Vanco and AG and Renal Disease (L1 and L2)

AUC/MIC ratio of __________ is the target for serious MRSA infections when using Vanco in order to balance safety and efficacy

40-600

9______/MIC ratio of 400-600 is the target for serious MRSA (gram+) infections when using Vanco in order to balance safety and efficacy

AUC (peak/Cmax is for AG)

AUC/MIC ratio of 400-600 is the target for serious ________ infections when using Vanco in order to balance safety and efficacy

MRSA (this target only applies to MRSA!)

Vanco trough-based monitoring is correlated with _______, but NOT with _________

safety, efficacy

can trough Vanco levels be used to predict efficacy

NO (only safety)

can trough Vanco levels be used to predict safety

YES (not efficacy; troughs are definitively associated with nephrotoxicity)

one risk factor for Vanco-induced kidney injury is use of __________ nephrotoxins

concomitant (double trouble)

one risk factor for Vanco-induced kidney injury is use of concomitant nephrotoxins

for example: aminoglycosides, loop diuretics, amphotericin B, __________ ________, vasopressors, etc.

IV contrast

one risk factor for Vanco-induced kidney injury is Vanco doses of >____ g/day

4

one risk factor for Vanco-induced kidney injury is __________ durations of Vanco therapy

longer (>7 days)

one risk factor for Vanco-induced kidney injury is longer durations of Vanco therapy (i.e. >___ days)

7

one risk factor for Vanco-induced kidney injury is Vanco trough concentrations >_____mg/L

15

one risk factor for Vanco-induced kidney injury is patient-specific factors such as higher severity of illness, obesity, pre-existing ____________

renal dysfunction

Aminoglycosides are bacteri_____ and concentration-dependent antibiotics

cidal

Aminoglycosides are bactericidal and ____________-dependent antibiotics

concentration

Aminoglycosides are bactericidal and concentration-dependent antibiotics

the concentration-dependent activity is based on _____/MIC ratio

peak or Cmax (AUC is for Vanco)

Aminoglycoside concentration-dependent activity is based on Cmax or peak/MIC ratio

the target Cmax/MIC ratio for gram-negatives is >______

8-10

Aminoglycoside concentration-dependent activity is based on Cmax or peak/MIC ratio

the target Cmax/MIC ratio for gram-__________ is > 8-10

negatives

the preferred Aminoglycoside for Acinetobacter is __________

amikacin

the preferred Aminoglycoside for Non-tuberculosis Mycobacteria is __________

amikacin

Amikacin is the preferred Aminoglycoside for _________ and ____________

acinetobacter and non-TB mycobacteria

the preferred Aminoglycoside for Enterobacterales is __________

Gentamicin

the preferred Aminoglycoside for gram-positive synergy is __________

Gentamicin

Gentamicin is the preferred Aminoglycoside for ____________ and ______________

enterobacterales and gram-positive synergy

the preferred Aminoglycoside for Pseudomonas is __________

Tobramycin

Tobramycin is the preferred Aminoglycoside for __________

pseudomonas (PSAE)

patients who are ineligible for Extended-Interval Dosing of Aminoglycosides are those with…

- anasarca

- ascites

- CrCl <______mL/min

- cystic fibrosis

- meningitis

- pregnancy

- severe burns (>20% BSA)

- unstable renal function

20

patients who are ineligible for Extended-Interval Dosing of Aminoglycosides are those with…

- anasarca

- ascites

- CrCl <20 mL/min

- cystic fibrosis

- meningitis

- ___________

- severe burns (>20% BSA)

- unstable renal function

pregnancy

patients who are ineligible for Extended-Interval Dosing of Aminoglycosides are those with…

- anasarca

- ascites

- CrCl <20 mL/min

- cystic fibrosis

- meningitis

- pregnancy

- severe ________ (>20%)

- unstable renal function

burns

patients who are ineligible for Extended-Interval Dosing of Aminoglycosides are those with…

- anasarca

- ascites

- CrCl <20 mL/min

- cystic fibrosis

- meningitis

- pregnancy

- severe burns (>20% BSA)

- unstable _________ function

renal

recovery of renal function should NOT be anticipated in ________ (CKD or AKI)

CKD

recovery of renal function SHOULD be anticipated in ________ (CKD or AKI)

AKI (since they are predominately a result of sepsis, rapid recovery is possible)

recovery of renal function should NOT be anticipated in CKD, while rapid recovery IS possible in AKI

SCr/CrCl is much more predictable/stable in ________ (CKD or AKI)

CKD (it’s always shitty)

recovery of renal function should NOT be anticipated in CKD, while rapid recovery IS possible in AKI

SCr/CrCl is much less predictable/stable in ________ (CKD or AKI)

AKI (these pts CrCl is constantly changing and they always need dose adjustments)

renal function is generally ________ predictable in CKD compared to AKI

more (CKD patients always have shitty kidneys basically forever)

renal function is generally ________ predictable in AKI compared to CKD

less (these pts will likely get better, therefore their CrCl is constantly changing and needing dose adjustments)

drugs that are removed by hemodialysis should be scheduled for administration __________ HD

after

Augmented Renal Clearance (CrCl >130mL/min) is most commonly observed in critically ill pts

ARC risk factors include…

- ________ severe critically ill patients (more or less)

- male sex

- pregnancy

- trauma

- young age

less (“the healthiest of the critically ill”)

Augmented Renal Clearance (CrCl >130mL/min) is most commonly observed in critically ill pts

ARC risk factors include…

- less severe critically ill patients (the healthiest of the critically ill)

- ______ sex

- pregnancy

- trauma

- young age

male

Augmented Renal Clearance (CrCl >130mL/min) is most commonly observed in critically ill pts

ARC risk factors include…

- less severe critically ill patients (the healthiest of the critically ill)

- male sex

- __________

- ________

- young age

pregnancy, trauma

Augmented Renal Clearance (CrCl >130mL/min) is most commonly observed in critically ill pts

ARC risk factors include…

- less severe critically ill patients (the healthiest of the critically ill)

- male sex

- pregnancy

- trauma

- ________ age

young

Augmented Renal Clearance (CrCl >130mL/min) is most commonly observed in critically ill pts

ARC strategies for dosing…

1. use the _________ approved dosing regimen (max or min)

2. administration via prolonged or extended infusion for time-dependent agents

3. therapeutic drug monitoring

4. use alternative agent that is not primarily renally eliminated

max

Augmented Renal Clearance (CrCl >130mL/min) is most commonly observed in critically ill pts

ARC strategies for dosing…

1. use the max approved dosing regimen

2. administration via prolonged or extended infusion for ______-dependent agents

3. therapeutic drug monitoring

4. use alternative agent that is not primarily renally eliminated

time (ex: beta-lactams)

Augmented Renal Clearance (CrCl >130mL/min) is most commonly observed in critically ill pts

when determining ARC doses, administration via a prolonged or extended infusion only applies to ________-dependent agents

time

Augmented Renal Clearance (CrCl >130mL/min) is most commonly observed in critically ill pts

when determining ARC doses, administration via a prolonged or extended infusion does NOT apply to or make a difference to ________-dependent agents

concentration