| Clinical Use Answers Question #1
What percent body weight is the volume of distribution (Vd) of aminoglycosides in normal volunteers?
A. 10-15%
B. 15-50%
C. 20-35%
D. 25-60% Question #2
Into which fluid compartment are aminoglycosides rapidly distributed after infusion?
A. Total body water
B. Intracellular water
C. Extracellular water Question #3
Which patient would likely require lower doses of an aminoglycoside to achieve therapeutic blood levels?
A. A young pregnant woman
B. A burn patient who has been fluid resuscitated
C. A patient with ascities
D. A dehydrated, elderly patient from a nursing home Question #4
You calculated a distribution volume of 0.40 L/kg for a pharmacokinetic study of a patient receiving gentamicin. Which of the following conditions would be consistent with this finding?
A. The patient is fluid overloaded
B. The patient is dehydrated
C. The patient has a rapid rate of elimination Question #5
Identify the traditional therapeutic peak concentration range for gentamicin, tobramycin and netilmicin.
A. Greater than 2 mcg/ml
B. 4 to 8 mcg/ml
C. 6 to 10 mcg/ml
D. Greater than 10 mcg/ml Question #6
Identify the traditional therapeutic peak concentration range for amikacin.
A. 5 to 8 ug/ml
B. 10 to 20 ug/ml
C. 20 to 30 ug/ml
D. Greater than 32 ug/ml Question #7
Identify the traditional trough concentration range for amikacin.
A. Less than 5 ug/ml
B. 4 to 8 ug/ml
C. 8 to 10 ug/ml
D. 10 to 20 ug/ml Question #8
Which of the following peak concentrations are recommended for single daily dosing?
A. 25 x's MIC
B. 10 x's MIC
C. 5 x's MIC
D. 2 x's MIC Question #9
Which of the following is not an important factor in choosing desired aminoglycoside peak and trough levels in a given patient?
A. A patient's lean body weight
B. Patient's clinical condition
C. Relative sensitivity of suspected or isolated pathogen
D. Site of infection Question #10
Which statement regarding aminoglycoside ototoxicity is not true?
A. Sensory cell damage is usually not reversible
B. Early hearing loss involves the conversational range
C. Tinnitus is an early sign of cochlear damage Question #11
Which two problems associated with aminoglycoside therapy are the most concerning?
A. Nephrotoxicity and neuromuscular blockade
B. Ototoxicity and nephrotoxicity
C. Ototoxicity and neuromuscular blockade Question #12
An aminoglycoside free period is suggested during the dosage interval to:
A. Overcome adaptive resistance
B. Limit tissue accumulation
C. Limit toxicity
D. All of the above Question #13
Indicate which of the following statements regarding ototoxicity is not true:
A. Damage is not permanent
B. Affects the 8th cranial nerve
C. Both auditory and vestibular function may be affected
D. It is progressive with continued exposure Question #14
The Hartford single daily dose nomogram uses a daily dose of:
A. 8 mg/kg/day
B. 7 mg/kg/day
C. 6 mg/kg/day
D. 5 mg/kg/day Question #15
Which statement regarding nephrotoxicity and aminoglycosides is not true?
A. Classically, it occurs on the 5th day of therapy or more in the course of therapy.
B. It is usually a non-oliguric type of renal failure
C. Damage may be detected by increases in BUN and serum creatinine
D. Renal damage cannot be reversed by discontinuation of the drug Question #16
Which factor does not influence the distribution volume of aminoglycosides?
A. Body composition (% fat)
B. Specific aminoglycoside chosen
C. Disease condition
D. Age Question #17
As the patient with sepsis is hydrated, what could happen to the dose of aminoglycoside required to maintain therapeutic concentrations?
A. No change required
B. Increase in dose
C. Decrease in dose Question #18
A patient infected with a gram negative rod with an MIC = 0.5 mg/L in the urinary tract should have a peak serum concentration of what magnitude to optimize the peak to MIC ratio?
A. 25 mg/L
B. 20 mg/L
C. 5mg/L
D. 3 mg/L Question #19
The initial signs of cochlear damage include:
A. Tinnitus and nystagmus
B. Pressure in ear and vertigo
C. Tinnitus and pressure in ear
D. Nystagmus and vertigo Question #20
Gentamicin doses of 7 mg/kg/day are designed to produce peak concentrations of:
A. 40 mg/L
B. 30 mg/L
C. 20 mg/L
D. 10 mg/L Question #21
Would you expect a patient with ascites to require larger doses of an aminoglycoside to achieve therapeutic concentrations?
A. Yes
B. No Question #22
After how many half-lives will a patient be at 90 percent of steady-state?
A. 1 to 2 half-lives
B. 2 to 3 half-lives
C. 3 to 4 half-lives
D. 4 to 5 half-lives Question #23
The distribution volume of an aminoglycoside:
A. Corresponds to a discrete physiological space
B. Is relatively consistent from patient to patient
C. Can be thought of as a percent of body weight into which the drug distributes
D. Usually does not change during a course of therapy CONGRATULATIONS!
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