39 pasko pcrrt drug dosing

Drug Dosing in PCRRT Deb Pasko, Pharm.D Pharmacy Clinical Specialist, PICU University of Michigan Health System

CRRT Solute Removal ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Diffusive Therapies

Joy MS, Matzke GR, Frye RF, Palevsky PM. AJKD 1998;31:1019-27 .

RRT Drug Removal Mechanisms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Vancomycin overdose ,[object Object],[object Object],[object Object]

Hemodialyzer differences: Are they important in CVVHD? ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Convective Therapies (Hemofiltration)

Doses Derived Via Sieving Coefficient ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Sieving Coefficient & Protein Binding 0.10 0.22 Valproic Acid 0.90 0.80 Vancomycin 0.85 0.78 Ranitidine 0.50 0.68 Penicillin 0.80 0.84 Metronidazole 0.80 0.78 Imipenem 0.95 0.93 Amikacin Free Fraction Reported SC Drug

Drug Dosing recommendations based on Sieving Coefficient (SC) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Non-renal clearance rates of selected drugs in patients with normal renal function and ESRD

CRRT Challenges: Drug Dosing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

CRRT Challenges: Drug Dosing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pediatric CrCl ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Calculating Total Clearance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Adjusting doses based on Cl ,[object Object],[object Object],[object Object],[object Object],[object Object]

What drugs do we care about? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Case ,[object Object],[object Object],[object Object],[object Object],[object Object]

Case con’t ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

So what drugs need adjustment? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Linezolid Clearance During CVVHDF ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Linezolid Calculations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Linezolid Results ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Gentamicin pharmacokinetics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Gent kinetics con’t ,[object Object],[object Object],[object Object]

Gent kinetics con’t ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Gent kinetics FINAL ,[object Object]

Phenobarbital case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Phenobarbital case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Phenobarbital case 25.9 Post-hemodiafilter 11.4 Effluent 26.2 Pre-hemodiafilter 24.7 Post-oxygenator 26.5 Pre-oxygenator Concentration (mg/L) Site

Drug dosing problems in high volume hemofiltration ,[object Object],[object Object],[object Object],[object Object],[object Object]

Phenobarb case final ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Mueller BA, Pasko DA. Artif Organs 2003;27:808-14.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],IV drug administration: Drug removed as it is infused

Drug Prescribing in Renal Failure edited by George Aronoff et al ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Strength of Evidence ,[object Object],[object Object],[object Object],[object Object],[object Object],58 drugs are A->C

D. “Known drug characteristics“ ,[object Object],[object Object],[object Object],[object Object],[object Object]

When in doubt, start here… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Future research needed ,[object Object],[object Object],[object Object]

CRRT Dosing should not be confusing!

39 pasko pcrrt drug dosing

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39 pasko pcrrt drug dosing