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Therapeutics IV > Vancomycin/Aminoglycoside Kinetics - Block 1 > Flashcards

Vancomycin/Aminoglycoside Kinetics - Block 1 Flashcards

1
Q

Round vanc doses to the nearest ___?

A

250 mg

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2
Q

What should the final concentration of vanc be?

A

50mg/mL: 500mg, 750mg, 1g, 1.25g, and 1.5g in SWFI
100 mg/mL: 5 g or 10 g in SWFI

Further dilutd in D5W or NS -> ≤5 mg/mL

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3
Q

What is the infusion rate of vanc?

A

≥30 minutes for every 500 mg -> 1g/hr

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4
Q

Indication for vanc?

A

1st line for moderate-severe MRSA

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5
Q

ADR of vanc?

A

Ototoxicity, nephrotoxicity, red man syndrome

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6
Q

What is the LD of vanc?

A

Crit ill or severe infection: 20-35 mg/kg of ABW
* don’t exceed 3 g

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7
Q

What is considered severe infection?

A
  1. Bacteremia
  2. Osteomyelitis
  3. Endocarditis
  4. Meningitis
  5. HAp
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8
Q

How do you prevent vanc resistance?

A
  1. Avoid troughs less than <10mcg/mL
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9
Q

Trough goal of vanc?

A

Crit ill or severe infection: 15-20 mcg/mL
Normal: 10-15 mcg/mL

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10
Q

Goal AUC/MIC for vanc?

A

400-600
MRSA resistance in AUC/MIC <400

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11
Q

What is the maintence dose of vanc?

A

Base on weight and target trough:
* 10-15 mg/kg or 15-20mg/kg

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12
Q

How do you determine vanc dose frequnecy?

A

Ke = 0.00117 x CrCl + 0.003 (will be given on the test)
T1/2 = 0.693/Ke
Dosing interval = T1/2 x 1.5
* Round to either Q8, Q12, Q24, Q48

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13
Q

When do you order a vanc trough level?

A

Order trough prior to the 4th dose in dose frequency < Q24h

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14
Q

How do you dose vanc in AKI

A

Pulse dosing or dose by levels:
* Give a dose and check a random level
* Give 10 – 20 mg/kg
* Your level should be in your “trough goal range” before giving another dose

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15
Q

What is the definition of AKI?

A
  • 1.5x baseline sCr within 7 days
  • SCr increase at least 0.3 mg/dL in 48H
  • UO <0.5 mL/kg/h for at least 6H
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16
Q

How should you adjust vanc based on trough?

A

Trough at goal: no changes
Trough below goal: Increase dose or shorten the frequency
Trough above goal: Decrease dose or extend the frequency

17
Q

What is thevanc dosing in dialysis?

A
  • LD: 20-25 mg/kg
  • Set target trough lvel
  • Order random level (6 hrs after HD)
  • Adjust the dose based on the level & utilize the facility protocol
18
Q

Vanc dosing for CVVH?

A
  • Loading dose of 15-25 mg/kg
  • Maintenance dosing of 10-15 mg/kg every 24-48 hours OR 1000 mg every 48 hours
  • Obtain trough level prior to 2nd maintenance dose
  • Adjust dose accordingly
19
Q

Vanc dosing for CVVHD?

A
  • Loading dose of 15-25 mg/kg
  • Maintenance dosing of 10-15 mg/kg every 24 hours OR 1000 mg every 24 hours
  • Obtain trough level prior to 3rd maintenance dose
  • Adjust dose accordingly
20
Q

Infusion rates of AG?

A

Gentamicin: 30-120 minutes
Tobramycin: 20-60 min, higher doses over 60 min, flush line with saline before and after admin
Amikacin: 30-60 minutes

21
Q

ADRof AG?

A

Nephrotox and ototoxicity

22
Q

Who should use extended interval dosing?

A

All patients with G- infections

23
Q

Who uses traditional dosing of AG?

A
  1. Pregnant, postpartum
  2. Burns
  3. Ascites
  4. Dialysis, CrCl <30
  5. Synergic dosing
24
Q

How do we dose AG?

A
  1. Determine IBW
  2. Compare with ABW
  3. AG distribution decreases in obeses
25
Q

What is the initial dosing for extended interval?

A
  1. Dose
  2. Draw random level 6-14 hrs after dose
  3. Plot level on nomogram to determine frequncy
  • If dosing amikacin, cut level in 1/2 before plotting
  • If level/time falls on the line, move UP
26
Q

What is the peak AG for extended interval?

A

Tobra and gent: 15-20 mcg/mL
Amikacin: 40-60 mcg/mL

27
Q

What is the trough AG for extended interval?

A

Tobra and gent: ≤ 1 mcg/mL
Amikacin: target at 1 to 2 mcg/mL

28
Q

How should you adjust AG in extended?

A

If the trough is too high, adjust the time
Plug in the nomogram – adjust the dose

29
Q

How do ou dose traditional AG dosing? Target?

A
30
Q

How do you calculate traditinal dosing interval?

A

Vd: 0.3 L/kg
Ke: 0.003 x CrCl + 0.01 (will be given)
T1/2: 0.693/Ke
Dosing interval: T1/2 x 3
* Round to nearest 8, 12, 24, 36, 48 hrs

31
Q

When do you draw ss levels for traditional dosing?

A

Trough: 30 min prior to infusion
Peak: 30 min after infusion completed

32
Q

How do you adjust AG based on trad peak levels

A

Adjust the DOSE
* If at goal: no change
* If high: decrease dose
* If low: increase dose

33
Q

How do you adjust AG based on trad trough levels?

A

Adjust the FREQUENCY:
* If at goal: no change
* If high: decrease frequency
* If low: increase frequency

Therapeutics IV (31 decks)

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