kinetics aminoglycosides

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coal
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250347
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kinetics aminoglycosides
Updated:
2013-12-12 23:36:31
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kinetics aminoglycosides
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kinetics aminoglycosides
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  1. 7 risk factors for toxicities
    • concurrent nephrotoxic agents(vanco, amphotericin B)
    • genetic disposition
    • shock
    • hypovolemia
    • preexisting renal dysfunction
    • elevated trough concentrationsadvanced age
  2. 2 factors that alter AG kinetics the most
    • Vd
    • Cl
  3. 5 situations that alter Vd
    • obesity
    • ascites, edema
    • sepsis
    • pregnancy
    • burn pts
  4. 5 situations that alter Cl
    • renal dysfunction - decrease Cl, increase T1/2
    • cystic fibrosis - increase Cl, decrease T1/2
    • sepsis - increase Cl, decrease T1/2
    • pregnancy - increase Cl
    • hypermetabolic states - increase Cl
  5. optimal Cmax:MIC ratio
    10:1
  6. conventional dosing intervals based on CrCl
    • > 60 - q8h
    • 40-59 - q12h
    • 20-39 - q24h
    • <20 - LD then monitor levels
    • HD - given after HD, follow levels
  7. once daily dosing goal peaks
    • G/T - 20-30 mg/L
    • A - 60-70 mg/L
  8. once daily dosing doses
    • G/T - 5-7 mg/kg
    • A - 15-20 mg/kd
  9. when do you repeat levels on once daily dosing
    • SCr increased by > 0.5 mg/dL or 50% from baseline
    • patient fluid status significantly changes
    • levels are older than 5 days
  10. exclusion criteria for once daily dosing
    • acute spinal cord injury
    • ascites
    • pregnant
    • pediatrics
    • CrCl <30ml/min or on HD
    • endocarditis
    • febrile neutropenia
    • meningitis
  11. goal peak and trough if gram-positive infections
    • 3-5 mg/L
    • < 2 mg/L
    • conventional dosing
    • not monotherapy - synergy with beta lactam or vancomycin
  12. conventional dosing that would warrant 8-10mcg/ml of G/T or 25-40 A
    • life-threatening infections
    • meningitis
    • febrile neutropenia
    • PNA
    • bacteremia
  13. conventional dosing that would warrant 6-8mcg/ml of G/T or 20-25 A
    • serious infections
    • pyelonephritis
    • peritonitis
    • abdominal
    • skin/soft tissue
  14. conventional dosing if they have a UTI
    • 4-6 mcg/mL G/T
    • 15-20 mcl/mL A
  15. conventional dosing goal troughs
    • G/T < 2mcg/mL
    • A < 8mcg/mL
  16. dosing if on HD
    • 1-2 mg/kg after each HD
    • redoes if post HD level < 2mcg/mL
  17. conventional dosing monitoring 5
    • dose infused over 60 minutes
    • draw levels when reach steady state (after 3rd dose)
    • peak: draw level 30 mins after end of infusion, if elevated reduse dose
    • trough: draw level 30 mins prior to next dose, if elevated, extend interval

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