PK/PD

Question 1

3 drugs that kill by Peak:MIC?

FAM

Hollie’s FAM is the PEAK of crazy

Answer 1

F - fluoroquinolones
A - aminoglycosides
M - metronidazole

Question 2

2 drugs that kill by time:MIC?

BO

Some people have BO all the TIME

Answer 2

B - beta-lactams

O - oxazilidinones

Question 3

3 rugs that kill by AUC:MIC?

VTM

Get money from the ATM with an upside down A so your stuff doesn’t get AUCtioned off

Answer 3

V - vancomycin
T - tetracyclines
M - macrolides

Question 4

4 bacteriostatic drugs?

CMTL

CMT’s Love to cause static

Answer 4

C - clindamycin
M - macrolides
T - tetracyclines
L - linezolid

Question 5

Clindamycin is __

a. bactericidal
b. bacteriostatic

Answer 5

b. bacteriostatic

Question 6

Linezolid is __

a. bactericidal
b. bacteriostatic

Answer 6

b. bacteriostatic

Question 7

Macrolides are __

a. bactericidal
b. bacteriostatic

Answer 7

b. bacteriostatic

Question 8

Tetracyclines are __

a. bactericidal
b. bacteriostatic

Answer 8

bacteriostatic

Question 9

Which drug is slowly bactericidal?

Answer 9

vancomycin

Question 10

Aminoglycosides are __

a. bactericidal
b. bacteriostatic

Answer 10

a. bactericidal

Question 11

Beta lactams are __

a. bactericidal
b. bacteriostatic

Answer 11

a. bactericidal

Question 12

Daptomycin is __

a. bactericidal
b. bacteriostatic

Answer 12

a. bactericidal

Question 13

fluoroquinolones are __

a. bactericidal
b. bacteriostatic

Answer 13

a. bactericidal

Question 14

Metronidazole is __

a. bactericidal
b. bacteriostatic

Answer 14

a. bactericidal

Question 15

3 ADME issues for the critically ill (hypercatabolic)?

Answer 15

• often poor oral absorption
• large Vd
• faster or slower excretion

Question 16

Why is Vd increased in crucially ill pts?

Answer 16

increased capillary permeability > fluid leaks into interstitial space (third spacing)

Question 17

Concentration __ drugs are more impacted by large Vd of critically ill pts

a. hydrophilic
b. lipophilic

Answer 17

a. hydrophilic

Question 18

Why is CrCl not always reliable for critically ill patients?

Answer 18

• renal perfusion decreased
• augmented renal clearance

dose adjustments are often required

Question 19

Renal clearance is unreliable in critically ill, but a significant portion do have __ renal clearance

a. increased
b. decreased

Answer 19

a. increased

Question 20

Volume status does not effect CrCl calculation

a. true
b. false

Answer 20

b. false

Question 21

Ke is the fraction of specific drug removed per unit time assuming what?

Answer 21

blood flow rate to the kidneys is stable

Question 22

PK equations do not work if you cannot assume stable clearance

a. true
b. false

Answer 22

a. true

Question 23

What is the main drug parameter that determines time to steady state?

Answer 23

half life

Question 24

2 independent factors for PK/PD?

Answer 24

Cl

Vd

Question 25

An increase in CrCl causes __ in Ke*Vd a. an increase b. a decrease

Answer 25

a. an increase

Question 26

An increase in CrCl causes a(n) __ in drug clearance and a(n)__ in half life a. increase, increase b. decrease, increase c. increase, decrease d. decrease, decrease

Answer 26

c. increase, decrease

Question 27

What is the formula for AUC? AUC =

Answer 27

dose/clearance

Question 28

Loading doses do not effect the time to steady state. a. true b. false

Answer 28

a. true

Question 29

Loading doses decrease the time to therapeutic levels a. true b. false

Answer 29

a. true

Question 30

5 main pt factors that change drug clearance?

Answer 30

- age - volume status - concomitant nephtrotoxic meds - muscle wasting - critical illness

Question 31

The minimum time to wait to get a vanc level after HD is __ hours

Answer 31

6

Question 32

Which type of CRRT does not need dose adjustments?

Answer 32

SCUF

Question 33

Vanc loading dose range?

Answer 33

25-30mg/kg

Question 34

Vanc dosing is based on __ a. TBW b. AjBW c. IBW

Answer 34

a. TBW

Question 35

The maintenance vanc dose is __ mg/kg

Answer 35

15-20

Question 36

Bayesian modeling does not always hold true in the ICU a. true b. false

Answer 36

a. true

Question 37

What is the AUC goal for vanc definitive dosing?

Answer 37

400-600

Question 38

Aminoglycosides are dosed on __ a. IBW b. TBW c. AdjBW

Answer 38

a. IBW

Question 39

Which type of aminoglycoside dosing is adjusted by nomogram?

Answer 39

definitive extended interval

Question 40

CrCl < __mL/min OR changing renal fxn OR HD are exclusions for aminoglycoside extended interval dosing

Answer 40

20

Question 41

Synergy dosing is preferred for aminoglycoside extended interval dosing a. true b. false

Answer 41

b. false synergy dosing is an EXCLUSION for EI dosing

Question 42

What kind of dosing should be used for AKI with vanc?

Answer 42

pulse dosing

Question 43

Vanc AKI is defined as SCr increase of >= __ mg/L or UOP decrease of __ %

Answer 43

0.3, 50

Question 44

Does pulse dosing impact loading dose?

Answer 44

no

Question 45

Vanc pulse dosing is preferred when drug clearance is unpredictable. a. true b. false

Answer 45

a. true

Question 46

Two main disadvantages of continuous infusions for time dependent antimicrobials?

Answer 46

- stability | - line occupation

Question 47

Aminoglycosides should be dosed > __ to __ times the MIC for extended interval dosing

Answer 47

8, 10 concentration dependent

Question 48

What class of antibiotics should be dosed at the higher end of ranges to overcome altered PK?

Answer 48

beta lactams