ANTIBIOTIC DOSE AND DOSE INTERVALS IN RRT and ECMO
|
|
- Todd Green
- 5 years ago
- Views:
Transcription
1 ANTIBIOTIC DOSE AND DOSE INTERVALS IN RRT and ECMO Professor Jeffrey Lipman Department of Intensive Care Medicine Royal Brisbane Hospital University of Queensland
2 NO CONFLICT OF INTERESTS
3 Important concept Recommended dosages are obtained from healthy volunteers and possibly (ward) sick patients
4 Clinical pharmacology: drug development Antibiotic regimens are derived from noncritically ill volunteers. Their haemodynamic system is normal, as is their liver and kidney blood flow. They have not leaky capillaries nor have they drips and pipes in every orifice.
5
6 The kidney and antibiotics Blot S et al. Diagnostic Microbiology and Infectious Disease 2014;79:77 84
7 Antibiotic related IMPORTANT pharmacokinetic parameters Cmax Peak Concentration Cmin t 1/2 V AUC Cl Trough Concentration Half-life (or V D ) Volume of distribution Area under curve Clearance Protein binding
8 Capillary lead and fluid administration
9 Marik PE Anaesthesia and Intensive Care 1993;21:172-3.
10 .we have found that higher-thanrecommended loading and daily doses of vancomycin seem to be necessary to rapidly achieve therapeutic serum concentrations. 35mg/kg loading 35mg/kg/day
11 VOLUME OF DISTRIBUTION ALTERATIONS IN ICU Antibiotics that stay in extravascular and extracellular space ie that don t penetrate solid organs, (hydrophilic tendencies) namely AMINOGLYCOSIDES GLYCOPEPTIDES β-lactams (to a lesser extent) COLISTIN
12 LOADING DOSE vs CLEARANCES Fundamental concept Loading dose is INDEPENDENT of clearances EVEN IN RENAL FAILURE (without clearance) YOU MUST GIVE LOADING DOSE
13 LOW EXPOSURE TO ANTIBIOTICS ENABLES DEVELOPMENT OF RESISTANCE Critical Care Medicine August 2008;36:
14 Sepsis changes PK Extracorporeal circuits Altered CL and Increased Vd cf AKI? Plasma concentrations
15 (C)RRT (Continuous) Renal Replacement Therapy Kidney Filter FLOW Semi-permeable Membrane FLOW Ultrafiltrate Dialysate
16 CRRT Effects on Electrolytes and Water.. and Drugs. FLOW K K Ca Ca PO4 H2O Cr Cr Cr Cr Ur Semi-permeable Membrane FLOW Ultrafiltrate +/- Dialysate
17 DRUG CLEARANCE If you know 1. Membrane Pore Size 2. Drug Size 3. Sieving Coefficient Then it s easy!
18 DRUG CLEARANCE If you know 1. Membrane Pore Size 2. Drug Size 3. Sieving Coefficient Then it s easy!
19 CRRT Continuous Renal Replacement Therapy Kidney Filter Access (Pre- Filter) From Patient Return (Post Filter) To Patient FLOW Semi-permeable Membrane FLOW Ultrafiltrate Dialysate
20 CVVHD Continuous Veno-Venous HeamoDialysis NO Replacement Fluid. Access (Pre- Filter) From Patient FLOW Kidney Filter Return (Post Filter) To Patient Semi-permeable Membrane FLOW Ultrafiltrate Dialysate
21 CVVHD Removal of urea, toxins, electrolytes & DRUGS (small molecules) FLOW K K Ca Ca PO4 Cr Cr Cr Cr Ur Semi-permeable Membrane FLOW Effluent Dialysate
22 CVVHD Sd = [Antibiotic] dialysate [Antibiotic] plasma
23 CVVHD Cl CVVHD Qd x Sd
24 CVVH Removal of H 2 O, urea, toxins, electrolytes & DRUGS (small + middle molecules) FLOW H2O K K Ca Ca PO4 H2O H2O H2O H2O H2O Cr Cr Cr Cr H2O Ur H2O Semi-permeable Membrane Ultrafiltrate
25 CVVH Continuous Veno-Venous Heamofiltration Replacement Fluid can be either Pre- Filter or Post Filter. Access (Pre- Filter) From Patient FLOW Kidney Filter Return (Post Filter) To Patient Semi-permeable Membrane FLOW Ultrafiltrate NO Dialysate
26 CVVH Sc = [Antibiotic] ultrafiltrate [Antibiotic] plasma
27 CVVH Cl CVVH(pre) = Qf x Sc x CF where CF = Qb Qb + Q pre
28 CVVHDF Continuous Veno-Venous HeamoDiaFiltration Replacement Fluid can be either Pre- Filter or Post Filter. Access (Pre- Filter) From Patient Kidney Filter Return (Post Filter) To Patient FLOW Semi-permeable Membrane FLOW Ultrafiltrate Dialysate
29 SLEDD as an alternative And then there is SLEDD Slow Low Efficiency Daily Dialysis, Extended Daily Dialysis A Hybrid of CRRT + IHD Minimal antibiotic clearance data published
30 Crit Care Med 2011;39: Nine original research articles plus a few case reports Roberts, Lipman. (Editorial) Crit Care Med 2011;39:602-3
31 Therapeutic Options of RRT Differ CVVH CVVHD CVVHDF SCUF SLEDD
32 Tables and equations
33 If you know 1. Membrane Pore Size 2. Drug Size 3. Sieving Coefficient Then it s easy!
34 If you know Convection 1. Membrane Pore Size Diffusion 2. Drug Size 3. Sieving Coefficient Protein binding Then Volume of it s distribution easy! Membrane characteristics
