Vancomycin

Question 1

What are some complicated infections that would use Vancomycin?

Answer 1

Endocarditis, osteomyelitis, meningitis, hospital-acquired pneumonia, bacteremia

Question 2

What are some common uses for Vancomycin?

Answer 2

MRSA, MRSE, severe PCN allergy, C. Diff, prophylaxis for endocarditis or prosthesis, prophylaxis in hospitals with high rates of MRSA or MRSE

Question 3

Two reasons to measure Vancomycin trough levels?

Answer 3

Risk of nephrotoxicity, inadequate response

Question 4

Serum concentration levels of Vancomycin are used as _____ ______ of effectiveness

Answer 4

Surrogate Markers

Question 5

What type of antibiotic is Vancomycin?

Answer 5

Glycopeptide antibiotic

Question 5

Are peak or trough levels advocated when using Vancomycin?

Answer 5

Trough, not peak

Question 7

What are the reference range trough levels for uncomplicated/less serious and complicated/serious infections?

Answer 7

Uncomplicated=10-20 µg/mL, Complicated 15-20µg/mL

Question 8

What are the peak levels for Vancomycin?

Answer 8

25-50µg/mL

Question 9

Trough levels below _____ are associated with inadequate therapy and bacterial resistance development

Answer 9

10 µg/mL

Question 10

Tough levels above therapeutic range may result in what complication?

Answer 10

Nephrotoxicity

Question 11

What kind of blood, what volume, and what “top” tube for trough and peak monitoring? How many doses in before testing?

Answer 11

Venous blood, 1mL, red top. 4 doses in for steady-state.

Question 12

What dose is steady-state achieved at?

Answer 12

4th dose

Question 13

When is blood collected to determine trough concentration?

Answer 13

Within 30 minutes of next dose

Question 14

When to draw for peak concentration?

Answer 14

1-2 hours after IV dose

Question 15

Is Vancomycin given orally? Why?

Answer 15

Not given orally due to poor bioavailability

Question 16

When is Vancomycin given orally?

Answer 16

Tx of C. Diff

Question 17

Vancomycin given in PTs who are allergic or intolerant to what?

Answer 17

Beta-lacams

Question 18

These are 4 important reasons to measure trough levels for nephrotoxicity in PT:

Answer 18

On nephrotoxic meds (ACE-Is, ARBs, NSAIDs, aminoglycoside ABX, sulfonamides, chemotherapy), reduced or changing renal function, high-than-normal Vancomycin dose, on prolonged therapy 3-5 days

Question 19

For PTs with renal problems what are their doses based on?

Answer 19

Creatinine Clearance (CrCl) levels

Question 20

A CrCl level greater than ___ requires no dose change

Answer 20

60 mL/min

Question 21

How frequently should levels be checked in hemodynamically stable patients who are on long-term therapy? What if they are not hemodynamically stable.

Answer 21

Weekly if stable, more often for those who arent

Question 22

Did PTs receiving Vancomycin develop auditory toxicity?

Answer 22

No

Question 22

Is ototoxicity (audio toxicity) dependent on dose?

Answer 22

No

Question 23

Vanomycin can cause nephrotoxicity or neutropenia. Was it reversible?

Answer 23

Yes, when discontinued.

Question 24

Vancomycin combined with what other medication can cause renal failure?

Answer 24

Aminoglycosides

Question 25

PTs on an aminoglycoside, receiving long-term Vancomycin, and with trough levels above 110 are at increased risk of what?

Answer 25

Nephrotoxicity

Question 26

Vancomycin is most often delivered via IV and can lead to what complication?

Answer 26

Phlebitis

Question 27

Vancomycin is used to treat what sort of bacteria?

Answer 27

Gram-positive bacteria resistant to other less-toxic meds

Question 28

What three levels should be evaluated before starting Vancomycin therapy?

Answer 28

BUN, Creatinine, CrCl

Question 31

What is the usual dose for Vanomycin? For seriously ill patients?

Answer 31

Usual=15-20 mg/kg. Seriously ill=25-30mg/kg

Question 32

What should subsequent Vancomycin dose be dependent on?

Answer 32

Serum trough levels

Question 33

If Vancomycin dose is above 1.0g what is the infusion time?

Answer 33

1.5 to 2 hours

Question 34

What are two alternatives to Vancomycin for MRSA when minimum inhibitory concentration needs to be above 2µg/mL?

Answer 34

Linezolid, Daptomycin

Question 35

If serum creatinine levels increase by 0.5mg/dL over 2-3 consecutive measurements -or- 50% increase in serum creatinine occurs what should be done?

Answer 35

Decrease Vancomycin dose

Question 36

If course of dose is less than 5 days long with a target less than 15 mg/mL how many trough levels are required?

Answer 36

Just one