Vancomycin/Aminoglycosides PK Questions

PHAR 899 Vancomycin/Aminoglycosides PK Vancomycin/Aminoglycosides PK Questions CASE 1. Determination of Vancomycin Initial Dose (Q1) JS is a 62 YO, 187 Ibs (height = 5 ft 6 in) female with an MRSA wound infection. A Physician ordered pharmacy to dose vancomycin for JS. 1. Based on the vancomycin protocol, decide initial maintenance dose of vancomycin and infusion time. Bwinlg = Initial doce Round 85k IS 15-20 Vancomlin my necrest X &S Ry 250 Initial maintance = 1275 my 1250 Su Lee, Pharm.D., MS, BCIDP, BCPS my > - my mylly) doe 1250 over my 1 him Page 1 PHAR 899 Vancomycin/Aminoglycosides PK CASE 2. Adjustment of Vancomycin Dose based on an AUC/Trough Level at Steady State (Q. 2-3) KP has been on vancomycin 1 g IV q 12 hrs for a prosthetic knee joint infection. Her 4th dose is scheduled at 9 am this morning. A pre-level measured at 8 am this morning, which was 25 mg/L and calculated AUC is 750. Anc target 2. Your assessment for vancomycin pre-level and AUC are: a. b. c. d. e. f. > Her vancomycin peak level and AUC are subtherapeutic. Her vancomycin peak level and AUC are within therapeutic range. Her vancomycin peak level and AUC are supratherapeutic. Her vancomycin trough level and AUC are subtherapeutic. Her vancomycin trough level and AUC are within therapeutic range. Her vancomycin trough level and AUC are supratherapeutic. 400-600 3. To achieve level and AUC within therapeutic range, how will you change her vancomycin dose or/and interval? > thoghlevel zsmg1 AU(level 730 + Decrease the dose Current dose Reduc to 19 - (10-20mg1) (400 IV 750 Su Lee, Pharm.D., MS, BCIDP, BCPS - 600) > - -> High High plehns my every 12hns Page 2 PHAR 899 Vancomycin/Aminoglycosides PK 21/2 2 . CASE 3. Determination of Aminoglycosides Initial Dose (Q. 4) TL, a 63 YOM on ventilator in MICU, will start Tobramycin for VAP. His vital signs are as follows; Tmax 39.8°C, BP 114/65 mmHg, PR 102 BPM, RR 18 /min, Ht 5’ 10’’, Wt 211 Ibs. Labs: WBC 17.8K (84% segs), BUN 48 mg/dL, Scr 1.1 mg/dL His critical care specialist ordered pharmacy to dose Extended Interval Tobramycin. 4. Calculate Tobramycin initial dose and interval. 1BW = 50 +2 . ABW x (10) +0 . % = 7 34g IBW 2 gsley 73 3 x (95 . tobnamain done Interval dosing 91 - + 76) . 0 76 + a = 5 x 81 . 8 . = 16 82 16129 = 410 . . . 8 + In t 110 A a calculate - my : Emin - Renal o a g24hp Su Lee, Pharm.D., MS, BCIDP, BCPS Page 3 = 4 Sly PHAR 899 Vancomycin/Aminoglycosides PK CASE 4. Adjustment of Aminoglycosides Dose based on patient’s levels at Steady State KG is on Tobramycin for 100 mg Q8h for VAP and 4 doses of tobramycin have been given. You also noticed that his Scr is trending up and his urine output has significantly decreased. You request tobramycin levels with the next dose to ensure that the levels are within therapeutic range. The lab reports the following: Tobramycin 1.5 mg/L at 5:30 and at 13:30 troad Tobramycin 100 mg was given at 6:00 – 6:30 Tobramycin 12 mg/L at 7:00 Pean His tobramycin at 0600, 1400, and 2200. As per hospital policy, all aminoglycosides are infused over 30 minutes. Conc 5:30 6:30 6:00 13:30 7:00 14:00 5. Calculate KG’s elimination rate constant of tobramycin based on KG’s measured levels. Crit40-GX82. k = 0 . 00293x(2908) + 0 = . a 7988 milin 04 = 0 . = 327ap 2404 Su Lee, Pharm.D., MS, BCIDP, BCPS Page 4 PHAR 899 Vancomycin/Aminoglycosides PK 6. Calculate the volume of distribution based on the change of concentration from 1.5 mg/L to 12 mg/L. tobramycin 100 doce my p = smll , C = 12mg1L C Damon s 8 32 7. His target a peak of > 5 mg/L and trough < 1 mg/L. What would be your assessment of the current Peak and trough levels? a. Peak is supratherapeutic and Trough is subtherapeutic b. Peak is subtherapeutic and Trough is supratherapeutic c. Peak is within therapeutic range, but Trough is supratherapeutic d. Peak is Subtherapeutic and Trough is within therapeutic range Dear a pm) le though level I. S (Si30, . 13 :30 8. How will you change the dosage or/and interval to achieve the target peak and trough levels? high though Increas lovely dosing dry not being Intral Maintain Su Lee, Pharm.D., MS, BCIDP, BCPS , to cleared plant loomy on gathn dose Page 5