35 HOW DO WE DOSE AT MY HOSPITAL?
36 Roberts JA, Hope WW, Lipman J. Int J Antimicrob Agents 2010;35: Roberts JA et al. Int J Antimicrob Agents 2010;36:332-0
37 BEST WE HAVE Choi et al Crit Care Med 2009;37:
38 CRRT and MEROPENEM Jamal et al Crit Care Med 2014:42:
39 CRRT and PIPTAZO Jamal et al Crit Care Med 2014:42:
40 CRRT and VANC Jamal et al Crit Care Med 2014:42:
41 ONE WAY Choi et al Crit Care Med 2009;37:
42 Advantages Individualized CRRT MIC Takes PK/PD relationships into account Choi G et al. Crit Care Med 2009; 37: Choi G et al. Blood Purif 2010; 30:
43 Alternatively Choose a PK article that most closely resembles the form of CRRT you use Use their clearances see if it seems a reasonable estimate of your clearances Dose accordingly
44 RECENTLY ACCEPTED REVIEW Jamal JA, Mueller BA, Choi GYS, Lipman J, Roberts JA How can we ensure effective antibiotic dosing in critically ill patients receiving different types of renal replacement therapy? Diagnostic Microbiology and Infectious Disease
45 RECENTLY ACCEPTED REVIEW Jamal JA, Mueller BA, Choi GYS, Lipman J, Roberts JA How can we ensure effective antibiotic dosing in critically ill patients receiving different types of renal replacement therapy? Diagnostic Microbiology and Infectious Disease TABLE 1: Pharmacokinetic parameters of different class of antibiotics in critically ill patients receiving variable types of renal replacement therapy modalities
46 IMPORTANT BEDSIDE PRACTICAL POINT.. You may prescribe Continuous RRT. but is it continuous? How often do you come on morning ward round to here the kidney was off for xxx hours? How often do you do rounds to here Oh we are changing the filter Do you factor in for the down time?
47 IMPORTANT BEDSIDE PRACTICAL POINT.. What do you do when you want to cease RRT. We say leave the filter off for awhile to see if pt passes urine And often forget to change dose of drugs.. Do you factor in for the down time?
48 CRITICAL CARE Conclusions: This matched cohort study confirms an increase in Vd and a decrease in CL for meropenem in adult patients receiving ECMO. In patients receiving meropenem on ECMO, standard dosing does not always result in optimal drug concentrations because of the significant PK changes in the setting of critical illness, ECMO and RRT. Therapeutic drug monitoring where possible is recommended until robust dosing guidelines become available. Therapeutic drug monitoring
49 DEFINITION Therapeutic Drug Monitoring (TDM) refers to analysis and subsequent interpretation of drug concentrations in biological fluids
50 PLACE TDM should be used to maximise efficacy minimize toxicity To personalise dosing for high probability of therapeutic success, prevent development of resistance, provide low probability of toxicity
51 BETA-LACTAMS Safe drugs Large therapeutic range TDM should be used to maximise efficacy minimize toxicity
52 J Chromatogr B 2010;878:
53 CONCLUSION For various reasons therapeutic drug monitoring (TDM) of most antibiotics is difficult if not impossible. We have set up a TDM service for all our beta-lactam use and have (not surprisingly ) shown that in more than half of our ICU patients we are dose adjusting once receiving back a drug level!
54 THE END!
55
56 ONE WAY Choi et al Crit Care Med 2009;37:
57 Loading dose=desired concentration x Vd Calculate CRRT clearance based on mode of CRRT, formulae & published values Total clearance (Cl tot ) =calculated CRRT clearance+non-crrt clearance Time above threshold concentration Pharmacokinetic target? C max :MIC ratio C max :MIC & AUC 24 :MIC Calculate elimination rate = concentration x Cl tot Calculate half-life = x Vd / Cl tot Calculate target mean concentration = target AUC 24 /24 Maintenance infusion rate= elimination rate Calculate time to reach target trough concentration Repeat loading dose at calculated time Calculate dosing interval = Dose/(Cp x Cl tot ) Repeat loading dose at calculated dosing interval
58 Loading dose=desired concentration x Vd Loading dose=desired concentration x Vd (28 l) Desired concentration = 5 x MIC = 20 mg/l Calculate CRRT clearance based on mode of CRRT, formulae & published values Loading dose = 20 x mg Total clearance (Cl tot ) =calculated CRRT clearance+non-crrt clearance Time above threshold concentration Pharmacokinetic target? C max :MIC ratio C max :MIC & AUC 24 :MIC Calculate elimination rate = concentration x Cl tot Calculate half-life = x Vd / Cl tot Calculate target mean concentration = target AUC 24 /24 Maintenance infusion rate= elimination rate Calculate time to reach target trough concentration Repeat loading dose at calculated time Calculate dosing interval = Dose/(Cp x Cl tot ) Repeat loading dose at calculated dosing interval
