Linezolid and Dalfopristin/Quinupristin (Nursing)

00:01 Now, linezolid. This is in a new class of drugs, and look at that name there.

00:06 That is a really interesting one to pronounce.

00:09 We use this for killer bugs, so this is a bad mama jama.

00:14 This drug is awesome, what it can do.

00:17 We use it against vancomycin- resistant enterococcus, VRE, and M-R-S-A, MRSA, methicillin-resistant Staphylococcus aureus.

00:28 We can also use it with strep and community-acquired pneumonia. We can use it for staph aureus infection, but we want to make sure that you only keep it for very severe infections.

00:39 Remember the mistakes we made with vancomycin? Well, we don't want to make them with this medication.

00:44 So we want to make sure that the patient has a severe infection.

00:47 We just don't want to prescribe it for anything.

00:49 Because it's active against VRE and MRSA, we want to keep it that way.

00:54 So, you have to be very particular which types of infection you use this medication.

01:00 Now, the most common adverse effect, obviously, is GI distress.

01:02 We see that with everything, but the most adverse -- this one, I really want you to stop and make sure you have this laid out in your brain, is a myelosuppression.

01:12 It is reversible, but when you suppress bone marrow, that's what myelosuppression means, you're risking your white cells, your red cells, and your platelets, or all of them being too low.

01:24 Well, when my white cells are too low, I can't fight off infection, because those are my defenders.

01:30 If my red cells are too low, I'm really tired, because that's what gives me my energy and carries my oxygen.

01:37 If my platelets are low, that's thrombocytopenia, and I'm a bleeder, so if I bump something, it's going to have a real hard time clotting in my body.

01:47 Pancytopenia means it hits all of them.

01:50 So that's an unusual side effect, it can be reversed.

01:54 We want you to watch that if you have the patient on this medication.

01:57 So if you notice unusual bleeding, if we're having a hard time with infection with them, you definitely would want to check on their blood counts.

02:04 Now, if you have to be on long-term treatment, which is possible if you have something like VRE and MRSA, sometimes people develop a peripheral neuropathy.

02:14 And that's kind of what we talk about with diabetic patients, but it's this really weird in sensation.

02:20 They might not have real good feeling in an extremity, but yet, they have this shooting, burning, searing pain.

02:28 So, we want to try to avoid that with a patient.

02:31 Be sure that you assess that with them, ask them if they're having any problems, and notify the health care provider if they start to develop that side effect, so they can make the best decision to intervene.

02:43 Now, we have a combination drug.

02:45 That's why whenever you see that slash in between that means we have 2 separate drugs that are given in combination; dalfopristin and quinupristin.

02:54 Now, the therapeutic use, that just says what do we use these for? And we use it for VRE.

03:00 It's really good for you to keep in mind because we have these superbugs, VRE and MRSA, what are the drugs that are actually effective for them? This combination is one of them.

03:10 Now, the most significant problem is hepatotoxicity.

03:14 Once again, toxic to your liver.

03:17 Now, I love what the artists have done on this picture. Take a look at it.

03:21 They have little AST and ALT all over the liver.

03:24 That is brilliant. I really like that they did that because that helps you remember, hey, for hepatotoxicity, how do I watch for that, as a nurse? I'm going to monitor their liver enzymes and they put them right there for you on the liver; ALT and AST.

03:41 You're also going to look at their bilirubin, okay? And initially, when they start, then kind of watch it weekly.

03:46 But for hepatotoxicity, I'm going to watch the liver enzymes, AST and ALT, and I'm also going to look at their bilirubin.

03:54 Now, I have a quick question for you.

03:57 Do you remember which of those lab tests, AST or ALT, is more specific for liver enzymes? Hopefully, you remember that ALT is the one that is more specific for liver enzymes.

04:15 Both are good, but the ALT is more specific.

04:19 So, if we're given this wonder drug to treat VRE, you want to watch their liver function very closely.