When to use vancomycin
The most common use for vancomycin is in invasive Gram positive infections
Cydia impactor 0.9.43. Home Video Courses Medicine Sketchy Pharmacology – SketchyMedical Complete – NOT FULL Previous product Music Of Woody Guthrie Arranged For Fingerstyle Guitar Taught By Fred Sokolow $ 10.00. I made an excel spreadsheet that's a little more simplified and way less pretty if anyone wants to DM me for a copy. I have check boxes for Zanki decks (+ some expansions), sketchy pharm and micro, USMLERx videos, and Goljan lectures. It's been helpful for me to keep track of.
You need to consider
- Infection site
- Patient weight
- Kidney function
- Pathogen susceptibility
Pharmacokinetics
- Vancomycin has bad oral bioavailability so it’s almost never used as a pill
- Occasionally it is orally to supplement C. diff infections (because that’s going on in the GI tract)
- Volume of distribution: IV serum 0.4-1 L / kg
- Normally vancomycin doesn’t cross the blood brain barrier very well, but in the setting of meningitis the inflamed meninges increases permeability
Adverse effects
- Redman syndrome: A histamine-like flushing during or immediately after dose. Occurs mostly on the face and neck. This is NOT life threatening
- Treatment: anti-histamine, pause infusion, then restart at a slower rate
- If the reaction is severe, stop the infusion, give antihistamines, wait until symptoms resolve before restarting. When you restart, give the infusion reaaaalllllly slooooooowly (over more than 4 hours)
- Nephrotoxicity
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Dosing
This is where vancomycin can get tricky, because you are aiming for a target trough (between dose) serum concentrations.
- Generally the target is 10 mcg/ml, but this may need to be higher for treating MRSA or osteomyelitis
- Trough concentrations should be measured 30 minutes before the 4th dose any time a course of vanco is started or the dose is changed
- Monitor creatinine at least once a week (remember that whole nephrotoxicity bit)
Starting dose should be 15-20 mg/kg (based on actualnot ideal body weight) every 12 hours. This usually works out to 1-2 g IV Q12H. If the kidneys are not working well, reduce the dose.
References
- UpToDate.com “Vancomycin: Parenteral dosing, monitoring, and adverse effects in adults”
The first three weeks of 2018 have been stressful and overwhelming. The craziness of exam week started as soon as we got back from winter break and after the unit exam on Monday we had the microbiology shelf exam that Friday. For those that don’t know, a shelf exam is basically a mini board exam with all the questions coming from the National Board of Medical Examiners (NBME). We pretty much covered the majority of the topics throughout the unit, but for this exam you had to rely a little more on outside resources such as First Aid and question banks. With microbiology now being a thing of the past, I just wanted to offer some advice on how to go about studying for the course in med school and talk more about the resources I used to make it through another crazy unit!
If you haven’t heard of it yet you will surely hear about it when you start school, but my main resource for microbiology was Sketchy Micro, which is part of the larger Sketchy Medical program geared towards USMLE Step 1 preparation. Sketchy has videos for microbiology, pharmacology, and pathology that uses cartoon stories and pictures to teach each topic. I'm pretty much obsessed with this program because it's the main reason I survived mirco! What’s great about it is that you don’t feel like you’re studying because you're watching cartoons. It provides an easy way to remember a crazy amount of bugs and drugs that would seem super daunting if you just had to scrolling through hundreds of lecture slides. It’s scary how much you can remember because of a video about a bakery that seems like it would have nothing to do with Streptococcus pyogenes (see below).
Tons of reviews already exist online about Sketchy, so I won't waste time going into great detail. Below are some of my likes and dislikes about the program:
Likes
- The majority of videos were short, ranging from 5-15 mins. I have a pretty short attention span, so If i can learn something in 15 minutes I'm happy.
- Provides additional details that may not be in First Aid. I ended up just annotating my book with these finer details, which made studying for the shelf exam a little easier.
- Most of the videos were fun to watch! You find yourself getting into the story and that ultimately helps you remember it.
Dislikes
- The pharmacology videos for antibiotics were a little overwhelming in the beginning, mainly because they exceeded my attention threshold of 15 minutes. I still found them super helpful once I got over the fact that were longer!
Let's talk cost for a second. The complete Sketchy Medical program, including mirco, path, and pharm will run you about $370 for 12 months of access. Most of us are living on loans, so you can save some money by checking to see if your school has discounts before purchasing. They also have a free trial on their website so you can try before you buy. I had a few classmates say that they didn't like the videos in the beginning of the unit, but by the end they came to their senses. They also have workbook you can purchase on Amazon and Etsy, but I chose to just print out the pictures on my own.
Here’s how I scheduled watching the videos:
- I would watch the relevant videos for the lecture as a preview of what bugs would be discussed in class.; this helped me start making connections to what was in the videos and turned lecture into a “review”. My plan didn't always work out this way because school gets crazy and sometimes I just wanted to sleep in!
- I would go to lecture and take notes on anything extra the lecturer added. Then I watched the videos again paying close attention to the details I may have missed the first time.
- Once my notes were organized- I like to use tables that I make myself or that classmates share with everyone- I would test my knowledge of the pictures and the details of lecture notes using Anki flash card decks. I also tested my knowledge by prompting myself and writing down everything I knew about a particular bacteria, fungus, parasite or virus. Since repetition is key, I tried to do this as often as possible.
- Practice, practice, practice. The most important part of studying any subject is to do a lot of practice questions. to ensure you actually know the material. For both the unit exams and the shelf, I did practice questions provided by my school and UWorld questions. I really took the time to read the answer explanations for the questions I got wrong and added any new notes to First Aid for later reference.
Some people like to binge watch a large amount of the videos over the weekend or whenever, but I do enough of that with Netflix. Download fifa manager 13. I think spacing them out gives you enough time to watch videos again, process the information, and commit it to memory. Do what works for you.
Sketchy Pharm Videos
Final thoughts: I would HIGHLY recommended using Sketchy when it’s time for microbiology. Use it early and often! It is not just a learning tool, it’s become a way of life! Seriously though you start making connections to the videos in real life and start questioning your sanity. If I could learn everything through sketchy I would be a very happy med student. Learn more about the program here.
Sketchy Pharmacology Videos
Now that microbiology is over, we are officially done the the foundations portion of MS1! We started systems on Tuesday and first up is the Musculoskeletal and Integumentary systems. I'll talk more about how I'm studying for things like anatomy and physiology in the coming posts. Thanks for reading and have a great week!