59 Loading dose=desired concentration x Vd Calculate CRRT clearance based on mode of CRRT & published Sc or Sd values Cl CVVH (post) = Qf x Sc = 2450 x 0.95 = 2327 ml/h = 39 ml/min Calculate CRRT clearance based on mode of CRRT, formulae & published values Total clearance (Cl tot ) =calculated CRRT clearance+non-crrt clearance Time above threshold concentration Pharmacokinetic target? C max :MIC ratio C max :MIC & AUC 24 :MIC Calculate elimination rate = concentration x Cl tot Calculate half-life = x Vd / Cl tot Calculate target mean concentration = target AUC 24 /24 Maintenance infusion rate= elimination rate Calculate time to reach target trough concentration Repeat loading dose at calculated time Calculate dosing interval = Dose/(Cp x Cl tot ) Repeat loading dose at calculated dosing interval
60 Loading dose=desired concentration x Vd Calculate CRRT clearance based on mode of CRRT, formulae & published values Total clearance Total clearance (Cl tot (Cl ) =calculated tot ) CRRT clearance+non-crrt clearance clearance = ml/min = 0.1 l/min Time above threshold concentration Pharmacokinetic target? C max :MIC ratio C max :MIC & AUC 24 :MIC Calculate elimination rate = concentration x Cl tot Calculate half-life = x Vd / Cl tot Calculate target mean concentration = target AUC 24 /24 Maintenance infusion rate= elimination rate Calculate time to reach target trough concentration Repeat loading dose at calculated time Calculate dosing interval = Dose/(Cp x Cl tot ) Repeat loading dose at calculated dosing interval
61 Loading dose=desired concentration x Vd Calculate CRRT clearance based on mode of CRRT, formulae & published values Total clearance (Cl tot ) =calculated CRRT clearance+non-crrt clearance Time above threshold concentration Calculate elimination rate Pharmacokinetic target? C max :MIC ratio C max :MIC & AUC 24 :MIC = concentration x Cl tot = 20 x 0.1 = 2 mg/min Calculate elimination rate = concentration x Cl tot Calculate half-life = x Vd / Cl tot Calculate target mean concentration = target AUC 24 /24 Maintenance infusion rate= elimination rate Calculate time to reach target trough concentration Repeat loading dose at calculated time Calculate dosing interval = Dose/(Cp x Cl tot ) Repeat loading dose at calculated dosing interval
62 Loading dose=desired concentration x Vd Calculate CRRT clearance based on mode of CRRT, formulae & published values Total clearance (Cl tot ) =calculated CRRT clearance+non-crrt clearance Time above threshold concentration Pharmacokinetic target? C max :MIC ratio C max :MIC & AUC 24 :MIC Calculate elimination rate = concentration x Cl tot Calculate half-life = x Vd / Cl tot Calculate target mean concentration = target AUC 24 /24 Maintenance infusion rate = elimination rate = 2 mg/min Maintenance infusion rate= elimination rate Calculate time to reach target trough concentration Repeat loading dose at calculated time Calculate dosing interval = Dose/(Cp x Cl tot ) Repeat loading dose at calculated dosing interval
Practical issues - dosing on extracorporeal circuits
Practical issues - dosing on extracorporeal circuits Jason A Roberts B Pharm (Hons), PhD, FSHP Professor of Medicine and Pharmacy The University of Queensland, Australia Royal Brisbane and Women s Hospital,
More informationCRRT and Drug dosing. Karlee Johnston Lead Pharmacist Division of Critical Care ICU Education June 2017
CRRT and Drug dosing Karlee Johnston Lead Pharmacist Division of Critical Care ICU Education June 2017 This talk In scope CRRT modalities with regard to medicine Principles of drugs with regard to dialysis
More informationIs the package insert correct? PK considerations
Is the package insert correct? PK considerations Jason A Roberts B Pharm (Hons), PhD, FSHP Professor of Medicine and Pharmacy The University of Queensland, Australia Royal Brisbane and Women s Hospital,
More informationContinuous Renal Replacement Therapy. Gregory M. Susla, Pharm.D., F.C.C.M. Associate Director, Medical Information MedImmune, LLC Gaithersburg, MD
Continuous Renal Replacement Therapy Gregory M. Susla, Pharm.D., F.C.C.M. Associate Director, Medical Information MedImmune, LLC Gaithersburg, MD 1 Definition of Terms SCUF - Slow Continuous Ultrafiltration
More informationAUGMENTED RENAL CLEARANCE and its clinical implications. Professor Jeffrey Lipman
AUGMENTED RENAL CLEARANCE and its clinical implications Professor Jeffrey Lipman Department of Intensive Care Medicine Royal Brisbane Hospital University of Queensland Introduction Recommended dosages
More informationContinuous Renal Replacement Therapy
Continuous Renal Replacement Therapy Gregory M. Susla, Pharm.D., F.C.C.M. Associate Director, Medical Information MedImmune, LLC Gaithersburg, MD Definition of Terms SCUF - Slow Continuous Ultrafiltration
More information- SLED Sustained Low-Efficiency Dialysis
Continuous Renal Replacement Therapy Gregory M. Susla, Pharm.D., F.C.C.M. Associate Director, Medical Information MedImmune, LLC Gaithersburg, MD 1 Definition of Terms - SCUF - Slow Continuous Ultrafiltration
More informationPHARMACOKINETIC & PHARMACODYNAMIC OF ANTIBIOTICS
PHARMACOKINETIC & PHARMACODYNAMIC OF ANTIBIOTICS SITI HIR HURAIZAH MD TAHIR Bpharm (UKM), MSc (Clinical Microbiology) (UoN) CLINICAL PHARMACIST HOSPITAL MELAKA WHY STUDY PHARMACOKINETICS (PK) AND PHARMACODYNAMICS
More informationShould we be performing TDM in seriously ill patients with Gram negative infections?
