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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)
What adverse effects and toxicities are of concern with vancomycin?
- 1. Nephrotoxicity
- 2. Ototoxicity
- 3. "Red-Man Syndrome"
- 4. Thrombophlebitis
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
What is the likely cause of ototoxicity in vancomycin?
high peaks (>50-80 mcg/ml)
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
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)
True or False: Thrombophlebitis is related to serum concentrations.
When should peak and trough concentrations be checked?
At time of steady state (3-4 doses)
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
When should trough vancomycin concentrations be drawn?
less than 1 hour before the next dose
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