Therapeutic Drug Monitoring Lecture 5: Vancomycin

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What is the typical trough vancomycin steady-state concentration range recommended for infections with susceptible organisms?

15-20 μg/mL

10-15 μg/mL (correct)

5-10 μg/mL

20-25 μg/mL

Why is a higher trough vancomycin concentration range of 15-20 μg/mL recommended in some institutions?

To treat infections with MRSA strains with higher MIC values (correct)

To ensure adequate vancomycin levels in critically ill patients

To prevent nephrotoxicity

To account for poor lung tissue penetration

What is the average serum to tissue ratio for vancomycin penetration in the lungs?

2:1

1:1

6:1 (correct)

4:1

What is the relationship between higher trough vancomycin concentrations and nephrotoxicity?

Higher trough concentrations are associated with an increased incidence of nephrotoxicity (C) Signup and view all the answers

How does vancomycin-induced nephrotoxicity typically compare to aminoglycoside-induced nephrotoxicity?

Vancomycin is usually considered to have less nephrotoxicity potential than aminoglycosides (D) Signup and view all the answers

What is the typical outcome of vancomycin-induced nephrotoxicity if the antibiotic is withdrawn or doses adjusted?

Vancomycin-induced nephrotoxicity is usually reversible with a low incidence of residual damage (A) Signup and view all the answers

What other potential causes of renal dysfunction should be considered in critically ill patients receiving vancomycin?

Hypotension and other nephrotoxic drug therapies should be ruled out (A) Signup and view all the answers

What is the typical recommendation for vancomycin trough concentrations in the treatment of hospital-acquired pneumonia?

15-20 μg/mL (D) Signup and view all the answers

Which statement about vancomycin is NOT true?

It is administered as a long-term continuous intravenous infusion. (D) Signup and view all the answers

What is the primary mechanism of action of vancomycin?

It inhibits cell wall synthesis in gram-positive bacteria. (B) Signup and view all the answers

Which of the following statements accurately describes the pharmacokinetics of vancomycin?

A waiting period of 0.5-1 hour is allowed before measuring peak concentrations. (A) Signup and view all the answers

What is the primary reason for using vancomycin in clinical practice?

To treat infections caused by resistant gram-positive bacteria. (C) Signup and view all the answers

What is the recommended ratio of vancomycin concentration to the minimum inhibitory concentration (MIC) for effective bacterial killing?

3-5 times the MIC (D) Signup and view all the answers

Which of the following statements accurately describes the bacterial spectrum of vancomycin?

It is effective against gram-positive bacteria but not gram-negative bacteria. (C) Signup and view all the answers

Which of the following patient populations is most likely to receive vancomycin therapy?

Patients with penicillin allergies and gram-positive infections. (A) Signup and view all the answers

What is the primary advantage of using vancomycin over other antibiotics for the treatment of resistant gram-positive infections?

It is effective against organisms resistant to other antibiotics. (C) Signup and view all the answers

What may be the only result of vancomycin nephrotoxicity with adequate patient monitoring?

Transient serum creatinine increases of 0.5–2.0 mg/dL (B) Signup and view all the answers

Which of the following is NOT mentioned as an indicator of a favorable response to antibiotic treatment?

Increase in serum vancomycin levels (B) Signup and view all the answers

When should vancomycin steady-state serum concentrations be measured, according to the text?

In 3–5 estimated half-lives (A) Signup and view all the answers

What is the reasoning behind measuring only a steady-state trough concentration for vancomycin?

Because vancomycin follows time-dependent bacterial killing (C) Signup and view all the answers

When is a good time to assess the clinical efficacy of vancomycin treatment, according to the text?

After the third dose, which typically occurs 1–3 days after dosing has commenced (D) Signup and view all the answers

What should be consulted regularly to note changes in resistance patterns and minimum inhibitory concentrations for pathogens?

Antibiograms (D) Signup and view all the answers

What is the primary factor that determines the antibiotic therapy prescribed for a patient, according to the text?

The patient's current microbiologic cultures and sensitivities (D) Signup and view all the answers

What is the term used in the text to refer to a plot of body temperature over time?

Fever curve (C) Signup and view all the answers

To avoid ototoxicity while receiving vancomycin, clinicians should measure:

Peak concentrations (B) Signup and view all the answers

Which parameter is primarily responsible for the elimination of vancomycin from the body?

Renal excretion (A) Signup and view all the answers

What can happen if vancomycin peak concentration exceeds 40 μg/mL?

Ototoxicity (C) Signup and view all the answers

Which route of vancomycin administration is typically avoided due to the risk of tissue necrosis?

Intramuscular (A) Signup and view all the answers

In which situation should clinicians assess renal and auditory/vestibular function daily?

When high vancomycin concentrations are needed for therapeutic reasons (A) Signup and view all the answers

What percentage of vancomycin elimination occurs through glomerular filtration?

>90% (C) Signup and view all the answers

What symptoms can be caused by vancomycin in terms of allergic reactions?

Chills, fever, skin rashes (A) Signup and view all the answers

(True/False) Oral bioavailability of vancomycin is high.

False (B) Signup and view all the answers

What is the recommended infusion time for vancomycin to avoid infusion-related side effects?

2 hours (A) Signup and view all the answers

What is the therapeutic range for steady-state peak vancomycin concentrations?

20-40 g/mL (C) Signup and view all the answers

Why may direct administration of vancomycin into the cerebral spinal fluid be necessary?

To achieve higher concentrations in the central nervous system (C) Signup and view all the answers

What is the consequence if ototoxicity caused by vancomycin is not addressed with appropriate dosing changes?

The ototoxicity can be permanent (C) Signup and view all the answers

Why are trough concentrations (pre-dose or minimum concentrations) usually related to therapeutic outcome for vancomycin?