PK/PD Sparks Flashcards
According to pharmacokinetics principle, What happened to the medication upon entering the body?
- Absorption
- Distribution
- Metabolism
- Excretion
What is absorption?
Ability of a drug to travel from the administration site to the bloodstream
what are the extra vascular sites that effect absorption? (Slide 5)
- Intramuscular/SubQ
- Inhaled
- Intraventricular/intrathecal
- Oral route
What are some of the advantages of IM/SubQ site administration (Slide 6)
- Avoids first-pass metabolism, may have higher bioavailability than oral route
Slide 6
What are the listed disease state for PenG?
- Syphilis infection
- Strep infection-Single dose
Slide 6
What are the listed disease state for Rocephin
- N. gonorrhea STI
- Otitis Media
Slide 6
What are the listed disease states for Aminoglycosides?
Mycobacterium infections
Which drugs have increased Vd in the lungs?
- Polymixin-Colistin
- Monobactam/Aztreonam
- ## Aminoglycosides-Tobramycin,Amikacin
Slide 7
What are some of the recommendations for Pt using ventilator with gram (-) ventilator-associated pneumonia (VAP)
- Use systemic Therapy
- Solution, Nebulizer device, mechanical vent settings, sedation, and other medications
What is the primary use if Intraventricular and intrathecal injection?
- Primary use in CNS infections
- It improves Vd crossing blood-brain barrier (BBB)
- May minimize toxicity outside of CNS
What are some of the drugs that can be injected Intrathecally?
- Aminoglycosides
- Colistin
- Daptomycin
- Vancomycin
Gastric pH
. Absorption in the stomach favor ______ drugs
. Absorption in the small intestines favors _____ drugs
Acidic; Basic
Gi motility
What are potential effects of Delayed-gastric emptying?
- Decrease the absorption of meds in small intestines
- Increase the absorption of meds in stomach
Through oral route, which drug would have poor absorption (First pass)
B-Lactams
Which drugs have excellent Bioavailability through Oral route?
- FQ
- Metronidazole
- Oxazolidinones
- Doxycycline
What’s important to know to admin Ciprofloxacin along with nutrition?
Hold nutrition 1-2 hours before and after enteral nutrition administration (bioavailability may drop 40%)
What’s important to know to admin FQ and Tetracycline along with nutrition?
Give 4 hours before or after cation’s (Calcium, Magnesium, iron, aluminum)
What is the concentration formula?
dose/Vd
What are some of the factors that affect Drug distribution?
- Tissue perfusion/permeability
- Lipid solubility/ Molecular size/Protein binding
What condition favors Distribution?
- High lipophilicity
- Low molecular weight
- Unionized state
- Low protein binding
What are some steps you could take to increase the CNS penetration?
- High doses
- higher frequencies
- Injecting intraventricular
What to do when serum albumin is slower then 3.5?
- Increase ECF/Increase Vd
- Decreases Plasma on optic pressure
- Increased proportion of unbound drug in plasma that can distribute in ECF
- Ultimately increases renal clearance of antibiotics with renal excretion
what would be the properties of a Hydrophilic drug be with general Pk
- Low Vd
- Low intracellular penetration
- typically renal clearance
what would be the properties of a Hydrophilic drug be with Critically ill pK?
- Higher Vd
- Clearence altered d/t changes in renal function
what would be the properties of a Lipohilic drug be general Pk?
- High Vd
- Good intracellular penetration
- Typically hepatic clearance
what would be the properties of a Lipohilic drug be critically ill Pk?
- Unchanged Vd
- Clearance altered d/t changes in hepatic function
What are 2 reactions that are primarily responsible for metabolism in the liver?
- Phase 1 Oxidative metabolism (Requires oxygen; CYP isoenzymes)
- Phase 2 glycosylation and glucoronidation
What are the medications usually found in Extracellular space post admin?
- B-Lactams (PCN, Cephlasporin, Carbapenems)
- Daptomycin
- AG
What are the medications usually found in Total body water post admin?
- Clindamycin
- Linezolid
- Metronidazole
- Vancomycin
What are the medications usually found Tissues post admin?
- Colistin
- FQ
- Macrolides
- Azithromycin
- Calrithromycin
- Tigecycline
What agents are with significant hepatic/biliary clearance or sensitivity to decreased metabolism?
- Amoxicilin,
- Ceftriaxone
- Clarithromycin
- Clindamycin
- Doxycycline
- Metronidazole
- Rifeampin
What are some of the antibiotics known for cyp inhibitors?
Macrolides
Metronidazole
Bactrim
What are some of the antibiotics known as CYP inducers
Rifamycins
Anti staphylococcus penicillins
Which antibiotic may cause serotonin syndrome?
Oxazolidinones
What are the antibiotics with highest risk of INR elevation with Warfarin (CYP2C9)
- FQ
- Bactrim
- Metronidazole
- Clarithromycin
What are the antibiotics with highest risk of decreased INR and risk of thromboses with Warfarin (CYP2C9)
- Rifampin
- Anti-Staphylococcal Penicillin
What antibiotics do not need renal adjustment?
- Avelox (Moxifloxacin)
- Rocephin (Ceftriaxone)
- Rifampin
- Azithromycin
- Cleocin
- Doxycycline
- Nafcillin
- Oxacillin
- Linezolid
- Tigecycline
(T/F) most antimicrobial agents are time-dependent
True
Time-dependent antimicrobials
- B-Lactams
- Linezolid
- Tetracycline
- Bactrim
How to admin Cefepime for E.Coli?
- 1gm q6hr
- 1gm q4hr
- 2pm q8hr
How to admin Cefepime for K. Pneumoniae?
- 1gm q6hr
- 1gm q4hr
- 2pm q8hr
