C3.1 R1: Perform and document the application of pharmacokinetics to clinical practice in a unique patient population (2/2)

I recommended a dose of low molecular weight heparin (dalteparin) in a 36 year old obese female with recurrent provoked pulmonary embolism on treatment with apixaban. The patient weighed approximately 125kg and had a BMI of 41.8. Observational data suggests that using actual weight for dalteparin dosing is safe and there is no data to … Continue reading C3.1 R1: Perform and document the application of pharmacokinetics to clinical practice in a unique patient population (2/2)

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C3.1 R1: Perform and document a vancomycin pharmacokinetic interpretation (2/3)

I completed a pharmacokinetic interpretation of a vancomycin trough level. The patient was a 28 year old male (62.3 kg) with refractory ascites and spontaneous bacterial peritonitis. The patient had an acute on chronic kidney injury with a fluctuating serum creatinine ranging from 120 to 150 mcrmol/L. Importantly for this patient, he was also cachectic … Continue reading C3.1 R1: Perform and document a vancomycin pharmacokinetic interpretation (2/3)

C3.2 R4: Recognize and submit a Patient Safety Learning System Report (2/2)

I identified, reported, and followed-up on a patient safety event. The patient was a 59 year old complex female admitted with bacterial pneumonia and subsequently found to have a PE. She had multiple drug allergies, including an allergy of unknown reaction or severity to norfloxacin. Over the weekend, the patient was stepped down from IV … Continue reading C3.2 R4: Recognize and submit a Patient Safety Learning System Report (2/2)

C3.1 R1: Perform and document a valproic acid pharmacokinetic interpretation (1/2)

The patient was a 19 year old male with epilepsy admitted for status epilepticus. His home medications included phenytoin (290mg po bid) and lamotrigine 150mg po bid. In the ED his home antiepileptics were continued and his seizures were aborted after initiation of propofol, midazolam, and ketamine infusions. Additionally, valproic acid (VPA) at a dose … Continue reading C3.1 R1: Perform and document a valproic acid pharmacokinetic interpretation (1/2)

C3.1 R1: Perform and document a situation where physical exam was performed to provide pharmaceutical care (2/4)

I completed serial volume assessments on a patient to guide my decision to re-initiate diuretic therapy. The patient was a 65 year old male with complex regional pain syndrome admitted for an upper GI bleed complicated by an AKI and gout flare in his right knee. He also had chronic lower-leg edema likely secondary to … Continue reading C3.1 R1: Perform and document a situation where physical exam was performed to provide pharmaceutical care (2/4)

C3.3 R6: Participate in Pharmacy Awareness Week at your local rotation site

March is pharmacy awareness month (PAM) across Canada. It is a time for pharmacists, pharmacy technicians, and pharmacy learners to promote their role to other health care professionals and patients. The theme for this year was "Your Hospital Pharmacy Team: Your Trusted Medication Experts". Key messages included "you are a pharmacist's priority", "you have access … Continue reading C3.3 R6: Participate in Pharmacy Awareness Week at your local rotation site

C3.3 R7: Peer review journal article, conference abstract, or award submission

Last week I had the opportunity to peer review a journal article for the Canadian Journal of Hospital Pharmacy. This was a great chance for me to provide a critical review of a therapeutic topic of interest in addition to getting some practice with my critical appraisal skills.  The journal asked reviewers to provide specific … Continue reading C3.3 R7: Peer review journal article, conference abstract, or award submission