Should we be performing TDM in seriously ill patients with Gram negative infections? Jason A Roberts B Pharm (Hons), PhD, FSHP Royal Brisbane and Women s Hospital, Australia. The University of Queensland,
More informationUNDERSTANDING THE CRRT MACHINE
UNDERSTANDING THE CRRT MACHINE Helen Dickie Renal Sister Critical Care Unit Guy s and St.Thomas NHS Foundation Trust 18.10.14 RRT options - IHD vs CRRT (1) Intermittent HaemoDialysis e.g. 4hrs daily or
More informationDrug dosing in patients with acute kidney injury
Drug dosing in patients with acute kidney injury They don t know what they are doing Jan Jan T. T. Kielstein Department of of Nephrology and and Hypertension Medical School School Hannover Drug dosing
More informationMedication Dosing in CRRT
Medication Dosing in CRRT Linda Awdishu, PharmD, MAS Associate Clinical Professor of Pharmacy and Medicine Learning Objectives 1. List the pharmacokinetic changes associated with AKI. 2. Determine the
More informationDrug Management in CRRT
Drug Management in CRRT Jeffrey Lipman, FCICM, MD Department of Intensive Care Medicine Royal Brisbane Hospital University of Queensland Bruce A. Mueller, PharmD, FCCP, FASN Clinical, Social & Administrative
More informationLessons from recent studies. João Gonçalves Pereira UCIP DALI
Lessons from recent studies João Gonçalves Pereira UCIP DALI 1 Patterns of Antimicrobial Activity Concentration C max Aminoglycosides Cmax/MIC>10 Metronidazol Area under the concentration curve Azithromycin
More informationManaging Acid Base and Electrolyte Disturbances with RRT
Managing Acid Base and Electrolyte Disturbances with RRT John R Prowle MA MSc MD MRCP FFICM Consultant in Intensive Care & Renal Medicine RRT for Regulation of Acid-base and Electrolyte Acid base load
More informationPhysiology of Blood Purification: Dialysis & Apheresis. Outline. Solute Removal Mechanisms in RRT
Physiology of Blood Purification: Dialysis & Apheresis Jordan M. Symons, MD University of Washington School of Medicine Seattle Children s Hospital Outline Physical principles of mass transfer Hemodialysis
More informationECMO & Renal Failure Epidemeology Renal failure & effect on out come
ECMO Induced Renal Issues Transient renal dysfunction Improvement in renal function ECMO & Renal Failure Epidemeology Renal failure & effect on out come With or Without RRT Renal replacement Therapy Utilizes
More informationDrug Use in Dialysis
(Last Updated: 08/22/2018) Created by: Socco, Samantha Drug Use in Dialysis Drambarean, B. (2017). Drug Use in Dialysis. Lecture presented at PHAR 503 Lecture in UIC College of Pharmacy, Chicago. DIALYSIS
More informationRenal Replacement Therapy in ICU. Dr. Sunil Sharma Senior Resident Dept of Pulmonary Medicine
Renal Replacement Therapy in ICU Dr. Sunil Sharma Senior Resident Dept of Pulmonary Medicine Introduction Need for RRT in patients with ARF is a common & increasing problem in ICUs Leading cause of ARF
More informationCRRT Fundamentals Pre- and Post- Test. AKI & CRRT Conference 2018
CRRT Fundamentals Pre- and Post- Test AKI & CRRT Conference 2018 Question 1 Which ONE of the following statements regarding solute clearance in CRRT is MOST correct? A. Convective and diffusive solute
More informationICU Volume 11 - Issue 3 - Autumn Series
ICU Volume 11 - Issue 3 - Autumn 2011 - Series Impact of Pharmacokinetics of Antibiotics in ICU Clinical Practice Introduction The efficacy of a drug is mainly dependent on its ability to achieve an effective
More informationContinuous renal replacement therapy. David Connor
Continuous renal replacement therapy David Connor Overview Classification of AKI Indications Principles Types of CRRT Controversies RIFL criteria Stage GFR Criteria Urine Output Criteria Risk Baseline
More informationPharmacokinetics pharmacodynamics issues relevant for the clinical use of betalactam antibiotics in critically ill patients
Veiga and Paiva Critical Care (2018) 22:233 https://doi.org/10.1186/s13054-018-2155-1 REVIEW Pharmacokinetics pharmacodynamics issues relevant for the clinical use of betalactam antibiotics in critically
More informationRENAL FAILURE IN ICU. Jo-Ann Vosloo Department Critical Care SBAH
RENAL FAILURE IN ICU Jo-Ann Vosloo Department Critical Care SBAH DEFINITION: RIFLE criteria Criteria for initiation of RRT Modes of RRT (options) CRRT = continuous renal replacement therapy SCUF : Ultra-filtration
More informationPediatric Continuous Renal Replacement Therapy
Pediatric Continuous Renal Replacement Therapy Farahnak Assadi Fatemeh Ghane Sharbaf Pediatric Continuous Renal Replacement Therapy Principles and Practice Farahnak Assadi, M.D. Professor Emeritus Department
More informationContinuous Infusion of Antibiotics In The ICU: What Is Proven? Professor of Medicine Vice-Chairman, Department of Medicine SUNY at Stony Brook
Continuous Infusion of Antibiotics In The ICU: What Is Proven? Michael S. Niederman, M.D. Chairman, Department of Medicine Winthrop-University Hospital Mineola, NY Professor of Medicine Vice-Chairman,
More informationDepartment of Clinical Pharmacy, University of Michigan College of Pharmacy, Pharmacy Faculty, Siam University, Bangkok, Thailand
1 2 Article Type: Guest Ed Mistakes We Make in Dialysis 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 We underdose antibiotics in patients on CRRT Alexander R. Shaw Weerachai Chaijamorn Bruce A. Mueller 1 Ann
