final part 2 Flashcards

1
Q

AG spectrum of activity

A
  • gram - aerobes
  • gram + organisms
  • sepsis/ abdominal/ respiratory tract/ SSTI/ endocarditis/ CNS/ UTI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

AG efficacy monitoring

A

peak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

AG toxicity monitoring

A
  • trough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

for EXTENDED interval what weight do you use?

A
  • actual BW unless >120% IBW
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

which drugs do you use population based dosing?

A
  • gentamicin & tobracycin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Ro=

A

mg/hr

  • per HOUR!
  • (divide by 0.5 for AGs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

AG patient monitoring

A
  • peak: 30 minutes post 30 minute infusion

- trough: 30 minutes immediated pre-dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

why extended interval dosing (EI)?

A
  • concentration depended killer
  • post-antibiotic effect
  • increased efficacy
  • less toxicity
  • minimize antimicrobial resistance
  • convenience
  • less costly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

use caution or avoid extended interval dosing in

A
  • enterococcal endocardiitis
  • burns
  • renal failure
  • osteomyelitis
  • meningitis
  • pregnancy/CF/ febrile neutropenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

gentamicin & tobramycin EXTENDED interval dosing

A
  • 7mg/kg (actual body weight)
  • CrCl:
  • > 60: 24 hrs
  • 40-59: 36hrs
  • 20-39: 48hrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

vanc spectrum of activity

A
  • gram +

- MRSA/ resistance strep/ beta lactam allergies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

vanc ototoxicity is related to

A

high peaks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

vanc nephrotoxicity is related to

A

prolonged high troughs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

vanc goal peak

A

30-40mg/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

vanc goal trough

A
  • 15-20mg/L: bacteremia, meniningitis, pneumonia, SSTI, MRSA, endocarditis, osteomyelitis
  • 10-15mg/L: everything else
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

which weight do you use for vanc dosing?

A

actual body weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

typically adult vanc starting dose

A

15-20mg/kg

  • 2g/dose limit
  • Q8 or Q12H frequency
  • loading dose in erious infections: 25-30mg/kg over 1.5-2hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

vanc infusion rate

A

1g/hour

- 1 hour infusion rates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

if vanc trough is high

A
  • increase interval (decrease frequency)

- decrease dose proportionally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

if vanc trough is low

A
  • decrease interval (increase freq)

- increase dose proportionally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

vanc pediatric dosing

A

15mg/kg Q6H

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

vanc peak monitoring

A

1 hour after infusion is done

- dont really get peaks though in peds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

when to draw serum concentrations of vanc

A
  • convention with 4th dose (sometimes 3rd)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

in whom to draw serum concentrations with vanc

A
  • aggressive doses (15-20mg/L troughs)
  • critically ill
  • changing renal function
  • concomitant nephrotoxic agents
  • prolonged therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

follow up serum concentrations with vanc

A
  • at least weekly in stable pts
  • monitor SCr 3xwk
  • peak monitoring not recommended
26
Q

intermittent HD with vanc

A
  • 20mg/kg LD prior to 1st session
  • 10mg/kg
  • Serum concentration 4 hours post 2nd session
27
Q

vanc toxicity

A
  • infusion related (Redman’s syndrome)
  • not allergy
  • decrease infusion rate
28
Q

lanoxin generic

A

digoxin

29
Q

digoxin indication

A
  • HF (HFrEF)

- Afib

30
Q

MOA of digoxin in HF

A

inhibition of Na/K/ATPase-> increased myocardial contractility

31
Q

MOA of digoxin in Afib

A

reduction of electrical impulses in the AV node & decreased HR

32
Q

digoxin effects on the heart

A
  • negative chronotropic (rate)

- positive ionotropic (contraction)

33
Q

PK for digoxin

A
  • linear at steady state
34
Q

factors to consider in digoxin dosing & monitoring

A
  1. renal function
    2, electrolytes (hypo-K & Mg-> enhance toxicity)
  2. thyroid disease (hypo-[high]; hyper [low]
  3. med review for interactions
35
Q

labs to check before digoxin use

A

Scr
TSH
K+
Mg+

36
Q

pediatic digoxin dosing is

A

weight based

- younger the pt, higher the dose

37
Q

when do you use a loading dose for digoxin?

A
  • Afib pts

- NOT HF

38
Q

digoxin loading dose

A
  • give 50% initially
  • 2 additional doses 25% each
  • all separated by 6 hours eah
  • monitor HR & EKG
39
Q

target concentrations of digoxin

A
  • narrow therapeutic drug
  • HF: 0.5-0.9mcg/L
  • Afib: 1-1.5mcg/L
40
Q

indications for digoxin level measurement

A
  • alterations in renal function
  • suspect toxicity
  • diagnosed with interacting disease state
  • drug-drug interaction
  • to assess compliance
41
Q

when to obtain digoxin drug concentrations

A
  • loading dose: 12-24 hrs after last dose
  • maintenance: 5-7days after initiation (trough 12-24hr after last dose)
  • ESRD take longer to SS
  • exercise may falsely lower trough
42
Q

toxic digoxin levels

A

> 2mcg/L

43
Q

signs and symptoms of digoxin toxicity

A
  • CNS: visual disturbances, HA, confusion, fatigue, dizziness
  • GI: N/V/D, abd pain, anorexia
  • *CV: bradycardia, AV block, vent. arrhythmias
44
Q

if digoxin toxicity occurs

A
  • stop digoxin

- monitor daily until

45
Q

what is digibind

A
  • digoxin immune fab

- used to counteract digoxin toxicity

46
Q

cardiac drips are used for

A
  • vasopressors
  • ionotropes
  • anti-hypertensives
47
Q

most B1 to most Alpha vasoactive activity

A
isoproterenol
dobutamine
dopamine
E(B>A)
NE(A>B)
phenylephrine
48
Q

low dose DA

A
  • primarily on DA receptor
  • works on urine output
  • 1-3 makes you pee
49
Q

intermediate dose DA

A

4-10 makes your heart beat again

50
Q

high dose DA

A

more vasoconstriction

>10

51
Q

vasopressin MOA

A
  • vasoconstriction via activity at V1 on smooth muscles
  • 0.3u/min
  • titrated off last when d/c other vasopressors
52
Q

vasopressor selection in adult pts

A
  • 1st line: NE
  • 2nd line: E
  • failure w/ other agents: DA
53
Q

goals of vasopressive therapy

A
  • increase BP & perfuse organs
  • titrate to desired effect
  • CVP 8-12
  • MAP>65
  • O2 sat >70%
54
Q

MAP=

A

1/3SBP+2/3DBP
or
DBP+0.33pulse pressure

55
Q

prevent extravasation with vasopressors adverse events by ensuring

A

central line is in place

56
Q

if extravasation does occur with vasopressors

A
  • tapper off

- give nitrobid ointment or phentolamine

57
Q

ionotrophs

A

dobutamine (dobutrex)

milrinone (primacor)

58
Q

target cardiac index with ionotrophs

A

> 2.2

59
Q

vasodilators

A

nitroglycerin

nitroprusside (nitropress)

60
Q

what drug had an ADE of methemoglobuinemia?

A

IV nitroglycerine

61
Q

nitroprusside ADE

A

cyanide toxicity

62
Q

IV antihypertensives

A

nicardipine (Cardene)

labetalol (trandate)