PKPD Flashcards
%T>MIC dependent drugs
- Penicillins
- Cephalosporins
- Carbapenems
- Macrolides
- Oxazolidiones
Dosing goal for %T>MIC dependent drugs
- Prolonged infusion time
- Continuous infusion
- Shorter dosing interval
- Increase dose
Cmax:MIC dependent drugs
- Aminoglycosides
- Quinolones
Dosing goal for Cmax:MIC dependent drugs
- Extended interval dosing
- Maximize safe dose
AUC:MIC dependent drus
- Vanco
- Azithro
- Tetra
Dosing goal for AUC:MIC dependent drugs
Optimize safe dose
Low vd and impaired Cl
Create high serum concentration
High vd and augmented cl
create low serum concentration
Changes to expect in the critically ill
- dec Cardiac output (dec cl)
- inc capillary leakiness (inc vd)
- AKI (hyperfiltration> inc cl)
- CKI (reduced renal cl)
Abx w/o renal dosing adjustments
- Metro
- Azithro
- Nafcillin
- Tigecycline
- Oxacillin
- Linezolid
- Doxy
- Moxifloxacin
- Erythro
- Ceftriaxone
- Clinda
Drugs that have rapid development of resistance
- Rifampin
- Clinda
- Quinolones (floxicin)
Vancomycin target
AUC:MIC > 400 mg+h/L
Vanco dosing
- old school (trough based; figure out Cl)
- AUC (non-Bayesian) - use peak/trough to calculate AUC
- AUC (Bayesian) -obtain random sample and previous knowledge and combine to get Cl
Trough based dosing problems
Without the peaks there is no way to know what the area is exactly (neglects the area from the infusion)
Two-point AUC dosing problems
- Partial miss of peak area
- Partial miss of infusion area
- Calculation intensive
Bayesian dosing problems
Impossible to determine without software assistance
AUC:MIC is dependent on these factors
- Daily dose a patient receives
- patient specific Cl
- bacterial specific MIC
