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Diagnostic Methods - Medical Lab > Vancomycin > Flashcards

Vancomycin Flashcards

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USMLE® Step 1 flashcards
1
Q

What are some complicated infections that would use Vancomycin?

A

Endocarditis, osteomyelitis, meningitis, hospital-acquired pneumonia, bacteremia

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2
Q

What are some common uses for Vancomycin?

A

MRSA, MRSE, severe PCN allergy, C. Diff, prophylaxis for endocarditis or prosthesis, prophylaxis in hospitals with high rates of MRSA or MRSE

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3
Q

Two reasons to measure Vancomycin trough levels?

A

Risk of nephrotoxicity, inadequate response

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4
Q

Serum concentration levels of Vancomycin are used as _____ ______ of effectiveness

A

Surrogate Markers

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5
Q

What type of antibiotic is Vancomycin?

A

Glycopeptide antibiotic

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5
Q

Are peak or trough levels advocated when using Vancomycin?

A

Trough, not peak

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7
Q

What are the reference range trough levels for uncomplicated/less serious and complicated/serious infections?

A

Uncomplicated=10-20 µg/mL, Complicated 15-20µg/mL

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8
Q

What are the peak levels for Vancomycin?

A

25-50µg/mL

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9
Q

Trough levels below _____ are associated with inadequate therapy and bacterial resistance development

A

10 µg/mL

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10
Q

Tough levels above therapeutic range may result in what complication?

A

Nephrotoxicity

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11
Q

What kind of blood, what volume, and what “top” tube for trough and peak monitoring? How many doses in before testing?

A

Venous blood, 1mL, red top. 4 doses in for steady-state.

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12
Q

What dose is steady-state achieved at?

A

4th dose

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13
Q

When is blood collected to determine trough concentration?

A

Within 30 minutes of next dose

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14
Q

When to draw for peak concentration?

A

1-2 hours after IV dose

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15
Q

Is Vancomycin given orally? Why?

A

Not given orally due to poor bioavailability

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16
Q

When is Vancomycin given orally?

A

Tx of C. Diff

17
Q

Vancomycin given in PTs who are allergic or intolerant to what?

A

Beta-lacams

18
Q

These are 4 important reasons to measure trough levels for nephrotoxicity in PT:

A

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

19
Q

For PTs with renal problems what are their doses based on?

A

Creatinine Clearance (CrCl) levels

20
Q

A CrCl level greater than ___ requires no dose change

A

60 mL/min

21
Q

How frequently should levels be checked in hemodynamically stable patients who are on long-term therapy? What if they are not hemodynamically stable.

A

Weekly if stable, more often for those who arent

22
Q

Did PTs receiving Vancomycin develop auditory toxicity?

A

No

22
Q

Is ototoxicity (audio toxicity) dependent on dose?

A

No

23
Q

Vanomycin can cause nephrotoxicity or neutropenia. Was it reversible?

A

Yes, when discontinued.

24
Q

Vancomycin combined with what other medication can cause renal failure?

A

Aminoglycosides

25
Q

PTs on an aminoglycoside, receiving long-term Vancomycin, and with trough levels above 110 are at increased risk of what?

A

Nephrotoxicity

26
Q

Vancomycin is most often delivered via IV and can lead to what complication?

A

Phlebitis

27
Q

Vancomycin is used to treat what sort of bacteria?

A

Gram-positive bacteria resistant to other less-toxic meds

28
Q

What three levels should be evaluated before starting Vancomycin therapy?

A

BUN, Creatinine, CrCl

31
Q

What is the usual dose for Vanomycin? For seriously ill patients?

A

Usual=15-20 mg/kg. Seriously ill=25-30mg/kg

32
Q

What should subsequent Vancomycin dose be dependent on?

A

Serum trough levels

33
Q

If Vancomycin dose is above 1.0g what is the infusion time?

A

1.5 to 2 hours

34
Q

What are two alternatives to Vancomycin for MRSA when minimum inhibitory concentration needs to be above 2µg/mL?

A

Linezolid, Daptomycin

35
Q

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?

A

Decrease Vancomycin dose

36
Q

If course of dose is less than 5 days long with a target less than 15 mg/mL how many trough levels are required?

A

Just one

Diagnostic Methods - Medical Lab (6 decks)

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