Please note that the candidates petitioners in question in this case have taken admission in year and tribunal decision is against the petitioner. With regard to question 8, if still the reply for Question 2 is yes, I would like quote what the counsel appearing on behalf of AICTE and UGC has presented before the tribunal Kindly verify the details at http: Please note that the candidate in question has completed B.
This has important implications for peak serum level sampling. If the peak level is drawn during the distribution phase, it cannot be used for analysis of the one compartment model.
Volume of distribution "Compared with aminoglycosides, the variability in the distribution volume of vancomycin is extreme. Published inter-patient variability has been reported as 0.
The average Vd also varies widely in the literature, with early reports suggesting a value of 0. There does not appear to be any readily identifiable clinical characteristic to explain this variability.
Unlike the aminoglycosides where one can often predict a larger or smaller than average Vd based on fluid status, variability in vancomycin Vd appears to be completely unpredictable.
Clearance Like the aminoglycosides, vancomycin is primarily cleared by glomerular filtration. Correlation of vancomycin clearance to creatinine clearance typically gives values for slope of between 0.
All studies have demonstrated a strong correlation between vancomycin clearance and creatinine clearance, however, there is significant variability in the non-renal clearance component.
This unpredictability is particularly evident in patients with impaired renal function who are more dependent on nonrenal clearance.
Therefore, extra caution is required when estimating clearance in patients with markedly decreased renal function.
Given the variability of Vd and clearance seen with vancomycin, standard doses are likely to be associated with a significant degree of variability in serum concentrations.
Regardless of the pk model used to assess the serum concentration time profiles, the terminal elimination half-life of vancomycin is prolonged and the total body clearance is reduced in patients with impaired renal function: Prospective dosing methods The relatively unpredictable relationship between dose and resultant serum levels of vancomycin has prompted the development of a wide variety of dosing methods.
The Burton method using an adjusted body weight ABW was ranked number one: Matzke's method using actual total body weight TBW was ranked second: Regardless, the authors of the Murphy study concluded "The seven methods studied for estimating vancomycin pharmacokinetic parameters varied widely in predicting vancomycin trough concentrations compared with measured serum concentrations and were not sufficiently reliable to replace therapeutic monitoring of vancomycin serum concentrations.
The Bayesian approach combines both population and patient-specific information i. The pharmacokinetic model most widely used by clinicians is the one-compartment open model.
Because vancomycin exhibits a multi-compartment pharmacokinetic profile, the clinical application of the one-compartment model requires post-distribution serum samples which may be difficult to accurately obtain.
Compared with the one-compartment model, the two-compartment model may produce better results in some patient populations. Monitoring parameters The following patient parameters should be monitored during vancomycin therapy: Vancomycin trough levels Obtain at steady-state approximately four half lifes after initiation and after dose changes.Birth control lets you decide when—or whether—to get pregnant.
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