an I tunes and rankings and all that good stuff and allows us to be found by more people. So with that, let's get into it. I'm talking about the nasal it today. The brand name of this medication is XIV. Ox in this medication is an antibiotic foreign faction, we've got oral and IV capabilities there that we can give this medication primarily, you know, it can be used for a variety of different infections some off label and things like that primarily probably skin and soft tissue infections and Monja are going to be the most common, but you may see it for various other things as well. So there's to at least really big bugs in in my experience that Lanese lid can help treat lineal it is kind of one of those down the line type of drugs due to cost and due to its coverage capabilities. So it's not gonna be. Typically, not going to be used for empirical therapy where you know somebody's coming in with pneumonia. Boom, you're going to give one as let. No, that's that's not typically how that drug is is going to be given. So the two specific bugs that it's really really helpful in managing and treating our VR e which is vancomycin resistant Enterococcus. So it's kinda right in the name. Right. Where if I if a Enterococcus bacteria is resistant to vancomycin vancomycin 's you don't considered one of our Goto drugs for certain gram, positive bacteria and Enterococcus is obviously one of those VR e is a very resistant bug in resistant to vancomycin so Liniers la- does have definitely a role to play there. And m are essay, so methicillin resistant staff aureus, so we may have certain situations where vancomycin maybe that specific bacteria is resistant to vancomycin maybe thank him icing. Can't be used for whatever specific reason. So m say in VR or two of the bigger kind of resistant bacteria that you may see Liniers lid used for now how exactly does the the drug work. Kind of the big blanket statement this drug inhibits the bacteria from producing synthesizing protein, that's kind of a big broad overview specifically, I it binds to the twenty three s Ravazzolo sub unit which is part of the fifty s sub unit and this blocks formation. Listen of this bigger unit called seventy s so it's kind of a detailed process as far as protein productions, and and Rivaz almo activity and things like that. So yeah. Primarily blocks binds in and blocks twenty three s which is part of that fifty s sub unit. One of the big reasons la- nasal ID isn't used incredibly often is because of adverse effects and drug interactions. Now. I'll talk a little bit about drug interactions after the break, but let's get into the side effects here a little bit. I so he mental logic side effects are kind of unique thing associated with Lynn as the lead so lower white blood cell count, lower platelets. And this is why we monitor things like CBC with typically with longer. Term us. Now, if you use the Nazlet for one day three days, and then you switch agents to another drug for some odd reason. Odds are likely in that short amount of time were probably not gonna run into reduced white blood cell count. Okay. So typically, this is going to be in situations where this drug is given for a longer period of time. Maybe a few weeks something of that nature, another potential side effect kind of unique Tila nasal it is neurologic side effects, and there is potential for these neurologic side effects to impair vision cause optic neuropathy. So that is obviously very very concerning. When you start talking about vision loss as a potential side effect, again more likely with extended course extended duration treatment with Lena's lead. But it definitely is something we need to be aware of and one of the downsides to initially using this drug. Lower can I guess lower risk side effects. But maybe more common. You may get some a GI upset things of that nature and particularly kinda ties in with the the mechanism of action. Linnea does have some Amei. Oh, I activity now if you remember MA wise, they can be used in depression, for example, but they are a last line agent because they cause all sorts of side effects, and they have a ton of drug interactions and really kind of a messy class drug. Well, l- nasal does have some of that activity as well. So this is something we need to be really careful really cautious about. And like I said I'm going to talk about that in the drug interaction section now for monitoring parameters same kind of mentioned that CD CBC complete both so count there visual. So if you're you've got a patient where they're on longer term when as lead you may wanna do some visual Susman's nervous system assessments monitoring for a neuropathy, and that type of pain, so those are a few important monitoring parameters, and again, you're going to monitor those things kind of the longer you go on with the the course of therapy. There may be a greater risk of of running into some of these things. Let's take a quick break here from our sponsor and I'll finish up with drug interactions. We've got a huge list of clinical pharmacy resources at med one on one dot com slash store. START we've also got certain Cheerios to help pass board exams. Like, nah, plex and BCP SPCA C p geriatric exam there as well. So definitely go take advantage of those resources. Very well priced all sorts of price ranges, if maybe you're a student or something like that. But lots of different pearls. You can pick up audible books. You can get your first audible book for free. So that's kind of a unique thing there. If you've never tried audible, you can go ahead and snag one of our books right off a med one dot com slash store. Let's finish up on drug interactions with Lenny's lid, and this is where things get really challenging in clinical practice. One of the things that that always comes up very frequently. With Lena's lead is patients who have depression, most patients drug of choice for depression is necessary high and they are probably going to be on. One. If they've got a history of depression. Now, it is generally recommended to avoid using the

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