Need help to reply three post.

DO NOT JUST REPEAT SAME INFORMATION, DO NOT JUST SAY I AGREE OR THINGS LIKE THAT. YOU NEED TO ADD NEW INFORMATION TO DISCUSSION.

1- Each reply should be at least 200 words.

2- One scholarly reference ( NO MAYO CLINIC/ AHA)

3- APA style needs to be followed.

4- Each response should have reference at the end

5- Reference should be within last 5 years

DQ-1

Linezolid is a bacteriostatic oxazolidinone antibiotic which is highly effective against gram-positive cocci, and also is effective against methicillin-resistant gram-positive bacteria as well as vancomycin-resistant enterococcal infections (Rebai, Fitouhi, Daghmouri, & Bahri, 2019). This makes Linezolid an effective second-line antibiotic when methicillin and penicillin class antibiotics are not effective (Rebai, Fitouhi, Daghmouri, & Bahri, 2019). Another point to remember with Linezolid is that it is also effective at penetrating past the blood-brain barrier and into the cerebral spinal fluid (Rebai, Fitouhi, Daghmouri, & Bahri, 2019). Linezolid has not been approved for the treatment of gram-negative infections, catheter-related bloodstream infections, or catheter site infections (Azzouz & Preuss, 2019).

Linezolid is a synthetic drug whose mechanism of action involves inhibiting bacterial protein synthesis by interfering with translation (Azzouz & Preuss, 2019). Linezolid binds to site 23s ribosomal RNA of the 50s subunit, which then prohibits bacteria from forming a functional 70s which causes failure in the bacterial multiplication process (Azzouz & Preuss, 2019). This failure to multiply is what helps curb the extent of the infection and ceases it from spreading, but does not kill already established microorganisms in the body (Azzouz & Preuss, 2019).

Linezolid is also a reversible, non-selective monoamine oxidase inhibitor which leads to increased concentration of neurotransmitters such as epinephrine, norepinephrine, dopamine, and serotonin in the central and sympathetic nervous systems (Azzouz & Preuss, 2019). This is important to keep in mind when ordering this antibiotic for a septic patient on vasopressors as it can have a cumulative effect if the patient is on levophed or an epinephrine drip (Azzouz & Preuss, 2019). Also, use caution in patients with hypertension as it can cause the GI tract to increase systemic absorption of large amounts of tyramine from the diet and could cause life-threatening hypertension (Azzouz & Preuss, 2019).

Monitoring for patients with linezolid includes vital signs, blood glucose, weekly CBC and BNP (Azzouz & Preuss, 2019).

Common side effects of taking linezolid include thrombocytopenia, low hemoglobin, leukopenia, headache, nausea, diarrhea, elevated pancreatic enzymes, elevated LFTs, and neuropathy (Azzouz & Preuss, 2019). There is also caution in the use of linezolid in patients on an insulin drip or hypoglycemic drugs which could lead to serotonin syndrome, drugs, seizures, lactic acidosis (Azzouz & Preuss, 2019).

Contraindications include do not use linezolid within two weeks of MAO inhibitors, avoid tyramine containing foods, and use caution with serotonergic and adrenergic drugs (Azzouz & Preuss, 2019). Avoid aged cheese, cured or smoked meats, draft beer, fava beans, and soy products (Azzouz & Preuss, 2019).

Toxicity can occur in some patients but is rare, and there is no antidote for linezolid, just supportive symptomatic treatment (Azzouz & Preuss, 2019). Toxicity examples would be exacerbations of adverse reactions (Azzouz & Preuss, 2019). For example, if thrombocytopenia occurs, then the prescriber would order a platelet transfusion (Azzouz & Preuss, 2019).

Reference

s:

Azzouz A. & Preuss C.V. (2019). Linezolid In: StatPearls. Treasure Island (FL): StatPearls Publishing. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK539793/

Rebai, L., Fitouhi, N., Daghmouri, M. A., & Bahri, K. (2019). Linezolid for the treatment of post neurosurgical infection caused by methicillin-resistant Staphylococcus. Surgical Neurology International, 10, 1–5.

https://doi-org.lopes.idm.oclc.org/10.25259/SNI_455_2019

DQ-2

Amoxicillin is a penicillin-type beta-lactam antibiotic that interferes with cell wall bacterial synthesis on both gram-negative and gram-positive bacteria (Yangyang et al., 2019). For this reason, Amoxicillin is one of the most used broad-spectrum antibiotics for fighting infections (Yangyang et al., 2019). Amoxicillin is also effective at permeating tissues of the human body, making it more effective than some other penicillin class antibiotics (Yangyang et al., 2019). Amoxicillin is effective and has antibacterial and bactericidal activity as well as a relatively low cost, contributing to amoxicillin’s frequent uses (Yangyang et al., 2019).

