The flashcards below were created by user
coal
on FreezingBlue Flashcards.
-
7 risk factors for toxicities
- concurrent nephrotoxic agents(vanco, amphotericin B)
- genetic disposition
- shock
- hypovolemia
- preexisting renal dysfunction
- elevated trough concentrationsadvanced age
-
2 factors that alter AG kinetics the most
-
5 situations that alter Vd
- obesity
- ascites, edema
- sepsis
- pregnancy
- burn pts
-
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
-
optimal Cmax:MIC ratio
10:1
-
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
-
once daily dosing goal peaks
- G/T - 20-30 mg/L
- A - 60-70 mg/L
-
once daily dosing doses
- G/T - 5-7 mg/kg
- A - 15-20 mg/kd
-
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
-
exclusion criteria for once daily dosing
- acute spinal cord injury
- ascites
- pregnant
- pediatrics
- CrCl <30ml/min or on HD
- endocarditis
- febrile neutropenia
- meningitis
-
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
-
conventional dosing that would warrant 8-10mcg/ml of G/T or 25-40 A
- life-threatening infections
- meningitis
- febrile neutropenia
- PNA
- bacteremia
-
conventional dosing that would warrant 6-8mcg/ml of G/T or 20-25 A
- serious infections
- pyelonephritis
- peritonitis
- abdominal
- skin/soft tissue
-
conventional dosing if they have a UTI
- 4-6 mcg/mL G/T
- 15-20 mcl/mL A
-
conventional dosing goal troughs
-
dosing if on HD
- 1-2 mg/kg after each HD
- redoes if post HD level < 2mcg/mL
-
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
|
|