Vancomycin

Question 1

Vanc Spectrum of Activity

Answer 1

Gram positive

Question 2

Vanc Uses

Answer 2

MRSA
Resistant Strep
BL allergy

Question 3

Vanc MOA

Answer 3

Cell wall inhibitor

Prevents crosslinking

Question 4

Vanc Max Efficacy

Answer 4

Concentration independent
Trough used as a surrogate
AUC/MIC >/= 400

Question 5

Vanc toxicity

Answer 5

Ototoxicity

Nephrotoxicity

Question 6

Trough 15-20 Goal for:

Answer 6

bacteremia
Meningitis/CNS
Pneumonia
Severe SSTI/necrotizing fasclitis due to MRSA
Endocarditis
Osteomyelitis

Question 7

Tough 10-15 Goal for:

Answer 7

Everything else - less severe infections

Question 8

What weight for Vanc dosing and why?

Answer 8

ACTUAL; increased GFR, renal hypertrophy and Vd not affected significantly

Question 9

Adult dosing range

Answer 9

15-20 mg/kg Q12 or Q8 hrs

Question 10

Loading dose range

Answer 10

25-30 mg/kg over 1.5-2 hrs

Question 11

Vanc infusion rate

Answer 11

1 gram per hour

Question 12

Q8 if:

Answer 12

30-40
Hypermetabolic
Very severely sick

Question 13

What Cmax do you use for Vanc?

Answer 13

40

Question 14

Pediatric dosing range

Answer 14

No range

15 mg/kg Q6 hrs

Question 15

When do you draw serum concentrations?

Answer 15

With 4th dose

Question 16

Who do you draw serum concentrations with?

Answer 16

Aggressive doses (15-20 trough)
Critically ill
Changing renal function 
Concomitant nephrotoxic agents
Prolong therapy

Question 17

Follow up serum concentrations

Answer 17

Weekly in stable pts (more frequent if unstable)
Monitor SCr 3X/wk (if up 0.5, increase monitoring)
No peak

Question 18

Avoid what drugs with vanc?

Answer 18

AG
Amphotericin
Acyclovir
Ketorolac
Pip/Tazo