The mechanism of action includes the beta-lactam binding to penicillin-binding proteins, inhibiting transpeptidation, leading to activation of autolytic enzymes in the bacterial cell wall (Akhavan &

Vijhani, 2019).

This process leads to the lysis of the bacterial cell wall, destroying the invading organism (Akhavan & Vijhani, 2019). Amoxicillin also has an additional amino group to the penicillin portion, helping to prevent bacterial resistance to amoxicillin (Akhavan & Vijhani, 2019).

Amoxicillin is given orally in two ways; immediate-release and extended-release (Akhavan & Vijhani, 2019). The importance of these two types of releases is that amoxicillin is time-dependent in order to maintain serum levels in the body and continue its effectiveness (Akhavan & Vijhani, 2019). This around the clock dosing provides less variability in peaks and troughs of the serum levels (Akhavan & Vijhani, 2019).

Amoxicillin is excreted by the kidneys, so in patients with a renal history, some dose adjustments may be required to prevent toxicity (Akhavan & Vijhani, 2019). Amoxicillin is also dialyzable and should be given after hemodialysis (Akhavan & Vijhani, 2019).

Adverse effects of amoxicillin include nausea, vomiting, and diarrhea but is normally well tolerated (Akhavan & Vijhani, 2019). There can also be a superinfection in which an organism is allowed to grow without competition from the originally targeted organism that can be caused by amoxicillin administration such as C-Diff colitis (Akhavan & Vijhani, 2019).

A severe adverse reaction can occur with amoxicillin as a type 1, 2, 3, or 4 hypersensitivity reaction and may cause anaphylaxis requiring hospitalization (Akhavan & Vijhani, 2019). For this reason, it is important to screen the patient for any sensitivities or allergies to antibiotics of the penicillin, cephalosporin, or carbapenem class and amoxicillin would be contraindicated in these patients (Akhavan & Monitoring for amoxicillin includes attention to hypersensitivity reactions of any kind while taking amoxicillin (Akhavan & Vijhani, 2019). Also, monitoring for diarrhea would be an indication for continued closer monitoring of diarrhea for fever, abdominal cramping, and foul-smelling stool as this may be the onset of a C-Diff infection and would require immediate intervention and antibiotic change (Akhavan & Vijhani, 2019). In some cases, amoxicillin may be prescribed for prolonged use, and in these cases, hepatic and renal monitoring would be indicated to prevent toxicity or organ damage (Akhavan & Vijhani, 2019).

References:

Akhavan, B.J., & Vijhani P. (2019). Amoxicillin In: StatPearls. Treasure Island (FL): StatPearls Publishing. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK482250/

Yangyang, Z., Xing, X., Maoda, P., Min, Z., Kaizhou, X., … & Jinyu, W. (2019). Depletion of Residual Amoxicillin and Its Major Metabolites in Muscle, Liver and Kidney of Chicken. Pakistan Veterinary Journal, 39(1), 19–24. https://doi-org.lopes.idm.oclc.org/10.29261/pakvetj/2018.120

Vijhani, 2019).

DQ-3

Antibiotic stewardship and handwashing campaigns reduce C. difficile infection without reported harms. There are an estimated 350,000 C. difficile infection related hospitalizations in the United States every year with approximately nine percent ending in death. The number of patients discharged from the hospital with any C. difficile related diagnosis has more than doubled since the 1990s ( Butler et al.,2016). The Agency for Healthcare Research and Quality (AHRQ) review update included 93 articles published between 2010 and April 2015. Based on a systematic review that included one randomized controlled trial (RCT) and five interrupted time series studies, antibiotic stewardship is associated with decreased C. difficile infection. AHRQ review found high strength of evidence based on four RCTs that oral vancomycin has higher initial C. difficile infection cure rates compared with metronidazole (83.9% vs. 75.7%; number needed to treat = 12; 95% confidence interval, 7 to 35) (Butler et al.,2016).