More informationRenal Physiology Intro to CRRT Concepts. Catherine Jones September 2017
Renal Physiology Intro to CRRT Concepts Catherine Jones September 2017 Learning Outcomes To revise anatomy & physiology of kidney in health: To understand basic principles of continuous renal replacement
More informationMODALITIES of Renal Replacement Therapy in AKI
MODALITIES of Renal Replacement Therapy in AKI Jorge Cerdá, MD, MS, FACP, FASN Clinical Professor of Medicine Albany Medical College Albany, NY, USA cerdaj@mail.amc.edu In AKI, RRT is a multidimensional
More informationThe general Concepts of Pharmacokinetics
The general Concepts of Pharmacokinetics What is this jargon? Is it useful? C max, clearance, Vd, half-life, AUC, bioavailability, protein binding F. Van Bambeke, E. Ampe, P.M. Tulkens (Université catholique
More informationegfr 34 ml/min egfr 130 ml/min Am J Kidney Dis 2002;39(suppl 1):S17-S31
Update on Renal Therapeutics Caroline Ashley Lead Pharmacist Renal Services UCL Centre for Nephrology, Royal Free Hospital, London Kongress für Arzneimittelinformation January 2011 What are we going to
More informationCRRT Fundamentals Pre-Test. AKI & CRRT 2017 Practice Based Learning in CRRT
CRRT Fundamentals Pre-Test AKI & CRRT 2017 Practice Based Learning in CRRT Question 1 A 72-year-old man with HTN presents to the ED with slurred speech, headache and weakness after falling at home. He
More informationCRRT: The Technical Questions Modality & Dose. Ashita J. Tolwani, MD, MSc University of Alabama at Birmingham 2018
CRRT: The Technical Questions Modality & Dose Ashita J. Tolwani, MD, MSc University of Alabama at Birmingham 2018 Case A 24YOM with HTN and OSA presents with acute pancreatitis. Despite aggressive fluid
More informationTiming, Dosing and Selecting of modality of RRT for AKI - the ERBP position statement
Timing, Dosing and Selecting of modality of RRT for AKI - the ERBP position statement Prof. Dr. Achim Jörres Dept. of Nephrology and Medical Intensive Care Charité University Hospital Campus Virchow Klinikum
More informationDialysis Dose Prescription and Delivery. William Clark, M.D. Claudio Ronco, M.D. Rolando Claure-Del Granado, M.D. CRRT Conference February 15, 2012
Dialysis Dose Prescription and Delivery William Clark, M.D. Claudio Ronco, M.D. Rolando Claure-Del Granado, M.D. CRRT Conference February 15, 2012 Dose in RRT: Key concepts Dose definition Quantifying
More informationPHA Second Exam. Fall On my honor, I have neither given nor received unauthorized aid in doing this assignment.
PHA 5127 Second Exam Fall 2011 On my honor, I have neither given nor received unauthorized aid in doing this assignment. Name Put all answers on the bubble sheet TOTAL /200 pts 1 Question Set I (True or
More informationRecent advances in CRRT
Recent advances in CRRT JAE IL SHIN, M.D., Ph.D. Department of Pediatrics, Severance Children s Hospital, Yonsei University College of Medicine, Seoul, Korea Pediatric AKI epidemiology and demographics
More informationPHA Spring First Exam. 8 Aminoglycosides (5 points)
PHA 5128 Spring 2012 First Exam 1 Aminoglycosides (5 points) 2 Aminoglycosides (10 points) 3 Basic Principles (5 points) 4 Basic Principles (5 points) 5 Bioavailability (5 points) 6 Vancomycin (5 points)
More informationSHC Vancomycin Dosing Guide
SHC Vancomycin Dosing Guide A: Initial dosing considerations B. Pharmacodynamic Targets: goal AUC and troughs C. Loading dose D: Initial Vancomycin Maintenance Dosing and Serum Concentration Monitoring
More informationCRRT for the Experience User 1. Claudio Ronco, M.D. David Selewski, M.D. Rolando Claure-Del Granado, M.D. AKI & CRRT Conference March, 2018
CRRT for the Experience User 1 Claudio Ronco, M.D. David Selewski, M.D. Rolando Claure-Del Granado, M.D. AKI & CRRT Conference March, 2018 Disclosures I have no actual or potential conflict of interest
More informationKaren Mak R.N. (Team Leader) Renal Dialysis Centre Hong Kong Sanatorium & Hospital
Karen Mak R.N. (Team Leader) Renal Dialysis Centre Hong Kong Sanatorium & Hospital - Renal Transplantation - Peritoneal Dialysis - Extracorporeal Therapy Extracorporeal Therapy It is the procedure in
More informationTitle. Author(s)Hayakawa, Mineji; Fujita, Itaru; Iseki, Ken; Gando, CitationASAIO Journal, 55(3): Issue Date Doc URL. Rights.
Title The Administration of Ciprofloxacin During Continuou Author(s)Hayakawa, Mineji; Fujita, Itaru; Iseki, Ken; Gando, CitationASAIO Journal, 55(3): 243-245 Issue Date 2009-05 Doc URL http://hdl.handle.net/2115/43035
More informationDrug Dosing in Renal Insufficiency. Coralie Therese D. Dimacali, MD College of Medicine University of the Philippines Manila
Drug Dosing in Renal Insufficiency Coralie Therese D. Dimacali, MD College of Medicine University of the Philippines Manila Declaration of Conflict of Interest For today s lecture on Drug Dosing in Renal
More informationLa farmacologia in aiuto
Ferrara, 15 giugno 2018 La farmacologia in aiuto Pier Giorgio Cojutti, Federico Pea Istituto di Farmacologia Clinica Azienda Sanitaria Universitaria Integrata di Udine Therapeutic Drug Monitoring of Beta-Lactams
More informationZIN EN ONZIN VAN ANTIBIOTICASPIEGELS BIJ NEONATEN
ZIN EN ONZIN VAN ANTIBIOTICASPIEGELS BIJ NEONATEN Anne Smits Fellow neonatologie UZ Leuven Use of antibiotics in neonates 50 European hospitals 23 non-european hospitals Countries n = 14 n = 9 Pediatric
More informationCan We Achieve Precision Solute Control with CRRT?
