阿摩線上測驗
12.下列何種情況會增加gentamicin腎臟毒性的發生？
(A)peak level ＞ 8 mg/L
(B)trough level ＞ 2 mg/L
(C)peak level ＞ 4 mg/L
(D)trough level ＞ 0.5 mg/L
統計： A(607), B(3796), C(72), D(30), E(0) #1631342
詳解 (共 10 筆)
毒性指標:peak>12 , trough>2 (mg/L)
Gentamicin /Tobramycin
|
|
Dose |
Peak levels |
Trough levels |
|
Gram (-) Traditionally |
5–7 mg/kg IV QD 1.6 mg/kg IV Q8H |
5–8 mg/L |
<2 mg/L |
|
Gram (+) 心內膜炎 |
1 mg/kg IV Q8H |
3–4 mg/L |
<1 mg/L |
Dose：CrCl ≥60 mL/min No Change Trough levels在大多數情況下將無法檢測到 Trough levels >2 mg/L腎毒性風險增加 |
|||
Ref. Koda-Kimble and Young's Applied Therapeutics：The Clinical Use of Drugs, 10th Edition, P.1455
資料來自 Uptodate：Gentamicin US warning box
Monitor serum concentrations of aminoglycosides when feasible to ensure adequate levels and to avoid potentially toxic levels.
When monitoring gentamicin peak concentrations, adjust dosage so that prolonged levels above 12 mcg/mL are avoided.
When monitoring gentamicin trough concentrations, adjust dosage so that levels above 2 mcg/mL are avoided.
Excessive peak or trough serum concentrations of aminoglycosides may increase the risk of renal and eighth cranial nerve toxicity.
總整理(來自阿摩的前輩)
[總整理]
除了Lithium，所有單位皆為ug/mL
抗生素
Gentamicin : Peak 5-8 ug/mL, Trough < 1 (or 2) ug/mL
Amikacin : Peak 20-30 ug/mL, Trough < 10 ug/mL
Vancomycin : Peak 20-40 ug/mL, Trough < 10-20 ug/mL
抗癲癇
Carbamazepine : 4-12 ug/mL
Phenytoin : 10-20 ug/mL
Phenobarbital : 15-40 ug/mL
Valproic acid : 50-150 ug/mL
抗心律不整
Quinidine : 1-4 ug/mL
Lidocaine : 1-5 ug/mL
Procainamide : 4-10 ug/mL
其他
Lithium : 0.6-1.2 mEq/L
Digoxin : 0.5-1 ug/mL(心衰竭), 0.8-2 ug/mL(心律不整)
Theophylline : 10-20 ug/mL
