Vancomycin and Linezolid

Question 1

Vancomycin Spectrum

Answer 1

Good: MSSA, MRSA, strept, C. diff
Mod: enterococci

Question 2

Vancomycin PD

Answer 2

AUC Dependent; AUC/MIC over 400

Question 3

Vancomycin PO Dose

Answer 3

125-500 mg q6h

Question 4

Vanco Vd

Answer 4

0.4-1 L/kg

Question 5

Vanco MIC

Answer 5

Less than 2 mg/L

Question 6

Vanco Trough

Answer 6

Trough: 10-20 mg/L
15-20 mg/L in bacteremia, endocarditis, osteomyelitis, meningitis, HAP
Obtain 30 min before 3rd to 5th dosing

Question 7

Vanco Ke

Answer 7

Ke=0.00083 x CrCl + 0.0044

Question 8

Vanco CL

Answer 8

(0.7 to 0.9) x CrCl (L/hr)

Question 9

Vanco Peak

Answer 9

20-40 mg/L Obtain about 1 hr after infusion of 3rd to 5th dose

Question 10

Vanco Steady State

Answer 10

4-5 half lifes

Question 11

Vanco Dose

Answer 11

LD = 15-25 mg/kg
MD = 10-15 mg/kg

Question 12

Patient Specific K

Answer 12

[ln (C1/C2)]/ (T2-T1)

Question 13

Patient Specific Vd

Answer 13

[(Dose/t’) x (1-e^-Kt’)]/ [K x Cpeak - (Ctrough x e^-Kt’))]

Question 14

Vanco Monitoring (Stable)

Answer 14

Obtain levels q7-10 days

Question 15

Linezolid Spectrum

Answer 15

Good: MSSA, MRSA, strept (MDR), enterococci (VRE), Nocardia
Mod: some atypicals, Mycobacterium

Question 16

Linezolid Dose

Answer 16

IV/PO: 600 mg q12h; no renal

Question 17

Linezolid Cautions

Answer 17

Bone marrow suppression, SSRI interaction

Question 18

Linezolid PD

Answer 18

Time dependent

Question 19

IHD and Vancomycin

Answer 19

High flux: removes 25-50% of vanco; level before 3rd HD

Question 20

CCRT and Vanco Dosing

Answer 20

Dosing: CVVH q24-48h, CVVHD q24h, CVVHDF q12h

Question 21

CCRT and Vanco Monitoring

Answer 21

Level at least 24 hr after start and at steady state with 4th dose;

Question 22

Vanco Induced Nephrotoxicity

Answer 22

Incr in SCr by 0.5 mg/dl or 50% from baseline