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)

C3.1 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 phenytoin pharmacokinetic interpretation

The patient I performed this PK interpretation on 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 were controlled with propofol, midazolam, and ketamine infusions. Additionally, valproic acid at … Continue reading C3.1 R1: Perform and document a phenytoin pharmacokinetic interpretation

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

I used pharmacokinetic information to dose clindamycin in a patient receiving plasmapheresis (plasma exchange; aka PLEX). Basically, PLEX is the extracorporeal removal of plasma from the blood and replacement with patients own filtered plasma (sometimes), albumin (usually) and other blood products (sometimes). PLEX can be therapeutically useful to remove certain pathologic substances from the plasma … Continue reading C3.1 R1: Perform and document the application of pharmacokinetics to clinical practice in a unique patient population (1/2)

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

I performed a vancomycin pharmacokinetic interpretation in a pediatric patient with pulmonary empyema in the PICU. As I learned, pediatric vancomycin dosing and response is different that adults. Typically, pediatric patients clear vancomycin much quicker than adults leading to a much shorter half-life (as little as 2-3 hours). As such, the typical empiric dose and … Continue reading C3.1 R1: Perform and document a vancomycin pharmacokinetic interpretation (1/3)

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

I treated a complex bipolar patient with a type B aortic dissection complicated by ileus, AKI, and delirium in the CICU. The patient had a history of well controlled bipolar disorder on a repeating cycle¬†of maintenance lithium dosed at 600mg/day on day 1, 600mg/day on day 2, and 450mg/day on day 3 (typical doses are … Continue reading C3.1 R1: Perform and document a psychotropic pharmacokinetic interpretation (1/2)