Vancomycin/Aminoglycoside Kinetics - Block 1 Flashcards
Round vanc doses to the nearest ___?
250 mg
What should the final concentration of vanc be?
50mg/mL: 500mg, 750mg, 1g, 1.25g, and 1.5g in SWFI
100 mg/mL: 5 g or 10 g in SWFI
Further dilutd in D5W or NS -> ≤5 mg/mL
What is the infusion rate of vanc?
≥30 minutes for every 500 mg -> 1g/hr
Indication for vanc?
1st line for moderate-severe MRSA
ADR of vanc?
Ototoxicity, nephrotoxicity, red man syndrome
What is the LD of vanc?
Crit ill or severe infection: 20-35 mg/kg of ABW
* don’t exceed 3 g
What is considered severe infection?
- Bacteremia
- Osteomyelitis
- Endocarditis
- Meningitis
- HAp
How do you prevent vanc resistance?
- Avoid troughs less than <10mcg/mL
Trough goal of vanc?
Crit ill or severe infection: 15-20 mcg/mL
Normal: 10-15 mcg/mL
Goal AUC/MIC for vanc?
400-600
MRSA resistance in AUC/MIC <400
What is the maintence dose of vanc?
Base on weight and target trough:
* 10-15 mg/kg or 15-20mg/kg
How do you determine vanc dose frequnecy?
Ke = 0.00117 x CrCl + 0.003 (will be given on the test)
T1/2 = 0.693/Ke
Dosing interval = T1/2 x 1.5
* Round to either Q8, Q12, Q24, Q48
When do you order a vanc trough level?
Order trough prior to the 4th dose in dose frequency < Q24h
How do you dose vanc in AKI
Pulse dosing or dose by levels:
* Give a dose and check a random level
* Give 10 – 20 mg/kg
* Your level should be in your “trough goal range” before giving another dose
What is the definition of AKI?
- 1.5x baseline sCr within 7 days
- SCr increase at least 0.3 mg/dL in 48H
- UO <0.5 mL/kg/h for at least 6H