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MLSCI 466 > Antimicrobial TDM and alcohol > Flashcards

Antimicrobial TDM and alcohol Flashcards

1
Q

What features make a drug suitable for TDM (4)

A
  1. narrow therapeutic window
  2. large inter patient variability
  3. method to measure
  4. does not replace patient assessment and monitoring
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2
Q

purpose of vancomycin

A

inhibit bacterial cell wall synthesis to treat resistant GPO

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3
Q

What is the pharmacodynamics of vancomycin

A
  • inoculum dependent = less effective with larger inoculum
  • time dependent = more time exposed with drug has best effect
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4
Q

What are required for AUC/MIC of vancomycin

A

Draw trough within 30 minutes but peak is NOT required

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5
Q

What are the adjustments needed for Vancomycin troughs of:

<10mg/L
10-20 mg/L
>20 mg/L

A

<10 mg/L = decrease interval or increase dosing

10-20mg/L = target troughs

> 20 mg/L = increase interval or decrease dose

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6
Q

What is the time dependent antibiotic

A

vancomycin

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7
Q

what is the concentration dependent antibiotic

A

aminoglycosides

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8
Q

what are aminoglycosides for

A

GNB

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9
Q

what is the AUC/MIC for aminoglycosides

A

measure peak levels to assess efficacy - concentration dependant

measure trough to minimize toxicity - narrow therapeutic index

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10
Q

which adverse effect of aminoglycosides is ireversible

A

otoxoticity - loss of hearing and balance

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11
Q

What does extended interval dosing use (EID)

A
  1. uses concentration dependent killing and drug free intervals
  2. Uses post antibiotic effect (stunning the bug before it starts to grow again)
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12
Q

Which antifungal is non linear and dangerously associated with toxicity

A

Voriconazole

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13
Q

What makes voriconazole dangerous (3)

A
  1. narrow therapeutic index
  2. well absorbed
  3. high tissue distribution
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14
Q

Why is inter/intra patient variability high for voriconazole?

A

CYP2C19 - is different for patients = different metabolism rates

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15
Q

why are genetics for pharmacokinetics important for voriconazole

A

asians are poor metabolizers of voriconazole due to CYP2C19

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16
Q

where is alcohol absorbed the most

A

small intestine due to more surface area

17
Q

What concentration of alcohol is best for absorption

A

20-30%

18
Q

how long does it take for majority of alcohol to be absorbed and reach peak BAC (blood alcohol curce)

A

15 minutes (90% of alcohol absorbed)

30 minutes to reach peak

19
Q

what is the alcohol content in high water tissues

A

more water in the tissue = higher alcohol content (blood and urine)

20
Q

what products are made when alcohol metabolized

A

alcohol turns into CO2 and H2O in the liver

21
Q

how does the body remove alcohol

A

breath, urine, sweat, tears, saliva, feces

22
Q

does alcohol eliminate from the body mostly through metabolism or elimination

A

metabolism (90-98% of consumed alcohol)

23
Q

T/F - the rate of elimination is dependent on body weight, height, age, and gender

A

F - rate of elimination is INDEPENDENT of those factors

24
Q

What is the best body fluid to draw for testing

A

Urine > vitreous humor > plasma

(more water in the eye than plasma = more alcohol)

25
Q

what is alcohol classified as

A

a CNS depressant

26
Q

what are the 4 progressive effects alcohol has on the CNS and what are the BAC %

A
  1. impairment - <100mg%
  2. Intoxication - 100-250mg%
  3. Severe intoxication - 250-400mg%
  4. death - >400 mg%
27
Q

What symptoms is seen in impairment

A

loss of emotion
effected driving skills - vision

28
Q

what symptoms seen for intoxication

A

motor function loss - balance, muscle coordination, slurred speech

29
Q

what symptoms seen in severe intoxication

A

sleep/comatosed
vomit

30
Q

how does death occur with alcohol consumption

A

respiratory centre of brain is depressed by alcohol = stop breathing

31
Q

what is the probability of causing an accident if driver is >100mg%

A

6x more than sober

32
Q

When should specimens be collected when using the Hartford nomogram method

A

every 8 hours

33
Q

What two methods of EID are there

A
  1. Hartford nomogram
  2. Trough method
34
Q

what is the method of conventional dosing of AG

A

Multiple administrations a day to find therapeutic targets

35
Q

When is sampling conducted using conventional AG monitoring

A

Draw levels pre and post 3rd dose

MLSCI 466 (8 decks)

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