Already an RPh, Need Help learning to do hospital PK, etc

[steveysmith54]

Hey guys, I am a retail RPh. I've been doing some hospital work couple of times a month and completely lost abt how to dose vanco, aminoglycosides , lovenox dosing.. Any help would be greatly appreciated. Thanks in advance.

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[confettiflyer]

Lovenox: CHEST, or just look it up in Lexi (but read CHEST...it's basic knoweldge for hospital pharm)

PK: Winter's (http://www.amazon.com/books/dp/0781779030)

 

[farmadiazepine]

Lovenox: CHEST, or just look it up in Lexi (but read CHEST...it's basic knoweldge for hospital pharm)

PK: Winter's (http://www.amazon.com/books/dp/0781779030)

Well that doesn't help

Next time someone asks me something I'll just refer them to the internet.

 

[PharmaTope]

google some protocols, a lot of hospitals post them online. this should help guide you. those books are overkill for the most part.

 

[lisinopril]

Paypal me and I will teach you everything you need to know in hospital setting as a clinical pharmacist in 1 day. Guaranteed. PM me for pricing.

 

[knight on horse]

Find some recent quality reference materials; your hospital should have some. And brush up on kinetics.

 

[ethyl]

Plus and chug your patient info into globalrph's aminoglycoside/vancomycin calculator.
For Vancomycin select Vd ~.75, typical peak goal ~40, your trough goal 12.5 (10-15) or 17.5 (15-20) depending on type of infection.
Gentamicin goal peaks and troughs are on this page as well. Do not use once daily dosing for the following:
CrCl less than 30, dialysis, pregnancy, endocarditis, cystic fibrosis, ascites, neutropenia, infants, 20% or greater BSA burns, history of hearing loss or vestibular dysfunction, gram positive synergy, or mycobacterial infections.

Lovenox dosing for CrCL >30mL/min = 1mg/kg SC Q12h for full anticoagulation or 1.5mg/kg Q24h. Check your institutions guidance on max weight for Q24h dosing, seems to differ depending on the hospital. I think I've seen 150mg or 180mg max for Q24h dosing.
If CrCL < 30mL/min, heparin drip should be preferred. 1mg/kg Q24h also possible.

 

[confettiflyer]

Plus and chug your patient info into globalrph's aminoglycoside/vancomycin calculator.

globalrph is wonky sometimes, i'm constantly revising the other pharmacists crap who don't use clinical judgment when they plug and chug.

 

[Sparda29]

Plus and chug your patient info into globalrph's aminoglycoside/vancomycin calculator.
For Vancomycin select Vd ~.75, typical peak goal ~40, your trough goal 12.5 (10-15) or 17.5 (15-20) depending on type of infection.
Gentamicin goal peaks and troughs are on this page as well. Do not use once daily dosing for the following:
CrCl less than 30, dialysis, pregnancy, endocarditis, cystic fibrosis, ascites, neutropenia, infants, 20% or greater BSA burns, history of hearing loss or vestibular dysfunction, gram positive synergy, or mycobacterial infections.

Lovenox dosing for CrCL >30mL/min = 1mg/kg SC Q12h for full anticoagulation or 1.5mg/kg Q24h. Check your institutions guidance on max weight for Q24h dosing, seems to differ depending on the hospital. I think I've seen 150mg or 180mg max for Q24h dosing.
If CrCL < 30mL/min, heparin drip should be preferred. 1mg/kg Q24h also possible.

Since when are vanco peaks looked at?

 

[confettiflyer]

Since when are vanco peaks looked at?

when you're that unsure of your volume of distribution...i never do it, i just infer it based on calcs. every now and then you get a weird patient where it could make sense and you're trying to hit a peak of 40 to better model AUC:MIC of 400.

But eh details details

 

[KARM12]

Those calculators don't work if you don't understand where the numbers come from. I correct mistkaes from pharmacists who use those all the time.

Don't normally use vanco peaks...AUC:MIC can be estimated using troughs. That is where those targets come from.

 

[confettiflyer]

Those calculators don't work if you don't understand where the numbers come from. I correct mistkaes from pharmacists who use those all the time.

My favorite was a pharmacist that just printed the sheet out and put in Q48hr dosing...I'm thinking, ya know this patient might die in 24. I humored myself and took a level at 12hrs post 1st dose and it was 4 (!)

Funny because I sucked at PK in school.

If you're gonna use globarph like that...you might as well just save time/effort and give everyone under the sun 1g q12.

 

[PharmDstudent]

globalrph is wonky sometimes, i'm constantly revising the other pharmacists crap who don't use clinical judgment when they plug and chug.

Yep. My issue with globalrph is that it'll dose at weird, non-standard intervals. If I'm on-call and I have to dose vanc or an aminoglycoside, I would rather go in and dose it myself than let globalrph give me something that doesn't work in the real world.

Since when are vanco peaks looked at?

I suppose you could use a peak if multiple troughs aren't coming like you would expect (maybe they aren't getting the drug for some strange reason?!), but I can't think of any other reason other than that Globalrph asks for it.

 

[ethyl]

Since when are vanco peaks looked at?

You don't "look" at peaks. In order to calculate a general population estimate it requires a typical peak number. It will spit out a non-standard dose like 1159mg Q10h. So you in turn plug in 1000g Q8h and it's a decent start.