PharmacoKinetics Flashcards
Vanc Nephro increases in?
Advanced age Prolong therapy >3 wk Troughs >20 Nephrotoxins -Monitor closely
Weight based doses use what weight?
Actual Body Weight
Renal function determines what?
Frequency
Loading doses are required in what pts?
Illness second line to MRSA Endocarditis Febrile neutropenia Meningitis OM Pnemonia Sepsis/Shock
F POEMS
Vanc loading dose
25-30 mg/kg IV x 1
MAX 2000
Vanc Maintenance Dose
15-20 mg/kg/dose Q8-12H
MAX 2000
Vanc Infusion rate
1 gram per hour
Vanc Target Trough and Who
15-20mg/L
Bacteremia, meningitis, pneumo, SSTI, endocarditis, OM
Vanc Target Rare Trough and Who
10-15 mg/L
UTI, mild SSTI
Vanc AUC/MIC target
> 400
Trough is lower than target
Efficacy is decreasing
Dose more freq
If trough is higher than target
Efficacy is too much
Dose less freq & possible decrease
Vanc Toxicity
Redman’s
Nephro
Oto
Genta/Tobra Traditional Dose
1-2.5 mg/kg/dose
Amikacin Traditional Dose
5-7.5 mg/kg/dose
AG Frequency based on CrCl
> 60 Q8
40-59 Q12
20-39 Q24
<20 monitor
AG Peak measures
Trough measures
Peak = efficacy Trough = toxicity
Gent/Tobra Peaks for: Life threatening Serious UTI Endocarditis
8-10
6-8
4-6
3-4
Amikacin Peaks for: Life threatening Serious UTI Endocarditis
25-35
20-25
15-20
—
Gent/Tobra Trough
0.5-2
Target: 1
Amikacin Trough
<8
Target 4
Measuring
Trough 30 minutes before 4th dose
Peak 30 minutes after 30 minutes infusion of 4th dose
Low/High Peak and Trough
Proportionally increase/decrease
AG Large dose, Less freq strategy?
Concentration dependent
Post-antibiotic effect
Gent/Tobra Extended Spectrum Dose
5-7 mg/kg/dose
Extended Spectrum Freq
> 60 Q24
40-59 Q36
30-39 Q48
Hartford
Gent/Tobra 7 mg/kg
Level around 10 hrs
See if interval needs to change
Urban and Craig
Gent/Tobra 5 mg/kg
Level around 10 hrs
See if interval needs to change
Exclusion Criteria for Extended Interval Dosing
Impaired renal Cirrhosis CF Prego Burns >20% of BSA
