A 58-year-old woman with chronic osteomyelitis has been receiving intravenous vancomycin for 10 days, with a trough level of 18 mcg/mL. Her temperature is 37.8°C, blood pressure is 132/84 mmHg, and serum creatinine has risen acutely from 0.9 to 3.2 mg/dL, consistent with acute kidney injury. Urinalysis shows granular casts. Her plasma drug level remains within the therapeutic range, but the team is concerned about progressive toxicity. To maintain therapeutic drug concentrations without further nephrotoxicity, which of the following parameters should be adjusted most directly?
- A)Decrease potency by adding a competitive antagonist
- B)Ignore the change because half-life is unrelated to renal function
- C)Increase bioavailability by changing to oral therapy
- D)Decrease the maintenance dose because clearance has fallenGABARITO
- E)Increase the loading dose because volume of distribution has fallen
Explicação
Maintenance dose is determined mainly by clearance, target concentration, dosing interval, and bioavailability. When renal clearance falls, the administration rate must usually be reduced to avoid accumulation and toxicity. The vignette specifically states tha... Ver explicação completa e trilha adaptativa →