Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

Vanco & Gent & Tobra...oh my!

Noon conference
by

Erin Barnett

on 18 July 2014

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Vanco & Gent & Tobra...oh my!

Vanco & Gent & Tobra...Oh My!!!
26 July 2012
Noon Conference
Erin M. Barnett, RPh, PharmD, BCPS
Clinical Pharmacy Specialist
Internal Medicine
Ext: 3434
Pager: 63-120

Hours: 700-1530 M-F
Vancomycin
Antibiotic
Spectrum of Activity
Mechanism of Action
Inhibits Cell Wall Synthesis
RNA synthesis
Permeability
Objectives
Explain dosing and monitoring of Vancomycin, Gentamycin & Tobramycin
Brief overview of the medications Vancomycin, Gentamycin & Tobramycin
Compare different methods to determine renal function
Identify the key factors when obtaining eGFR in patients
Review of commonly dose-adjusted medications in renal disease
Indications
FDA
Non-FDA
C. diff diarrhea
Infective endocarditis
Lower RTI
MRSA

infection
Staph enterocolitis
Dosing
Monitoring
Peaks?
Troughs?

Goal therapeutic range?
Gentamycin
Tobramycin
Aminoglycosides
Antibiotics
Spectrum of Activity
Mechanism of Action
Indications
Dosing
Monitoring
FDA
Non-FDA
Gentamycin
Tobramycin
Inhibits protein synthesis
Gentamycin
19 indications
Tobramycin
8 indications
Traditional
Extended-Interval
Traditional
Extended-Interval
Peaks?
Troughs?

Goal therapeutic range?
Traditional
Extended-Interval
Renal Function
Key Factors
Age
Height
Creatinine
Gender
Body composition
Weight
Actual
Ideal
Adjusted
Kidney Function
Assessment

Urine Collection
MDRD
Cockcroft-Gault
= 186 * (SCr^-1.154) * (age^-0.203) * (0.742 for females) * (1.21 if AA)
Units in mL/minute/1.73m^2
(140-age) * (Weight)
----------------------
SCr * 72
* (0.85 if female)
Units in mL/minute
Dosage Adjustments
Jelliffe
CrCL (
male
) = 98 - {0.8} * (age-20)
------------------------
Scr
CrCL (
female
) = 88 - {0.7} * (age-20)
-----------------------
Scr
Units in mL/minute/1.73m^2
Follow the Yellow Brick Road
Follow the Yellow Brick Road
Follow the Yellow Brick Road
Follow the Yellow Brick Road
Follow the Yellow Brick Road
Follow the Yellow Brick Road
Follow the Yellow Brick...
Follow the Yellow Brick...
Follow the Yellow Brick Road
Kinetic
A
D
M
E
Antibiotics
Cardiac meds
Lipid lowering meds
Narcotics
Neurological meds
Antiretrovirals
Miscellaneous
Medication Classes
Antipsychotics
Antiepileptics
References
Comparisons
Hypoglycemic meds
1. Rybak M, Lomaestro B, Rotchafer, JC, et al. Therapeutic Monitoring of Vancomycin in Adult Patients: A Consensus Review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm 2009; 66(1): 82-98.
2. Micromedex 2.0. Vancomycin. Online. Accessed 12 July 2012.
3. Winter, Michael E. Basic Clinical Pharmacokinetics. Fourth ed. Lippincott Williams & Wilkins, 2004: 97-110, 129-171, 451-476.
4. Prins JM, Buller HR, Kuijper ED, et al. Once Versus Thrice Daily Gentamycin in Patients with Serious Infections. The Lancet; vol 341: 6 Feb 1993: 335-339.
5. Micromedex 2.0. Gentamycin. Online. Accessed 12 July 2012.
6. Micromedex 2.0. Tobramycin. Online. Accessed 12 July 2012.
7. Nicolau DP, Wu AH, Finocchiaro S, et al. Once-Daily Aminoglycoside Dosing: Impact on Requests and Costs for Therapeutic Drug Monitoring. Ther Drug Monit: Vol 18(3), June 1996; 263-266.
8. Foote, Edward F. Nephrology. In: 2009 Updates in Therapeutics: The Pharmacotherapy Preparatory Course Volume 2. ACCP, 2009: 2-27.
9. Kappel J, Calissi P. Nephrology: 3. Safe Drug Prescribing for Patients with Renal Insufficiency. Can Med Assoc J 2002; 166: 473-477.
10. Matke GR, Frye RF. Drug Therapy Individualization for Patients with Renal Insufficiency. In: Dipiro JT, Talbott RL, Yee GC, et al eds. Pharmacotherapy: A Pathophysiologic Approach, 7th ed. New York: McGraw-Hill, 2008: 833-844.
11. Winter M, Guhr K, Berg GM. Impact of Various Body Weights and Serum Creatinine Concentrations on the Bias and Accuracy of the Cockcroft-Gault Equation. Pharmacotherapy 2012; 32(7): 604-612.
12. Levey AS, Coresh J, Greene T, et al. Using Standardized Serum Creatinine Values in the Modification of Diet in Renal Disease Study Equation for Estimating Glomerular Filtration Rate. Ann Intern Med. 2006; 145: 247-254.
13. Michels WM, Grootendorst DC, Verduijn M, et al. Performance of the Cockcroft-Gault, MDRD and new CKD-EPI Formulars in Relation to GFR, Age and Body Size. Clin J Am Soc Nephrol. 5: 1003-1009, 2010.
14. VHA Pharmacy Benefits Management Services. Information on the Use of the Modification of Diet in Renal Disease Equation to Estimate Glomerular Filtration Rate and the Cockcroft-Gault Equation to Estimate Creatinine Clearance for Medication Dosing in Patients with Kidney Dysfunction. Online. VHA Pharmacy Benefits Management Services. Accessed 25 July 2012.
15. Bouchard J, Macedo E, Soroko S, et al. Comparison of Methods for Estimating Glomerular Filtration Rate in Critically Ill Patients with Acute Kidney Injury. Nephrol Dial Transplant. 2010 January; 25(1): 102-107.
16. Munar MY and Singh H. Drug Dosing Adjustments in Patients with Chronic Disease. Am Fam Physician. 15 May 2007; 75(10): 1487-1496.
Questions?
Extended Interval
Full transcript