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  1. What patient weight for CrCl, Vd and dose should be used for vancomycin?
    CrCl = TBW (use Adjusted BW if obese)

    Vd = TBW (even if obese)

    Dose = TBW (even if obese)
  2. What adverse effects and toxicities are of concern with vancomycin?
    • 1. Nephrotoxicity
    • 2. Ototoxicity
    • 3. "Red-Man Syndrome"
    • 4. Thrombophlebitis
  3. How does nephrotoxicity occur with vancomycin?
    • Originally thought to be associated with high troughs (>10-20 mcg/ml) by earlier data
    • Most likely due to impure formulation and often being combined with amnoglycosides
  4. What is the likely cause of ototoxicity in vancomycin?
    high peaks (>50-80 mcg/ml)
  5. How does "red-man syndrome" occur with vanocmycin toxicity?
    • Fast infusion
    • Reaction is a histamine-mediated response, resulting in redness & pruritic over the over torso, arms & neck
  6. How can "red-man syndrome" be avoided when giving vancomycin?
    Give diphenhydramine 30 minutes prior to infusion and SLOW down the rate of infusion (increase from 1 hour to 2 hour infusion time)
  7. True or False: Thrombophlebitis is related to serum concentrations.
  8. When should peak and trough concentrations be checked?
    At time of steady state (3-4 doses)
  9. When should peak vancomycin concentrations be drawn?
    • at least 1-2 hours after end of infusion
    • this avoids the distribution phase, which may result in erroneous calculations
  10. When should trough vancomycin concentrations be drawn?
    less than 1 hour before the next dose
  11. If a random vancomycin level is desired, when should it be drawn?
    It should be at least 1 anticipated half-life from the previous level to ensure the accuracy in calculating the Ke
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