Vancomycin Flashcards
What are some complicated infections that would use Vancomycin?
Endocarditis, osteomyelitis, meningitis, hospital-acquired pneumonia, bacteremia
What are some common uses for Vancomycin?
MRSA, MRSE, severe PCN allergy, C. Diff, prophylaxis for endocarditis or prosthesis, prophylaxis in hospitals with high rates of MRSA or MRSE
Two reasons to measure Vancomycin trough levels?
Risk of nephrotoxicity, inadequate response
Serum concentration levels of Vancomycin are used as _____ ______ of effectiveness
Surrogate Markers
What type of antibiotic is Vancomycin?
Glycopeptide antibiotic
Are peak or trough levels advocated when using Vancomycin?
Trough, not peak
What are the reference range trough levels for uncomplicated/less serious and complicated/serious infections?
Uncomplicated=10-20 µg/mL, Complicated 15-20µg/mL
What are the peak levels for Vancomycin?
25-50µg/mL
Trough levels below _____ are associated with inadequate therapy and bacterial resistance development
10 µg/mL
Tough levels above therapeutic range may result in what complication?
Nephrotoxicity
What kind of blood, what volume, and what “top” tube for trough and peak monitoring? How many doses in before testing?
Venous blood, 1mL, red top. 4 doses in for steady-state.
What dose is steady-state achieved at?
4th dose
When is blood collected to determine trough concentration?
Within 30 minutes of next dose
When to draw for peak concentration?
1-2 hours after IV dose
Is Vancomycin given orally? Why?
Not given orally due to poor bioavailability
When is Vancomycin given orally?
Tx of C. Diff
Vancomycin given in PTs who are allergic or intolerant to what?
Beta-lacams
These are 4 important reasons to measure trough levels for nephrotoxicity in PT:
On nephrotoxic meds (ACE-Is, ARBs, NSAIDs, aminoglycoside ABX, sulfonamides, chemotherapy), reduced or changing renal function, high-than-normal Vancomycin dose, on prolonged therapy 3-5 days
For PTs with renal problems what are their doses based on?
Creatinine Clearance (CrCl) levels
A CrCl level greater than ___ requires no dose change
60 mL/min
How frequently should levels be checked in hemodynamically stable patients who are on long-term therapy? What if they are not hemodynamically stable.
Weekly if stable, more often for those who arent
Did PTs receiving Vancomycin develop auditory toxicity?
No
Is ototoxicity (audio toxicity) dependent on dose?
No
Vanomycin can cause nephrotoxicity or neutropenia. Was it reversible?
Yes, when discontinued.
Vancomycin combined with what other medication can cause renal failure?
Aminoglycosides
PTs on an aminoglycoside, receiving long-term Vancomycin, and with trough levels above 110 are at increased risk of what?
Nephrotoxicity
Vancomycin is most often delivered via IV and can lead to what complication?
Phlebitis
Vancomycin is used to treat what sort of bacteria?
Gram-positive bacteria resistant to other less-toxic meds
What three levels should be evaluated before starting Vancomycin therapy?
BUN, Creatinine, CrCl
What is the usual dose for Vanomycin? For seriously ill patients?
Usual=15-20 mg/kg. Seriously ill=25-30mg/kg
What should subsequent Vancomycin dose be dependent on?
Serum trough levels
If Vancomycin dose is above 1.0g what is the infusion time?
1.5 to 2 hours
What are two alternatives to Vancomycin for MRSA when minimum inhibitory concentration needs to be above 2µg/mL?
Linezolid, Daptomycin
If serum creatinine levels increase by 0.5mg/dL over 2-3 consecutive measurements -or- 50% increase in serum creatinine occurs what should be done?
Decrease Vancomycin dose
If course of dose is less than 5 days long with a target less than 15 mg/mL how many trough levels are required?
Just one
