Modelling and Simulation Group, School of Pharmacy For Clinical Pharmacist Clinical Pharmacology.

Modelling and Simulation Group, School of Pharmacy

For Clinical Pharmacist

Clinical Pharmacology


Abbreviation Spoiler Alert

• PK = Pharmacokinetics

• PD = Pharmacodynamics

• PG = Pharmacogenomics

• PO = Per Os

• PM = Post Meridiem

• PC = Personal Computer

BARRY = Clinical Pharmacology


Educational Objectives

• By the end of this session you should be able to: – Feel less daunted by Barry – Understand how Barry complements evidence

based practice– Provide rationale recommendations for

aminoglycoside monitoring


OVERVIEW

• Who is Barry?

• What can Barry do for me?

• What does Barry want from me?

• How do I get the most out of Barry


Barry as an equation

BARRY =

DISEASE PROGRESS

+

DRUG ACTION


Disease progression


Drug Action


Concentration Time Profiles following administration of IV paracetamol to neonates

2011, Anderson and Holford et al.


OVERVIEW

• Who is Barry?





What can Barry Do for me

• Understanding Barry can make you a better clinical pharmacist through improving evidence based practice.

www.homeopathyworldcommunity.com/


Clinical Pharmacy

Sufficient Outcome for a patient

=

(Drug Action/Blah)Concordance

Warning Blah may contain traces of actual evidence, dosage

regimen,legislation, pharmacoeconomics, local policy, personal

preference, sales representative influence, health beliefs of the patient,

nocebo/placebo effect, stock availability, etc)


OVERVIEW

• Who is Barry?





Starting a relationship with Barry

• PK– First Order Kinetics– AUC– Clearance– Half Life


First Order Kinetics



MDR = CPave,ss X Cl


• PD

Chapter 8. Principles of Pharmacokinetics and PharmacodynamicsC. Lindsay DeVane, Pharm.D.

DOI: 10.1176/appi.books.9781585623860.408715


OVERVIEW

• Who is Barry?





TDM VS TCI


• Once daily dosing – from AMH

“Methods for monitoring drug concentration include graphical, trough plasma concentration and target AUC (area under the plasma concentration – time curve) methods. Not all are valid for use in renal impairment.

Although no method is proven to be clinically superior, the current preferred, but most complex, method is based on target AUC (can be used in renal impairment). It requires 2 samples: collect the first about 30 minutes after completing the infusion/injection and the second 6–14 hours later. The estimated 24-hour AUC is generally calculated using a computer program, eg the one available from TCIWorks at www.tciworks.info.”


What Does QHealth have to Say


AMINOGLYCOSIDE MONITORING

• Trough Concentrations

• 6-14 Hour Nomogram

• Target AUC– Bayesian Forecasting



Bayesian Forecasting

Disclamer regarding TCI works



• You (as the junior doctor) are told by your consultant to write up gentamicin for Beryl. You haven’t met Beryl but you have seen that her sputum sample is positive for pseudomonas.

• What would you do next.


Questions for Cases

• Later that day you are ask to provide advice regarding monitoring for gentamicin in a woman about to have a caesarean birth.

• What would you ask and recommend?


• 5 days later Beryl from case 1 has a blood sample taken at 8:50pm, it is sent to the lab for assay. The next morning at 10:30 on the ward round the doctor reviews the result (1mg/L) and rings the pharmacist for advice.

• What do you do?


• A further 3 days pass and Beryl is looking better. The doctors want your fantastic and friendly pharmacist advice regarding monitoring.

• What do you say?

Modelling and Simulation Group, School of Pharmacy For Clinical Pharmacist Clinical Pharmacology.

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