Are most Pharmacists Ill-tempered?

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alwaystired said:
Is this right? I am on a hospital rotation and totally blew my first vanco dosing. i had an obese woman and wasn't sure to use IBW or actual and my preceptor is nonexistant basically so I ended up going too high because I used her actual weight. when you say lean body weight, what do you mean? sorry for the dumbest question ever. hospital is a foriegn country to me and my tour guide (preceptor) doesn't have any interest in teaching me anything.....
Click to expand...

....i guess you could say the preceptor is ill-tempered....
 
alwaystired said:
Is this right? I am on a hospital rotation and totally blew my first vanco dosing. i had an obese woman and wasn't sure to use IBW or actual and my preceptor is nonexistant basically so I ended up going too high because I used her actual weight. when you say lean body weight, what do you mean? sorry for the dumbest question ever. hospital is a foriegn country to me and my tour guide (preceptor) doesn't have any interest in teaching me anything.....
Click to expand...

I highly doubt this is a dumb question.
 
alwaystired said:
Is this right? I am on a hospital rotation and totally blew my first vanco dosing. i had an obese woman and wasn't sure to use IBW or actual and my preceptor is nonexistant basically so I ended up going too high because I used her actual weight. when you say lean body weight, what do you mean? sorry for the dumbest question ever. hospital is a foriegn country to me and my tour guide (preceptor) doesn't have any interest in teaching me anything.....
Click to expand...

Alright grasshopper.

Let's think through it. First...how will Vanco get ditributed? Everywhere in the body...or some areas more than other?

Vanco doesn't get absorbed very well into adipose tissues. So, we can't assume entire Adipose area will absorb Vanco.

Lean body weight...I meant IBW.

Dosing Weight(vanc) = IBW + 0.4X(Actual Body weight - IBW)

Assume.. Dosing weight = 70KG.

How big is the bucket? Bucket meaning the compartments where the Vanco will get distributed. Well, the Volume of Distribution of Vanc = 0.7L/kg

Therefor, the Vdvanc = 70kg x 0.7L/kg = 49 Liters.

The size of the bucket i = 49 liters.

So...if you dump 1.5 grams in 49 liters of bucket = 1.5grams/49 liters

then you get an absolute peak of 30.6ug/ml.

Heck..I would have dumped 2grams as a loading dose.. to get a peak of around 40ug/ml. Then in 1 half life...the level will be 20 ug/ml...then 2 half life...the level will be 10ug/ml...then I would dump 1.5grams...which will add 30ug/ml to existing 10ug/ml....to get the peak of 40ug/ml again...

does that make sense?
 
ZpackSux said:
Alright grasshopper.

Let's think through it. First...how will Vanco get ditributed? Everywhere in the body...or some areas more than other?

Vanco doesn't get absorbed very well into adipose tissues. So, we can't assume entire Adipose area will absorb Vanco.

Lean body weight...I meant IBW.

Dosing Weight(vanc) = IBW + 0.4X(Actual Body weight - IBW)

Assume.. Dosing weight = 70KG.

How big is the bucket? Bucket meaning the compartments where the Vanco will get distributed. Well, the Volume of Distribution of Vanc = 0.7L/kg

Therefor, the Vdvanc = 70kg x 0.7L/kg = 49 Liters.

The size of the bucket i = 49 liters.

So...if you dump 1.5 grams in 49 liters of bucket = 1.5grams/49 liters

then you get an absolute peak of 30.6ug/ml.

Heck..I would have dumped 2grams as a loading dose.. to get a peak of around 40ug/ml. Then in 1 half life...the level will be 20 ug/ml...then 2 half life...the level will be 10ug/ml...then I would dump 1.5grams...which will add 30ug/ml to existing 10ug/ml....to get the peak of 40ug/ml again...

does that make sense?
Click to expand...


Yes, thanks. as for the Vd for vanco, where do you find that. I know we learned it, but I forget.

My patient already had some Vanco on board which makes calculating Vd and theoretical peaks/troughs a little more hazy. I dosed her based on her 80kg weight, and should have done it on the dosing weight of 67kg. Her trough came out 23, but I don't think it was even the right time to draw the trough because the nurse got all mixed up with the prev. vanco dosing q12 and the new vanco dose i put on (q8) and so the pharmacist just started over 1 gm q12 and no one really told me a better way to calc initial dose for obese pts. thanks.
 
alwaystired said:
Yes, thanks. as for the Vd for vanco, where do you find that. I know we learned it, but I forget.

My patient already had some Vanco on board which makes calculating Vd and theoretical peaks/troughs a little more hazy. I dosed her based on her 80kg weight, and should have done it on the dosing weight of 67kg. Her trough came out 23, but I don't think it was even the right time to draw the trough because the nurse got all mixed up with the prev. vanco dosing q12 and the new vanco dose i put on (q8) and so the pharmacist just started over 1 gm q12 and no one really told me a better way to calc initial dose for obese pts. thanks.
Click to expand...

But now you'll never forget the Vd of Vanco... it's a population data.
Vd of Aminoglycoside is 0.25L/kg.

Vd is a constant.. so it doesn't matter how much vanco is in her system.
You probably didn't dose her too high... you just dosed it to frequent. Trough of 23 isn't so bad.. I wouldn't worry about it. Just hold a dose and go with a longer interval.
 
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