PK/PD Antimicrobials

Question 1

Time dependent drugs (minimal effects)

Answer 1

-Penicillins
-Cephalosporins
-Carbapenems
-Macrolides
-Oxazolidiones

Paul can cook my oxtails

Question 2

Time dependent dosing goals (minimal effects)

Answer 2

-Prolong Infusion Time
-Continuous Infusion
-Shorter Dosing Interval
-Increased Dose

Question 3

Time dependent index (minimal effects)

Answer 3

%T > MIC

Question 4

PK/PD Indices

Answer 4

• %T/MIC
• Cmax/MIC
• AUC/MIC

Question 5

Concentration Dependent drugs

Answer 5

-Aminoglycosides
-Quinolones

Question 6

Concentration dependent index

Answer 6

Cmax:MIC
AUC:MIC

Question 7

Concentration dependent dosing goals

Answer 7

-Extend dosing interval
-Maximize safe dose

Question 8

Time dependent drugs (prolonged effects)

Answer 8

-Vancomycin
-Azithromycin
-Tetracyclines

Question 9

Time dependent index (prolonged effects)

Answer 9

AUC:MIC

Question 10

Time dependent dosing goals (prolonged effects)

Answer 10

Optimize safe dose

Question 11

Vancomycin PK/PD dosing goal

Answer 11

AUC:MIC >/= 400 ng/L

Question 12

Disease related changes

Answer 12

• pH - change in drug ionization
• Organ blood flow - change in Cl
• Fluid shift (into 3rd space) - change in Vd
• Albumin changes - change in free drug

Question 13

Drugs related changes

Answer 13

• hydrophilic drugs
• lipophilic drugs

Question 14

Hydrophilic drug changes

Answer 14

Tissue distribution - extracellular
Clearance - renal

Question 15

Hydrophilic drugs

Answer 15

-Aminoglycosides
-Beta Lactams
-Glycopeptides
-Lipopeptides

Question 16

Lipophilic drug changes

Answer 16

Tissue distribution - intracellular
Clearance - Hepatic

Question 17

Lipophilic drugs

Answer 17

Fluroquinolones
Macrolides
Tetracycline

Question 18

Antibiotics with NO renal adjustment

Answer 18

C - Ceftriaxone
C - Clindamycin
O - Oxacillin
M - Moxifloxacin
M - Metronidazole
A - Azithromycin
N - Nafcillin
D - Dalfopristin
D - Doxyxycline
L - Linezolid
E - Erythromycin
T - Tigecycline

Question 19

High serum concentration

Answer 19

low Vd and impaired CL

Question 20

Low serum concentration

Answer 20

high Vd and augumented CL

Question 21

Biggest Factor Controlling PD is what?

Answer 21

Bacteria Species

Question 22

Infection sites (highly perfused tissues)

Answer 22

Blood
Lung
Soft Tissue
Bone
CNS

Question 23

Blood infection site PK alteration

Answer 23

Expanded Vd
Enhanced CL

Question 24

How to optimize regimen for blood infection?

Answer 24

Loading dose
Increase dosing frequency

Question 25

How to optimize regimen for lung infection?

Answer 25

Increase dose

Question 26

Lung site PK alteration

Answer 26

Impaired permeability

Question 27

Soft Tissue site PK alteration

Answer 27

Variable

Question 28

How to optimize regimen for Soft tissue infection?

Answer 28

Increase dose in obesity

Question 29

Bone infection Pk alteration

Answer 29

Impaired permeability

Question 30

How to optimize regimen for bone infection?

Answer 30

Increase dose
Increase duration of therapy

Question 31

CNS infected PK alteration

Answer 31

Impaired permeabilty

Question 32

How to optimize dose for CNS infection?

Answer 32

Maximize dose

Question 33

What is the gold standard for MIC measurement?

Answer 33

Broth Macrodilution

Question 34

Methods to monitor and dose Vancomycin

Answer 34

Old school - trough
AUC (non-Bayesian)
Bayesian method

Question 35

AUC adjustment formula

Answer 35

AUC(observed) Dose(observed)
_______________ = ________________

AUC(target) Dose(target)