This CE activity is co-sponsored by ProCE, Inc. and Hospital Pharmacy. ProCE, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. ACPE Universal Activity Number 0221-9999-14-234-H01-P has been assigned to this knowledge-based home-study CE activity (initial release date 12-01-2014). This CE activity is approved for 1.5 contact hours (0.15 CEUs) in states that recognize ACPE providers. This CE activity is provided at no cost to participants. Completion of the evaluation and the post-test with a score of 70% or higher are required to receive CE credit. No partial credit will be given.

Faculty: Dennis J. Cada, PharmD, FASHP, FASCP (Editor), Founder and Contributing Editor, The Formulary; Danial E. Baker, PharmD, FASHP, FASCP, Director, Drug Information Center, and Professor of Pharmacy Practice, College of Pharmacy, Washington State University. The authors indicate no relationships that could be perceived as a conflict of interest. This activity is self-funded by Hospital Pharmacy.

Release Date: December 1, 2014

Expiration Date: December 1, 2016

Continuing Education for this activity is processed through the ProCE online CE Center. To receive CE credit, please go to:

• www.ProCE.com/HPJFDR
• Click to access the activity page to enroll and complete the Post-Test and Evaluation.

For questions related to registering for and obtaining CE credit, contact ProCE at 630-540-2848 or Info@ProCE.com.

1. The US Food and Drug Administration (FDA)–approved indication for oritavancin is for the treatment of:
   1. Adult and pediatric patients with acute bacterial SSSIs.
   2. Adult patients with acute bacterial SSSIs caused by susceptible isolates of gram-positive microorganisms.
   3. Adult patients with acute bacterial SSSIs caused by susceptible isolates of gram-negative microorganisms.
   4. Adult patients with acute ventilator-associated pneumonia caused by susceptible isolates of gram-positive microorganisms.
      
      
2. Oritavancin produces its antimicrobial effects by:
   1. Binding bacterial RNA and preventing formation of the functional 50S initiation complex essential to the bacterial translation process.
   2. Inhibiting topoisomerases required for bacterial DNA replication, transcription, repair, and recombination.
   3. Binding the bacterial ribosome, interfering with protein synthesis.
   4. Binding the D-alanyl-D-alanine of the pentapeptide, interrupting bacterial cell-wall synthesis.
      
      
3. After intravenous administration, the time to maximal concentration (Tmax) of oritavancin is:
   1. Immediately following infusion.
   2. 2 hours.
   3. 6 hours.
   4. 24 hours.
      
      
4. Which of the following is a contraindication relative to oritavancin?
   1. Administration of intravenous unfractionated heparin within 48 hours post oritavancin dose
   2. Administration of subcutaneous low molecular weight heparin within 48 hours post oritavancin dose
   3. Known hypersensitivity to beta-lactams
   4. Known hypersensitivity to vancomycin
      
      
5. Oritavancin is in Pregnancy Category:
   1. A.
   2. B.
   3. C.
   4. X.

Case History

N.J. is a 54-year-old male patient with a no known medical history soon to be discharged from the hospital 4 days after a total knee arthroplasty. His inpatient medications include hydromorphone, ketorolac, enoxaparin, cefazolin, and acetaminophen. He has normal renal and hepatic function. His only known drug allergy is to sulfonamide-containing drugs. Two days ago, he developed inflammation and pus at the incision site. Cefazolin was continued from the pre-op orders with the addition of doxycycline. Culture and sensitivity show methicillin-resistant Staphylococcus aureus (MRSA) resistant to his current therapy. His clinician wants to discharge him as soon as possible and follow-up in an outpatient setting. His clinician wants to start treatment with either oritavancin or dalbavancin.

6. The recommended dose of oritavancin for N.J. would be:
   1. 10 mg/kg every 24 hours for 7 to 14 days.
   2. 1,000 mg every 12 hours for 10 to 14 days.
   3. 1,000 mg today and 500 mg in 1 week.
   4. 1,200 mg as a single dose.
      
      
7. How many vials of oritavancin will be used for N.J.’s dose?
   1. 1
   2. 1.5
   3. 3
   4. 4
      
      
8. Oritavancin should be administered via:
   1. Intravenous infusion over 3 hours.
   2. Intravenous push over 5 to 10 minutes.
   3. Intravenous infusion over 30 minutes.
   4. Subcutaneous injection over 5 minutes.
      
      
9. Which of N.J.’s medications has been reported to interact with oritavancin?
   1. Enoxaparin
   2. Ketorolac
   3. Hydromorphone
   4. None of the above
      
      
10. Which of the following potential options for the prevention of venous thromboembolism postoperatively may have a drug-drug interaction with oritavancin?
    1. Enoxaparin
    2. Rivaroxaban
    3. Warfarin
    4. None of the above
       
       
11. A day and a half after his last dose of oritavancin, N.J. presents to the emergency department with unilateral lower limb swelling. If deep vein thrombosis is diagnosed, which of the following would NOT be an appropriate treatment?
    1. Enoxaparin
    2. Fondaparinux
    3. Rivaroxaban
    4. Unfractionated heparin intravenous drip
       
       
12. The most common side effects associated with oritavancin include:
    1. Clostridium difficile–associated diarrhea, diarrhea, and urticaria.
    2. Nausea, headache, and diarrhea.
    3. Nausea, headache, and pruritus.
    4. Vomiting, rash, and abnormal liver function tests.
       
       
13. What dose of oritavancin is recommended for patients with decreased renal function?
    1. 200 mg on day 1 followed by 200 mg on day 3
    2. 200 mg once daily for 3 days
    3. 800 mg given once
    4. 1,200 mg given once
       
       
14. In which of the following intravenous fluids can oritavancin be diluted?
    1. Dextrose 5% in water
    2. Lactated Ringer’s injection
    3. Potassium phosphate rider
    4. 0.9% sodium chloride
       
       
15. Oritavancin is not likely to be Y-site compatible with which of the following antibiotics?
    1. Aztreonam
    2. Ciprofloxacin
    3. Gentamicin
    4. None of the above