C3.1 R1: Perform and document a situation where physical exam was performed to provide pharmaceutical care (3/4)

I conducted an orthostatic vitals assessment on an elderly male with a history of coronary artery disease, permanent atrial fibrillation, possible Castleman's disease (diagnostic workup ongoing), and a new diagnosis of lymphoma. The patient was reported as being bradycardic (HR in the high 50s) with new dizziness and one episode of presyncope over the past … Continue reading C3.1 R1: Perform and document a situation where physical exam was performed to provide pharmaceutical care (3/4)

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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)

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 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)

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

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 (2/2)

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)