Can We Achieve Precision Solute Control with CRRT? Claudio Ronco, M.D. David Selewski, M.D. Rolando Claure-Del Granado, M.D. AKI & CRRT Conference February, 2019 Disclosures I have no actual or potential
More informationRationale for renal replacement therapy in ICU: indications, approaches and outcomes. Richard Beale
Rationale for renal replacement therapy in ICU: indications, approaches and outcomes Richard Beale RIFLE classification (ADQI group) 2004 Outcome AKIN classification Definition: Abrupt (within 48 hrs)
More informationTDM of Aminoglycoside Antibiotics
TDM Lecture 3 5 th Stage TDM of Aminoglycoside Antibiotics The aminoglycoside antibiotics are widely used for the treatment of gram-negative infections, often in combination with a β-lactam antibiotic
More informationRenal Disease and PK/PD. Anjay Rastogi MD PhD Division of Nephrology
Renal Disease and PK/PD Anjay Rastogi MD PhD Division of Nephrology Drugs and Kidneys Kidney is one of the major organ of drug elimination from the human body Renal disease and dialysis alters the pharmacokinetics
More informationAntibiotic Dosing in Critically Ill Patients. Receiving Prolonged Intermittent. Renal Replacement Therapy
Antibiotic Dosing in Critically Ill Patients Receiving Prolonged Intermittent Renal Replacement Therapy Compendium of publications authored by: Bruce A. Mueller, et al. Department of Clinical Pharmacy
More informationRenal replacement therapy in acute kidney injury
6 February 2009 CONTENTS Renal replacement therapy in acute kidney injury S Jithoo Commentator: CL Quantock Moderator: LW Drummond INTRODUCTION... 3 WHAT IS RENAL REPLACEMENT THERAPY?... 3 MODES OF RENAL
More informationprophylaxis for endocarditis in patients at high risk prophylaxis for major surgical procedures
1 Glycopeptides appropriate uses serious infections due to beta-lactam- resistant gram-positive microorganisms infections due to gram-positive microorganisms in patients with serious allergy to beta-lactam
More informationCRRT Fundamentals Pre- and Post- Test Answers. AKI & CRRT 2017 Practice Based Learning in CRRT
CRRT Fundamentals Pre- and Post- Test Answers AKI & CRRT 2017 Practice Based Learning in CRRT Question 1 A 72-year-old man with HTN presents to the ED with slurred speech, headache and weakness after falling
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,900 116,000 120M Open access books available International authors and editors Downloads Our
More informationUncommon Indications for Extracorporeal Toxin Removal (ECTR) Robert S. Hoffman, MD Director, Division of Medical Toxicology NYU School of Medicine
Uncommon Indications for Extracorporeal Toxin Removal (ECTR) Robert S. Hoffman, MD Director, Division of Medical Toxicology NYU School of Medicine Disclosure I have no financial or academic conflicts of
More informationUAB CRRT Primer Ashita Tolwani, MD, MSc University of Alabama at Birmingham
UAB CRRT Primer 2018 Ashita Tolwani, MD, MSc University of Alabama at Birmingham 1 CRRT Primer Continuous Renal Replacement Therapy (CRRT) is a "catch all" term used for all the continuous modes of renal
More informationAcute Kidney Injury- What Is It and How Do I Treat It?
Acute Kidney Injury- What Is It and How Do I Treat It? Jayant Kumar, MD Renal Medicine Assoc., Albuquerque, NM Incidence of ARF in ICU Causes of ARF Non -ICU ICU 1 KDIGO criteria for AKI Increase in serum
More informationRenal replacement therapy in Pediatric Acute Kidney Injury
Renal replacement therapy in Pediatric Acute Kidney Injury ASCIM 2014 Dr Adrian Plunkett Consultant Paediatric Intensivist Birmingham Children s Hospital, UK Aims of the presentation Important topic: AKI
More informationPK/PD degli antibiotici utilizzati nella sepsi
PK/PD degli antibiotici utilizzati nella sepsi Dario Cattaneo, U.O. Farmacologia Clinica ASST Fatebenefratelli Sacco, Milano Bergamo, città alta Variability of antibiotic concentrations in critically ill
More informationContinuous Renal Replacement Therapy in PICU: explanation/definitions/rationale/background
Continuous Renal Replacement Therapy in PICU: explanation/definitions/rationale/background Index: 1. Introduction Pg. 1 1.1 Definitions Pg. 2 1.2 Renal replacement therapy principles Pg. 2 2. Continuous
More informationPHA Second Exam. Fall On my honor, I have neither given nor received unauthorized aid in doing this assignment.
PHA 5127 Second Exam Fall 2012 On my honor, I have neither given nor received unauthorized aid in doing this assignment. Name Put all answers on the bubble sheet TOTAL /150 pts 1 Question Set I (True or
More informationCRRT. ICU Fellowship Training Radboudumc
CRRT ICU Fellowship Training Radboudumc Timing RRT Consider the following: Underlying cause and reversibility. Rapid improvement unlikely with high dose vasopressors and continuous exposure to other risk
More informationEXTRACORPOREAL TECHNIQUES IN MODS: An Update :Techniques For Organ Support Where Are We In 2013? Prof Patrick Honoré,MD, PhD, Intensivist-Nephrologist
EXTRACORPOREAL TECHNIQUES IN MODS: An Update :Techniques For Organ Support Where Are We In 2013? 1.-CRRT : A «Lego» Module? 4.-Antibiotic Adaptation During Low Dose CRRT? 2.- CRRT + ECMO: What to do? 5.-
More informationAcute Kidney Injury (AKI) How Wise is Early Dialysis in Critically Ill Patients? Modalities of Dialysis
Acute Kidney Injury (AKI) How Wise is Early Dialysis in Critically Ill Patients? A common condition in ICU patients Associated with high mortality and morbidity Renal Replacement Therapy (RRT) is the cornerstone
More informationCommentary Recent evolution of renal replacement therapy in the critically ill patient Claudio Ronco
Commentary Recent evolution of renal replacement therapy in the critically ill patient Claudio Ronco Department of Nephrology, St Bortolo Hospital, Vicenza, Italy Corresponding author: Claudio Ronco, cronco@goldnet.it
More informationPD In Acute Kidney Injury. February 7 th -9 th, 2013
PD In Acute Kidney Injury February 7 th -9 th, 2013 Objectives PD as a viable initial therapy PD in AKI PD versus dhd PD versus CVVHD Why not PD first PD for AKI Early days (1970 s) PD was the option of
More informationVancomycin: Class: Antibiotic.
