aminoglycosides PK - dr sing

don't just use this...make sure you look at the math !!!

aminoglycosides are

a. time dependent

b. concentration dependent

c. AUC:MIC dependent

b.

T/F aminoglycosides are bactericidal and exhibit post-antibiotic effect (PAE)

TRUE

ADRs of aminoglycosides

-nephrotoxicity

-ototoxicity

-hypotension

-neuromuscular blockade

nephrotoxicity is _____

ototoxicity is ______

reversible

irreversible

nephrotoxicity is caused by _____

ototoxicity is caused by _____

high trough

high peak

what is the preferred dosing strategy for most patients?

extended-interval

list the exclusions for extended-interval dosing

IMPORTANT

-CrCl < 20 mL/min, unstable renal function, dialysis

-synergy

-burns > 20% BSA

-ascites

-pregnancy

-pediatrics

-spinal cord injury

extended-interval dosing

monitoring is most commonly done with a ______. measured _______

IMPORTANT

random level

6-14 hours after a dose is administered

extended-interval dosing

what is the goal trough (Cssmin) for all aminoglycosides?

IMPORTANT

< 1 mg/L or undetectable

traditional dosing

measuring is done with ______ levels at _______

IMPORTANT

peak and trough levels

at steady state

traditional dosing

when is a peak level taken?

30 minutes after the end of 30 minute infusion or at the end of a 1 hour infusion

traditional dosing

when is a trough level taken?

30 minutes prior to dose

traditional dosing

what is the goal peak for gentamicin/tobramycin for a serious infection?

8-10 mg/L

traditional dosing

what is the goal peak for gentamicin/tobramycin for a moderate infection?

5-7 mg/L

traditional dosing

what is the goal peak for gentamicin/tobramycin for synergy?

3-4 mg/L

traditional dosing

what is the goal peak for amikacin for a severe infection?

25-30 mg/L

traditional dosing

what is the goal peak for amikacin for moderate infection?

15-25 mg/L

traditional dosing

what is the goal trough for gentamicin/tobramycin?

< 2 mg/L

traditional dosing

what is the goal trough for amikacin?

< 6 mg/L

extended-interval dosing

amikacin dosing weight for initial dose

15 mg/kg

extended-interval dosing

gentamicin/tobramycin dosing weight for initial dose for moderate infection

5 mg/kg

extended-interval dosing

gentamicin/tobramycin dosing weight for initial dose for severe infection

7 mg/kg

extended-interval dosing

the Hartford Nomogram is based on _______ dosing

7 mg/kg gentamicin/tobramycin dosing

extended-interval dosing

if gentamicin/tobramycin 5 mg/kg dosing is being used, how do we adjust before plotting on the Hartford Nomogram?

multiply random level by 1.4

extended-interval dosing

if amikacin 15 mg/kg dosing is being used, how do we adjust before plotting on the Hartford Nomogram?

divide random level by 2

extended-interval dosing — Hartford nomogram

if plotted result falls within an interval that is DIFFERENT than the original interval, adjust to _____

new dosing interval

extended-interval dosing — Hartford nomogram

if plotted result falls on the line BETWEEN two intervals, adjust to _______

the LONGER interval

extended-interval dosing — Hartford nomogram

if plotted result falls OFF the nomogram, adjust to ______

switch to traditional dosing once level falls below 1 mg/L

extended-interval dosing — Hartford nomogram

when using the nomogram, are you adjusting the dose and interval?

NO

just adjusting the interval

traditional dosing

Volume of distribution = ?

0.26 L/kg

traditional dosing

T/F you use dosing weight for CrCl, then use actual weight for the remaining calculations

FALSE

use dosing weight for ALL calculations

what is the normal infusion time (t) for aminoglycosides?

1 hour

doses are rounded to the nearest ___

10 mg

what method is used for dose adjustment with extended-interval dosing?

Hartford Nomogram

what methods are used for dose adjustment with traditional dosing?

proportional adjustment

pharmacokinetic method

traditional dosing

when changes to both the dose and interval are necessary, what method do you use?

pharmacokinetic

IHD removes ____ of aminoglycosides from serum

50%