Vancomycin on the NCLEX
Vancomycin for NCLEX: trough monitoring, red man syndrome, nephrotoxicity, MRSA.
Vancomycin is the workhorse for MRSA. The NCLEX tests trough monitoring, red man syndrome, and nephrotoxicity.
Uses
MRSA (IV). C. diff (oral, not absorbed systemically). Severe gram-positive infections.
Red man syndrome
Histamine release from rapid infusion. Flushing, rash, hypotension. Not a true allergy. Slow the infusion (over 1-2 hours minimum). Antihistamine premedication if recurring.
Trough monitoring
Target trough 15-20 mcg/mL for serious infections. Trough drawn 30 min before 4th or 5th dose.
Nephrotoxicity
Dose- and duration-related. Monitor BUN/creatinine. Risk amplified with aminoglycosides.
Oral vs IV
Oral vancomycin doesn't absorb systemically, used only for C. diff. Don't substitute oral for IV when systemic infection.
Frequently asked
Trough too high, what to do?
Hold next dose. Reduce dose or extend interval per pharmacy. Recheck trough before resuming.
Red man during infusion, what to do?
Stop the infusion. Antihistamine. Restart at slower rate.
Quick check
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