Vancomycin: Class: Antibiotic. Indications: Treatment of patients with infections caused by staphylococcal species and streptococcal Species. Available dosage form in the hospital: 1G VIAL, 500MG VIAL.
More informationAquarius Study Day Adult Pre-Reading Study Pack
Aquarius Study Day Adult Pre-Reading Study Pack An Introduction to CRRT (Continuous Renal Replacement Therapy) Name Date. Hospital.. Please take the opportunity to read this booklet prior to attending
More informationContinuous Renal Replacement Therapy Based Dose Adjustments - Adult - Inpatient Clinical Practice Guideline
Continuous Renal Replacement Therapy Based Dose Adjustments - Adult - Inpatient Clinical Practice Guideline Note: Active Table of Contents Click to follow link Table of Contents EXECUTIVE SUMMARY... 3
More informationAMINOGLYCOSIDES TDM D O N E B Y
AMINOGLYCOSIDES TDM DONE BY: SARA ALARFAJ 2014 OUTLINE Introduction about Aminoglycosides. Spectrum/uses. TDM Aminoglycosides TDM Pharmacodynamics Pharmacokinetics. Dosing in AG. Sampeling time and Monitoring.
More informationTherapeutic drug monitoring of β-lactams
CORATA Belgique Reims 1-2/10/2014 Therapeutic drug monitoring of β-lactams Frédéric Cotton Clinical Chemistry Erasme Hospital Faculty of Pharmacy ULB TDM of β-lactams β-lactams pharmacokinetics pharmacodynamics
More informationPICANet Custom Audit Definitions Renal Dataset
PICANet Custom Audit s Renal Dataset Version 1.0 (July 2016) PICANet Renal Custom Audit Data s Manual Version 1.0 July 2016 Renal Dataset Contents PICANet Custom Audit s... 1 Renal Dataset... 1 Version
More informationASN Board Review: Acute Renal Replacement Therapies
ASN Board Review: Acute Renal Replacement Therapies Ashita Tolwani, M.D., M.Sc. University of Alabama at Birmingham 2014 Key issues for boards: RRT for AKI When should therapy be initiated? What are the
More informationDecision making in acute dialysis
Decision making in acute dialysis Geoffrey Bihl MB.BCh M.MED FCP(SA) Nephrologist and Director Winelands Kidney and Dialysis Centre Somerset West South Africa Important questions in AKI What is the cause?
More informationPharmacodynamic indices in targeting therapy of critical infections
Pharmacodynamic indices in targeting therapy of critical infections P.M. Tulkens Cellular and Molecular Pharmacology, Catholic University of Louvain, Brussels, Belgium & International Society of Anti-infective
More informationSolute clearances during continuous venovenous haemofiltration at various ultrafiltration flow rates using Multiflow-100 and HF1000 filters
Nephrol Dial Transplant (2003) 18: 961 966 DOI: 10.1093/ndt/gfg055 Original Article Solute clearances during continuous venovenous haemofiltration at various ultrafiltration flow rates using Multiflow-100
More informationPHA Final Exam. Fall On my honor, I have neither given nor received unauthorized aid in doing this assignment.
PHA 5127 Final Exam Fall 2010 On my honor, I have neither given nor received unauthorized aid in doing this assignment. Name Please transfer the answers onto the bubble sheet. The question number refers
More informationOptimizing antifungal dosing regimens. Joseph Meletiadis, PhD, FECMM Assistant Professor of Microbiology
ATHENA 2017 International Conference November 28 30, 2017 Optimizing antifungal dosing regimens Joseph Meletiadis, PhD, FECMM Assistant Professor of Microbiology Clinical Microbiology Laboratory, «Attikon»
More informationPICANet Renal Dataset supplement Renal Daily Interventions
PICANet Renal Dataset supplement Renal Daily Interventions Version 2.0 (March 2017) 1 Contents PICANet Renal Dataset supplement... 1 Renal Daily Interventions... 1 Version 2.0 (March 2017)... 1 Recording
More informationFull title of guideline INTRAVENOUS VANCOMYCIN PRESCRIBING AND MONITORING GUIDELINE FOR ADULT PATIENTS. control
Full title of guideline Author: Contact Name and Job Title Division and specialty Scope Explicit definition of patient group to which it applies (e.g. inclusion and exclusion criteria, diagnosis) Changes
More information7/17/2017 FSHP 2017 ANNUAL MEETING. Medication Considerations for the Adult/Pediatric ICU Patient Receiving Renal Replacement Therapy
FSHP Medication Considerations for the Adult/Pediatric ICU Patient Receiving Renal Replacement Therapy Disclosure I do not have (nor does any immediate family member have) a vested interest in or affiliation
More informationPICANet Custom Audit Definitions Renal Dataset
PICANet Custom Audit s Renal Dataset Version 2.0 (March 2017) PICANet Renal Custom Audit Data s Manual Version 2.0 29/03/2017 Renal Dataset Contents PICANet Custom Audit s... 1 Renal Dataset... 1 Version
More informationCan We Achieve Precision Solute Control with CRRT?
