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APK1 > Vanco PK > Flashcards

Vanco PK Flashcards

1
Q

what is the MoA of vanco?

A

binds to peptidoglycan on bacterial cell membrane and interferes with cell wall building/repair

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2
Q

what does vanco treat?

A

MRSA, MSSA, and coagulase-negative staph

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3
Q

Vanco should be discontinued after 72 hours if?

A

MRSA not found

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4
Q

what is the minimum inhibitory concentration for vanco?

A

1 mg/L or less

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5
Q

what’s the bioavailability of vanco when given IV/IM?

A

F=1

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6
Q

what’s the bioavailability of vanco given intraperitoneally?

A

F= 0.5-0.6

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7
Q

what’s the dose for vanco given intrathecal/intraventricular?

A

5-20mg q24h

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8
Q

does vanco cross placenta?
does it get into breast milk?

A

yes and yes

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9
Q

when do we draw a vanco peak concentration after administration? what about post-distribution?

A

after 4-5 alpha half-lives
draw 1 hour after a 1 hour infusion

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10
Q

what is vancos half-life?
time to steady-state?

A

8 hours
48 hours

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11
Q

what are our monitoring parameters for efficacy and toxicity for vanco?

A

efficacy:
vitals (temp)
WBCs
repeat culture and sensitivty (C&S)

toxicity:
kidney function
SCr
Urine I/O
hearing & balance
vanco trough

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12
Q

what is the target vanco AUC for MIC =1 mg/L?

A

400-600 mg/L*h

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13
Q

why do we prolong infusion time w/ vanco doses over 1000mg?

A

prevent vanco flushing syndrome

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14
Q

some morbidly obese pts require every __ hour dosing

A

8

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15
Q

which of the following is true regarding vancomycin and obesity?
A. VD is moderately increased
B. T1/2 decreases to about 6 hours
C. Clearance increases
D. The Dosing interval remains the same

A

C

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16
Q

for burn patients, may need every ______ hour vanco dosing

A

6-8

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17
Q

a central line vanco concentration should NOT be _________

A

> 10 mg/mL

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18
Q

a peripheral line vanco concentration should NOT be __________

A

> 5 mg/mL

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19
Q

when do we consider using a loading dose for vanco?

A

seriously ill pts:
Severe sepsis
meningitis
bacteremia
infective endocarditis
pneumonia
osteomyelitis

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20
Q

what is vanco loading dose?

A

25-30 mg/kg based on actual body weight (max 3g)

21
Q

what is the cockcroft-gault equation?

A

CLCR= [(140-age) x IBW / 72 X SCr] x 0.85 (for females)

22
Q

how do we calculate IBW?

A

Men: 50 kg + 2.3 * (inches over 5 ft)
Women: 45.4 kg + 2.3 * (inches over 5 ft)

23
Q

how do we determine what weight to use to calculate creatinine clearance?

A

use total body weight if its less than IBW. if IBW is 120% or more over TBW, use ABW

24
Q

how do we calculate ABW?

A

IBW + [0.4 (TBW-IBW)]

25
Q

when do we use a minimum Scr =1?

A

for age 65 or more or malnourished pts with Scr less than 1

26
Q

how do we initially dose vanco based on creatinine clearance?

A

> 80: 15 mg/kg q8-12h
50-80: 15 mg/kg q12h
30-50: 15 mg/kg q24h
<15: 15 mg/kg as one time dose
** not to exceed 2g
q8h recommended only in patients under 40 and CLCR over 80

27
Q

all vanco troughs should be drawn __________ to next dose (within ______ minutes of next dose)

A

immediately prior, 30

28
Q

vanco troughs should be obtained at steady-state before ___________ dose in patient with stable kidney function or before _________ dose in patients requiring >24 hour dosing such as CKD patients

A

4th or 5th
2nd or 3rd

29
Q

volume of distribution for vanco is determined using the equation:
when do you use ABW?

A

0.7 or 0.8 L/kg * weight
if >120% IBW

30
Q

mcg/ml = mg/L

A
31
Q

what does t’ mean?

A

infusion time: t’=2 if vanco was infused over 2 hours

32
Q

what does tau mean?

A

the dosing interval: q12h, q24h…

33
Q

if you want to change the Cmax, you should?
if you want to change the Cmin, you should?

A

change the dose
change the dosing interval

34
Q

is vanco concentration-dependent or time-dependent killing?

A

time-dependent

35
Q

AUC divided by the MIC is the primary predictive pharmacodynamic parameter for _____

A

efficacy

36
Q

T/F AUC is the measure of cumulative drug exposure

A

true

37
Q

T/F AUC is the serum concentration-time curve over a dosing interval

A

true

38
Q

vanco trough range should be?

A

10-20 mg/L

39
Q

for calculating extrapolated Cmax, Tmax is the time between __ and the _______

A

T1, end of infusion

40
Q

Ct = concentration at the start of infusion which is the same as?

A

trough (Cmin) at steady-state

41
Q

back extrapolating to the end of the infusion will
a. overpredict AUC
b. underpredict AUC
c. predict AUC exactly

A

b

42
Q

what is the AUC associated w/ AKI?

A

600-800 mg/L*h

43
Q

what is the AUC associated w/ nephrotoxicity?

A

700-1300 mg/L*h

44
Q

smaller volume of distribution = what to k and half-life?

A

faster elimination and shorter half-life

45
Q

prior to systemic circulation, oral drugs metabolized by cyp are located in the:
a. small intestine
b. liver
c. small intestine and liver
d. small intestine, liver, kidney, and other minor organs

A

d

46
Q

which dosage form(s) have a high first-pass effect?
a. IV/IM
b. SL
c. capsule/tablet
d. transmucosal
e. transdermal
f. suppository
g. inhalation

A

c

47
Q

in general, if a drug has a high first-pass effect, then switching from IV to oral dose requires:
a. a smaller oral dose
b. a larger oral dose
c. the same dose

A

b

48
Q

if a drug has a high first-pass effect, then switching from an oral dose to IV requires:
a. a smaller IV dose
b. a larger IV dose
c. the same dose

A

a

APK1 (3 decks)

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