Hi, I'm trying to create a mobile nursing app. It has a section on Vancomycin (see below). Could you please take a look at it and tell me if the description is dead-on and if there is anything else you'd like to add? Thanks...
MEDSURG APP: Vancomycin Infusion
As with all medications given, a dose has to be administered to the patient where it reaches a therapeutic level. That is, there must be enough medication concentration to help the patient, but not so much that it causes excessive toxicity. You must maintain a balance.
REASON FOR THIS METHOD
Nothing applies to this more than vancomycin (Vancocin) infusions. In the United States, the common way to give vancomycin is through intermittent infusion (II). Other countries prefer to continuously infuse (CI) vancomycin rather than intermittently with dose adjustment. Both methods have their advantages and disadvantages, specifically that CI is convenient and relieves the patient and nurse from constantly monitoring the serum concentration level in the blood. That means, less blood draws that have to be drawn 30 minutes prior to the next dose (STAT) and cannot wait due to the time sensitive issue. However, II allows the medical team to adjust dosage at different times to find a custom dose for each patient that works for them.
PHYSIOLOGICAL CONSIDERATIONS: Terminology
Therapeutic level - the serum concentration level needed to effect the patient's healing process while effectively avoiding adverse events
Minimum effective concentration - the area amount of medication that does not harm the patient (but does not benefit them, either)
Toxic concentration - the point of area serum concentration where the medication does more harm than good
Onset of action - the time it takes for the medication to become therapeutic
Peak action - the highest level of serum concentration
Half-life - the time it takes for the body to nullify half the medication given in the body
Trough - the lowest level of serum concentration (30 min. before the next dose)
Duration of action - how long the serum concentration stays in the therapeutic level
When you are given orders to administer vancomycin, after verifying you must understand why you are giving the medication.
The vancomycin works by attacking the beta-lactam rings of bacteria, albeit in other ways from conventional antibiotics (The Complete (but Practical) Guide to Vancomycin Dosing — tl;dr pharmacy
). However, it must reach areas that house bacteria, such as the blood brain barrier (BBB).
Current vancomycin consensus guidelines promote aggressive dosing to achieve trough levels of 10-15 or 15-20 mg/L, but also include recommendations to target a daily area under the curve (AUC24 ) to minimum inhibitory concentration (MIC) ratio of at least 400 (Waineo, 2015). So watch for doses to achieve this level. Look for the trough results and see if they achieve this amount. The area under the curve (AUC) is a level used to determine how much dose is present in the body and is determined using classic calculus methods. It's best to leave this to the pharmacist but an awareness of this is useful to the nurse. Just know that you want your patient within 10-20 mg/L trough level (refer to your hospital policy).
Vancomycin is used mainly as a last result medication....