Can We Achieve Precision Solute Control with CRRT? Claudio Ronco, M.D. David Selewski, M.D. Rolando Claure-Del Granado, M.D. AKI & CRRT Conference February, 2019 Disclosures I have no actual or potential
More informationBasic Concepts of TDM
TDM Lecture 1 5 th stage What is TDM? Basic Concepts of TDM Therapeutic drug monitoring (TDM) is a branch of clinical pharmacology that specializes in the measurement of medication concentrations in blood.
More informationThe Physiology of Peritoneal Dialysis As Related To Drug Removal
The Physiology of Peritoneal Dialysis As Related To Drug Removal Thomas A. Golper, MD, FACP, FASN Vanderbilt University Medical Center Nashville, TN thomas.golper@vanderbilt.edu Clearance By Dialysis Clearance
More informationPHA 5128 Final Exam Spring 2004 Version A. On my honor, I have neither given nor received unauthorized aid in doing this assignment.
PHA 5128 Final Exam Spring 2004 Version A On my honor, I have neither given nor received unauthorized aid in doing this assignment. Name There are 18 questions. Total /120 pts Final 2004 1 1. T.P., a 66-year-old,
More informationCRRT Interactive Hyperkalemia Cases AKI & CRRT conference 2018
CRRT Interactive Hyperkalemia Cases AKI & CRRT conference 2018 Case 1 Potassium Clearance A 70 kg male is placed on CVVH with a total ultrafiltration rate (effluent rate) of 20 ml/kg/hr. The Blood Flow
More informationCRRT Interactive Hyperkalemia Cases AKI & CRRT conference 2018
CRRT Interactive Hyperkalemia Cases AKI & CRRT conference 2018 Case 1 Potassium Clearance A 70 kg male is placed on CVVH with a total ultrafiltration rate (effluent rate) of 20 ml/kg/hr. The Blood Flow
More informationDisclosures. Efficacy of the drug. Optimizing Dosing Based on PKPD- An overview. Dose Finding - The Past
Disclosures Optimizing Dosing Based on PKPD- An overview Johan W. Mouton MD PhD FIDSA FAAM Professor pharmacokinetics and pharmacodynamics Research grants advisory boards speaker This Patient Needs Antibiotics.
More informationNew method of blood purification (Recycle Filtration System)
Tokai J Exp Clin Med., Vol. 33, No. 3, pp. 124-129, 2008 New method of blood purification (Recycle Filtration System) Hajime SUZUKI 1), Miho HIDA 1), Makoto KITAMURA 1), Shin-ichi TANAKA 2), Takayo MIYAKOGAWA
More informationWho? Dialysis for Acute Renal Failure: Who, What, How, and When? Kathleen D. Liu, MD, PhD, MAS June 2011
Dialysis for Acute Renal Failure: Who, What, How, and When? Kathleen D. Liu, MD, PhD, MAS June 2011 Dorre Nicholau MD PhD Clinical Professor Department of Anesthesia and Perioperative Care University of
More informationCystatin C: A New Approach to Improve Medication Dosing
Cystatin C: A New Approach to Improve Medication Dosing Erin Frazee Barreto, PharmD, MSc, FCCM Assistant Professor of Pharmacy and Medicine Kern Scholar, Center for the Science of Health Care Delivery
More informationContinuous renal replacement therapy Gulzar Salman Amlani Aga Khan University, School of Nursing, Karachi.
Special Communication Continuous renal replacement therapy Gulzar Salman Amlani Aga Khan University, School of Nursing, Karachi. Abstract Acute renal failure refers to sudden deterioration in biochemical
More informationhigher dose with progress in technical equipment. Continuous Dialysis: Dose and Antikoagulation. prescribed and delivered
1 2 Continuous Dialysis: Dose and Antikoagulation higher dose with progress in technical equipment Comparison of pump-driven and spontaneous continuous haemofiltration in postoperative acute renal failure.
More informationComparing Methods for Once Daily Tobramycin Exposure Predictions in Children with Cystic Fibrosis
Comparing Methods for Once Daily Tobramycin Exposure Predictions in Children with Cystic Fibrosis Stefanie HENNIG, Franziska STILLER, Beverly TEO, Christine STAATZ, Brisbane Cystic fibrosis (CF) & Once
More informationNurse-Pharmacist Collaboration in the Delivery of Continuous Renal Replacement Therapy
Cedarville University DigitalCommons@Cedarville Pharmacy Faculty Presentations School of Pharmacy 2-23-2012 Nurse-Pharmacist Collaboration in the Delivery of Continuous Renal Replacement Therapy Jeb Ballentine
More informationPHA5128 Dose Optimization II Case Study I Spring 2013
Silsamicin is an investigational compound being evaluated for its antimicrobial effect. The route of administration for this drug is via intravenous bolus. Approximately 99.9% of this drug is eliminated
More informationPHA5128 Dose Optimization II Case Study 3 Spring 2013
Use the vancomycin dosing nomogram table below: A female patient, 57 years of age, 5 6 in height and 100 in weight had an infection requiring vancomycin treatment. Her serum creatinine was 0.8 mg/d. What
More informationOperation-Fluids-Electrolytes-Acid Base COMPLICATIONS OF DIALYSIS 2
Operation-Fluids-Electrolytes-Acid Base COMPLICATIONS OF DIALYSIS 2 Maureen Craig, RN, MSN, CNN University of California Davis Medical Center Sacramento, California macraig@ucdavis.edu Hospital Details
More informationTechnical aspects of RRT in AKI: access, anticoagulation, drug dosage and nutrition. Marlies Ostermann
Technical aspects of RRT in AKI: access, anticoagulation, drug dosage and nutrition Marlies Ostermann AKI guideline Chapter 3: Nutrition Chapter 5.3: Anticoagulation Chapter 5.4: Vascular access for RRT
More information