Okay, let's dive into our first medication class, which is vancomycin. Vancomycin is a glycopeptide antibiotic. The trade name for vancomycin is vancosin.
Let's look at the mechanism of action for vancomycin. Vancomycin inhibits cell wall synthesis and blocks the growth, ultimately killing the bacteria. Remember, this drug is... bactericidal, so its primary goal is to kill the existing infection.
Let's look at the therapeutic uses. Vancomycin is a strong antibiotic used for strong infections which are resistant to other medications. These are things such as MRSA, infections of skin or bone, and C. diff. It's important to know that vancomycin is only effective in treating C.
diff in the oral form, not through the IV route. You can remember this by the memory trick, vancomycin is a first-line medication for these infections because it vanquishes bacteria the best. Let's look at some must-know side effects that the NCLEX loves to test on, which is called vancomycin flushing syndrome. You may also hear it called red man syndrome or redneck syndrome.
This happens when IV vancomycin is infused too quickly. The name comes from a red rash that is seen on the face, chest, and extremities. It can also cause flushing and itching of the skin, as well as a decrease in blood pressure or hypotension.
You want to stop the infusion right away if this occurs. Let's review the routes of administration. Vancomycin can be given intravenously. It commonly comes as a powder which is added to fluid. This is called reconstituted.
Vancomycin can also be given orally, which is primarily used for C. diff. But it's important to know that the IV route is the most common route for most infections.
IV doses should be infused over 60 minutes and 100 minutes if you're infusing greater than 1 gram. Remember that administering too quickly can cause vancomycin flushing syndrome. You want to stop the infusion if vancomycin flushing syndrome occurs. Not slow the rate, not decrease the dose, stop the infusion.
The NCLEX loves to ask about this. As a nurse, you'll need to monitor peak and trough with vancomycin administration. Let's talk about what peak and trough are.
So we start with the administration of the initial dose. Then as the medication levels rise in the blood, you have your peak. The peak is the highest concentration of the drug in the patient's body. Then as serum levels fall in the blood, we have our trough, which is the lowest concentration of the drug in the patient's body.
And it's time for another dose. It's so important to know that vancomycin trough must be drawn prior to administration of the next dose. The therapeutic level for peak is 20 to 40. And the therapeutic level for trough is 5 to 15. You want to be sure to report a trough that is greater than 20, which is too high for the trough or the lowest therapeutic level.
And lastly, for vancomycin, it's important to monitor the patient's IV sites for thrombophlebitis, which is inflammation of the vein, and extravasation, which is leaking of the medication into the surrounding tissue. Vancomycin is so irritating to the veins and can cause issues with peripheral insertion sites, so be sure to monitor your patient's IV sites. Let's look at the most commonly tested on topics for vancomycin. It's an antibiotic used for various infections which are resistant to other antibiotics, including MRSA and C. diff.
Remember, C. diff can be treated with vancomycin taken orally, not intravenously. You want to stop the infusion if vancomycin flushing syndrome, also called red man syndrome, occurs. You want to infuse IV vancomycin over at least 60 minutes and infuse longer for doses greater than 1 gram.
And be sure to monitor the peak and trough. Remember, always draw trough prior to administering the next dose. If you want the rest of this video, check out Nurse in the Making Plus. This includes access to our growing video library, interactive worksheets that go with each video, and practice questions.
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