An antimicrobial medication that inhibits bacterial protein synthesis is vancomycin. The bactericidal action of vancomycin results primarily from inhibition of cell-wall biosynthesis (production of a chemical compound by a living organism). In addition, vancomycin alters bacterial-cell-membrane permeability and RNA synthesis(Micromedex, 2020). The key role of the bacterial ribosome makes it an important target for antibacterial agents such as vancomycin. A large number of clinically useful antibiotics target this complex translational ribonucleoprotein machinery. The majority of these compounds, mostly of natural origin, bind to one of the three key ribosomal sites: the decoding (or A-site) on the 30S, the peptidyl transferase center (PTC) on the 50S, and the peptide exit tunnel on the 50S. Antibiotics that bind the A-site, such as the aminoglycosides like vancomycin, interfere with codon recognition and translocation. Peptide bond formation is inhibited when small molecules like oxazolidinones bind at the peptidyl transferase center. Finally, macrolides tend to block the growth of the amino acid chain at the peptide exit tunnel (McCoy & Xie, 2011). Patient’s receiving vancomycin monitoring include obtaining cultures and WBC count to monitor for efficacy. Physical findings : Symptomatic improvement, including resolution of fever, is indicative of efficacy. Assessment of serum vancomycin trough concentrations is recommended for monitoring efficacy. Troughs should be obtained just prior to the next dose under steady state conditions (approximately just before the fourth dose) and then repeated as clinically necessary. To avoid the development of resistance, target serum vancomycin trough concentrations above 10 mg/L (7 mcmol/L) are recommended. For complicated infections, such as endocarditis, osteomyelitis, meningitis, bacteremia, and hospital acquired pneumonia caused by Staphylococcus aureus, goal serum vancomycin trough concentrations of 15 to 20 mg/L (10 to 14 mcmol/L) are recommended to increase penetration, increase likelihood of achieving target serum concentrations, and improve clinical outcomes. Trough concentrations (not peak) are the most accurate measure to monitor for efficacy. Trough monitoring is recommended for patients receiving aggressive dosing (to attain trough levels of 15 to 20 mg/L or 10 to 14 mcmol/L), in patients at high risk for nephrotoxicity (receiving concomitant nephrotoxins), patients with unstable renal function, and patients receiving prolonged courses of treatment (more than 3 to 5 days). However, for lower intensity dosing (target troughs less than 15 mg/L or 10 mcmol/L) and short course therapy, frequent monitoring (more than 1 trough before the fourth dose) is not recommended(Micromedex, 2020).

Toxicity: Close monitoring of serum concentrations of vancomycin is recommended in neonates and children. Monitor renal function for nephrotoxicity during and after completion of therapy, especially in patients over 65 years of age. Monitor serum vancomycin concentrations following oral administration, especially in patients with inflammatory disorders of the intestinal mucosa, renal insufficiency and/or colitis, and those receiving concomitant therapy with an aminoglycoside antibiotic. Contraindications: Assess WBC count periodically to screen for neutropenia in patients on prolonged therapy with vancomycin or those who are receiving concomitant drugs that may cause neutropenia. Monitor auditory function, especially in patients who receive excessive IV doses, have underlying hearing loss, or who receive concomitant therapy with another ototoxic agent such as when both Vancomycin and Amikacin is ordered. Cholera Vaccine live reduced immune response to the cholera vaccine. Antibiotics which possess activity against Vibrio cholerae organisms may interfere with the immunological response to the live cholera vaccine. Do not administer the vaccine and antibiotics concomitantly; do not administer the vaccine in patients who have received oral or parenteral antibiotics within 14 daysprior to vaccination. CAM: Vancomycin and St John’s wort has not been tested to determine interaction(Micromedex, 2020).

Reference

Butler, M., Olson, A., Drekonja, D. (2016). Early diagnosis, prevention, and treatment of Clostridium difficile. Retrieved from Agency for Healthcare Research and Quality; March 2016. https://ahrq-ehc-application.s3.amazonaws.com/media/pdf/c-difficile-update_research .

McCoy, L.S, Xie,Y. (2011). Antibiotics that target protein synthesis. Retrieved from Wiley Interdiscip Rev RNA. 2011 Mar-Apr;2(2):209-32. doi: 10.1002/wrna.60.

Micromedex. (2020). Vancomycin Hydrochloride. Retrieved from www.micromedexsolutions.com,SSL+evidencexpert.

1-

After Each question, write down references

2- 300 minimum words for each question, you can go up to 700 words.

3- 2-3 references for each question

4- References should be within 5 years

5- I am in acute care nurse practitioner program.