Antibiotic Dosing Strategies in Patients Undergoing Hemodialysis: Pharmacokinetic and Pharmacodynamic Considerations

1.) The primary goal of adjusting antibiotic dosing regimens in patients undergoing hemodialysis is:

a) To reduce risk of drug-induced toxicities
b) To optimize drug efficacy
c) To enhance patient convenience
d) All the above

2.) Which of the following does not require dose adjustment in patients undergoing hemodialysis?

a) Cefazolin
b) Vancomycin
c) Cephalexin
d) Ceftriaxone

3.) _______ is the PK/PD index which best correlates with tobramycin efficacy.

a) T > MIC
b) AUC:MIC
c) Cmax: MIC
d) Cmax

4.) Drug related factors most influencing dialysis clearance include:

a) Molecular weight
b) Protein binding
c) Elimination route
d) Volume of distribution
e) All of the above

5.) Close therapeutic drug monitoring is advisable for which of the following:

a) Vancomycin
b) Cefazolin
c) Tobramycin
d) Both a and c

6.) In patients undergoing hemodialysis vancomycin plasma level is influenced by the following:

a) The timing of drug administration
b) The duration of dialysis
c) The interdialytic interval
d) All of the above

7.) Ciprofloxacin is a fluoroquinolone antibiotic with concentration-dependent bactericidal activity. It is commonly used in the treatment of urinary tract infections (UTI), and primarily eliminated by the kidneys. The standard oral dosing regimen to treat complicated UTI in adults is 500 mg given every 12 hours for 5-7 days. Based on this information, which of the following dosing regimens is most appropriate in a patient undergoing hemodialysis?

a) 500 mg every 24 hours
b) 500 mg every 12 hours
c) 250mg every 12 hours
d) None of the above

8.) Although vancomycin is significantly removed by dialysis, it is typically infused over the last hour of dialysis

a) To minimize drug removal by dialysis
b) To maximize patient convenience by eliminating the need for staying an additional 60-90 minutes (vancomycin infusion time) after dialysis
c) To reduce the operational costs of holding a dialysis chair for an additional 60-90 minutes after dialysis
d) All the above

9.) Targeting a high Cmax:MIC ratio for tobramycin dosing by administering conventional doses at extended intervals

a) Takes advantage of tobramycin’s post antibiotic effects (PAE)
b) Optimizes Tobramycin’s concentration dependant killing capacity
c) Allows sufficient time for drug elimination
d) All the above

10.) _______ is the target predialysis vancomycin serum trough concentration for treating MRSA infections in patients undergoing hemodialysis

a) 10-20 mcg/ml
b) 15-20 mcg/ml
c) 5-10 mcg/ml
d) 15-25 mcg/ml

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