What does this mean?

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I'm a first-semester nursing student, and on my patient's meds list it says this:

"Vancomycin 1,000 mL IVPB trough 30-60 mins before"

What does this mean? Specifically, "trough"... I'm assuming it means something like, readminister the Vancomysin 30-60 minutes before the trough (which would be at about 23 hours)... but really, that's just a guess that I made by knowing what the general word "trough" means. Anyone's help would be greatly appreciated :) Thanks.

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Hi there,

A "trough" refers to the level of the drug in the blood when it is lowest, and "peak" refers to the level of the drug in the blood at its highest.

Most drugs will have a peak and trough, to some extent, but it is particularly important to know these when the drug is potentially toxic in higher doses (Vancomycin is nephrotoxic).

The physician will probably order a "trough" level, which means blood is drawn to measure the circulating drug when it is at its lowest (in your patient's case, 30-60 mins. before the new dose is administered). The same will be done for "peak" (highest level, a certain time after administration). This helps to ensure the drug is not building up too much in the bloodstream. It also makes sure the drug levels are high enough to be effective against the organism it is supposed to be destroying. So...like Goldilocks said, we're trying to get the drug level "Juuuust right." ;P

:specs:

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Wow, that was so helpful. Thank you sooo much, you're better than half my instructors ;)

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LOL - No problem! :D:redbeathe Thanks for making me feel useful!

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Specializes in Emergency Dept. Trauma. Pediatrics.
LOL - No problem! :D:redbeathe Thanks for making me feel useful!

You should eventually go into teaching. You have a great way of putting things into words and making it easy to understand.

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Agree! Go into teaching!

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Well thanks, guys. Funny you should say that - people tell me that quite a bit lately, and my clinical instructor said it too. I gotta work on getting through nursing school first, though - LOL! Thanks for bringing a smile to my face :loveya:

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Specializes in med/surg, telemetry, IV therapy, mgmt.

"vancomycin 1,000 ml ivpb trough 30-60 mins before"

this order specifically means that 30-60 minutes before giving the vancomycin, have the lab come and draw a vancomycin level on the patient. that is when the patient's blood level of vancomycin will be the lowest (it's called a trough) and it helps the doctor evaluate if the patient has enough of the drug circulating in their blood so he can determine if the dosage needs to be changed. the doctors will also order a "peak" level to be drawn x minutes after a dose of the vancomycin is administered.

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