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Flashcards in final part 2 Deck (62):
1

AG spectrum of activity

- gram - aerobes
- gram + organisms
- sepsis/ abdominal/ respiratory tract/ SSTI/ endocarditis/ CNS/ UTI

2

AG efficacy monitoring

peak

3

AG toxicity monitoring

- trough

4

for EXTENDED interval what weight do you use?

- actual BW unless >120% IBW

5

which drugs do you use population based dosing?

- gentamicin & tobracycin

6

Ro=

mg/hr
- per HOUR!
- (divide by 0.5 for AGs)

7

AG patient monitoring

- peak: 30 minutes post 30 minute infusion
- trough: 30 minutes immediated pre-dose

8

why extended interval dosing (EI)?

- concentration depended killer
- post-antibiotic effect
-increased efficacy
-less toxicity
- minimize antimicrobial resistance
-convenience
- less costly

9

use caution or avoid extended interval dosing in

- enterococcal endocardiitis
- burns
- renal failure
- osteomyelitis
- meningitis
- pregnancy/CF/ febrile neutropenia

10

gentamicin & tobramycin EXTENDED interval dosing

-7mg/kg (actual body weight)
- CrCl:
- >60: 24 hrs
- 40-59: 36hrs
-20-39: 48hrs

11

vanc spectrum of activity

- gram +
- MRSA/ resistance strep/ beta lactam allergies

12

vanc ototoxicity is related to

high peaks

13

vanc nephrotoxicity is related to

prolonged high troughs

14

vanc goal peak

30-40mg/L

15

vanc goal trough

-15-20mg/L: bacteremia, meniningitis, pneumonia, SSTI, MRSA, endocarditis, osteomyelitis
- 10-15mg/L: everything else

16

which weight do you use for vanc dosing?

actual body weight

17

typically adult vanc starting dose

15-20mg/kg
- 2g/dose limit
- Q8 or Q12H frequency
- loading dose in erious infections: 25-30mg/kg over 1.5-2hours

18

vanc infusion rate

1g/hour
- 1 hour infusion rates

19

if vanc trough is high

-increase interval (decrease frequency)
- decrease dose proportionally

20

if vanc trough is low

- decrease interval (increase freq)
- increase dose proportionally

21

vanc pediatric dosing

15mg/kg Q6H

22

vanc peak monitoring

1 hour after infusion is done
- dont really get peaks though in peds

23

when to draw serum concentrations of vanc

- convention with 4th dose (sometimes 3rd)

24

in whom to draw serum concentrations with vanc

- aggressive doses (15-20mg/L troughs)
- critically ill
- changing renal function
- concomitant nephrotoxic agents
- prolonged therapy

25

follow up serum concentrations with vanc

- at least weekly in stable pts
- monitor SCr 3xwk
- peak monitoring not recommended

26

intermittent HD with vanc

- 20mg/kg LD prior to 1st session
- 10mg/kg
- Serum concentration 4 hours post 2nd session

27

vanc toxicity

- infusion related (Redman's syndrome)
- not allergy
- decrease infusion rate

28

lanoxin generic

digoxin

29

digoxin indication

- HF (HFrEF)
- Afib

30

MOA of digoxin in HF

inhibition of Na/K/ATPase-> increased myocardial contractility

31

MOA of digoxin in Afib

reduction of electrical impulses in the AV node & decreased HR

32

digoxin effects on the heart

- negative chronotropic (rate)
- positive ionotropic (contraction)

33

PK for digoxin

- linear at steady state

34

factors to consider in digoxin dosing & monitoring

1. renal function
2, electrolytes (hypo-K & Mg-> enhance toxicity)
3. thyroid disease (hypo-[high]; hyper [low]
4. med review for interactions

35

labs to check before digoxin use

Scr
TSH
K+
Mg+

36

pediatic digoxin dosing is

weight based
- younger the pt, higher the dose

37

when do you use a loading dose for digoxin?

- Afib pts
- NOT HF

38

digoxin loading dose

- give 50% initially
- 2 additional doses 25% each
- all separated by 6 hours eah
- monitor HR & EKG

39

target concentrations of digoxin

- narrow therapeutic drug
- HF: 0.5-0.9mcg/L
- Afib: 1-1.5mcg/L

40

indications for digoxin level measurement

- alterations in renal function
- suspect toxicity
- diagnosed with interacting disease state
- drug-drug interaction
- to assess compliance

41

when to obtain digoxin drug concentrations

- loading dose: 12-24 hrs after last dose
- maintenance: 5-7days after initiation (trough 12-24hr after last dose)
- ESRD take longer to SS
- exercise may falsely lower trough

42

toxic digoxin levels

>2mcg/L

43

signs and symptoms of digoxin toxicity

- CNS: visual disturbances, HA, confusion, fatigue, dizziness
- GI: N/V/D, abd pain, anorexia
- *CV: bradycardia, AV block, vent. arrhythmias

44

if digoxin toxicity occurs

-stop digoxin
- monitor daily until

45

what is digibind

- digoxin immune fab
- used to counteract digoxin toxicity

46

cardiac drips are used for

- vasopressors
- ionotropes
- anti-hypertensives

47

most B1 to most Alpha vasoactive activity

isoproterenol
dobutamine
dopamine
E(B>A)
NE(A>B)
phenylephrine

48

low dose DA

- primarily on DA receptor
- works on urine output
- 1-3 makes you pee

49

intermediate dose DA

4-10 makes your heart beat again

50

high dose DA

more vasoconstriction
>10

51

vasopressin MOA

-vasoconstriction via activity at V1 on smooth muscles
- 0.3u/min
- titrated off last when d/c other vasopressors

52

vasopressor selection in adult pts

- 1st line: NE
- 2nd line: E
-failure w/ other agents: DA

53

goals of vasopressive therapy

- increase BP & perfuse organs
- titrate to desired effect
- CVP 8-12
- MAP>65
- O2 sat >70%

54

MAP=

1/3SBP+2/3DBP
or
DBP+0.33pulse pressure

55

prevent extravasation with vasopressors adverse events by ensuring

central line is in place

56

if extravasation does occur with vasopressors

- tapper off
- give nitrobid ointment or phentolamine

57

ionotrophs

dobutamine (dobutrex)
milrinone (primacor)

58

target cardiac index with ionotrophs

>2.2

59

vasodilators

nitroglycerin
nitroprusside (nitropress)

60

what drug had an ADE of methemoglobuinemia?

IV nitroglycerine

61

nitroprusside ADE

cyanide toxicity

62

IV antihypertensives

nicardipine (Cardene)
labetalol (trandate)