kinetics vanco

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Author:
coal
ID:
250450
Filename:
kinetics vanco
Updated:
2013-12-12 16:07:59
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kinetics vanco
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kinetics vanco
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  1. vancomycin adverse effects
    • red man syndrome - acute not hypersensitivity
    • nephrotoxicity - usually reversible
    • ototoxicity - can be irreversible
    • thrombocytopenia, neutropenia - rare
  2. red man syndrome presentation
    • upper body and face
    • w/I 20 minutes of infusion
  3. prevention of red man syndrome
    • 1. increase time, infuse slowly
    •   if 1000mg or less - infuse over 1 hour
    •   > 1000 mg - infuse over 2 hours
    • 2. dilute appropriately
    • 3. can consider diphenhydramine prior to infusion
  4. criteria to eliminate vanco in case of nephrotoxicity
    • at least 2 consecutive elevated SCr values after 2 or more days of therapy and no alternative cause identified
    • >0.5 mg/dL increase in SCr
    • >50% decrease in CrCl
  5. meds that can contribute to ototoxicity with concurrent use with vanco
    • aminoglycosides
    • macrolides
    • NSAIDS
    • ASA
  6. Vd of vanco
    0.7 L/Kg
  7. affect of diabetic pt on distribution
    decreased
  8. special populations that affect elimination
    • burn pts - increased metabolism, shorter T1/2
    • obese pts - increased glomerular filtration
  9. best indicator of clinical success of vanco
    • AUC:MIC - 400 or higher
    • AUC 400 approximate trough of 15mcg/ml
  10. 3 factors that can have variable effects of the clearance and distribution, pt specific
    • pt wt
    • age
    • renal function
  11. trough vanco level that must be maintained
    10 mcg/ml
  12. CrCl cap for vanco
    125 ml/min
  13. dosing intervals of vanco
    • 8,12,24
    • possible 6 if peds
    • possible 48 if severe renal dysfunction
  14. maximum vanco dose
    2000 mg
  15. goal peak and trough of vanco
    • peak 25-40 mcg/ml - higher if meningitis
    • trough 15-20 mcg/ml
    •            10-15 mcg/mL - UTI or uncomplicated
    •                                     cellulitis
  16. when is a loading dose considered and the IDSA recommendation
    • pts who are seriously ill
    • 25-30 mg/kg based on actual body weight
  17. 4 cases when monitoring of trough vanco levels are warranted
    • therapy planned for more than 3 days
    • aggressive dosing - trough 15-20 mcg/ml
    • risk of nephrotoxicity
    • unstable renal function
  18. when to check trough levels
    • prior to 5th dose if 8h dosing
    • prior to 4th dose if 12h dosing
    • prior to 3rd dose if 24h dosing

    • subsequent levels
    • 5-7 days if renal function stable and level adequate
    • sooner if renal function changes or dosing changes
  19. loading dose if acute renal failure
    • 15 mg/kg (consider 20-25 mg/kg if severe infection
    • redoes based on random 24 level, repeat if level is < 15-20 mcg/ml

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