Here is what I learned at the talk about Vfend last Wed at Brick Oven. Other pharmacists in attendance were Jeff, Kerry, Ann, and Doug. If you were there please feel free to add to this!
If you have a catheter in you are at risk for fungal infections. Also, if you have a TPN or are immunocompromised.
Candida is the most common fungal infection but now there are many different strains.
If you start the antifungals early you decrease the mortality rate drastically....so it is good to do prophylaxis b/c it can take a few days for the cultures to come back...then you can just dc the antifungal if you don't need it. It is best to start it w/in 12-24 hrs.
Vfend has ALOT of drug interactions. Carbamazepine, phenytoin, rifampin....plus several others I can't remember. So, that is something we can watch out for.
Vfend has EXCELLENT oral bioavailability so if they have a working gut no need for IV.
Vfend works better than Diflucan b/c it works on 2 different pathways and Diflucan just works on one.
If it is an uncomplicated fungal infection use Diflucan b/c it is cheaper.
Other tidbits:
Vancomycin doesn't reach high levels in the lungs so if you have MRSA in the lungs use Zyvox. Zyvox reaches concentrations in the lungs 5-6 x that of vanco.
A common mistake in dosing Vanco is to increase the dose instead of decreasing the frequency. You are not concerned about high peaks but rather a consistent trough of 15-20. So, if it is 1 G q12h and you get a low trough do q8h.
There is no need to use Zosyn for community acquired pneumonia.
He talked about continuous infusion antibiotics, such as Zosyn, and how studies have said it works better but it isn't catching on yet.
Tuesday, September 29, 2009
Saturday, September 12, 2009
Thursday, September 10, 2009
OMNICELL
I learned something new today. Omnicell will not accept 4 digits past a decimal point. For example when entering levothyroxine 0.075mg 1/2 tab bid (0.0375mg) it will cross to clinicomp, but it won't be anywhere on the omnicell screen. So, after taking 6 hours to figure this out, we ended up entering the dose in mcg...
Tuesday, September 8, 2009
Pregnancy & H1N1
More on H1N1 from your H1N1 specialist:
If you look up the pregnancy risk factor for both Tamiflu and Relenza you will find them both to be a risk factor C. However, the CDC does recommend treatment and prophylaxis in pregnant women. The flu seems to be more severe in pregnant women than in non-pregnant individuals and not treating has been linked to increased maternal mortality.
The manufacturers have based their risk rating on animal studies that have shown minor skeletal deformities, however no adverse effects have occurred in humans (or their fetuses) who have taken either antiviral. Also, and an in vitro study of a human placenta found that the active metabolite in Tamiflu does not cross the placenta.
Interestingly enough, Tamiflu is the drug of choice for the TREATMENT of influenza in pregnancy. This is because it is systemically absorbed. (I know that sounds backwards, but it must provide better protection for the infant) However, Relenza is the drug of choice for PROPHYLAXIS in pregnancy. This is because it is not systemically absorbed.
If you look up the pregnancy risk factor for both Tamiflu and Relenza you will find them both to be a risk factor C. However, the CDC does recommend treatment and prophylaxis in pregnant women. The flu seems to be more severe in pregnant women than in non-pregnant individuals and not treating has been linked to increased maternal mortality.
The manufacturers have based their risk rating on animal studies that have shown minor skeletal deformities, however no adverse effects have occurred in humans (or their fetuses) who have taken either antiviral. Also, and an in vitro study of a human placenta found that the active metabolite in Tamiflu does not cross the placenta.
Interestingly enough, Tamiflu is the drug of choice for the TREATMENT of influenza in pregnancy. This is because it is systemically absorbed. (I know that sounds backwards, but it must provide better protection for the infant) However, Relenza is the drug of choice for PROPHYLAXIS in pregnancy. This is because it is not systemically absorbed.
Sunday, September 6, 2009
Fun Facts From Rotations
Here are some things I learned on my rotation this week.
We had a gentlemen with a Hb=17.9 The range for men is 13.8 to 17.2
Polycythemia is the condition and in this case, it is smoker's polycythemia. There are multiple forms. Primary is of unknown cause. Secondary, has a known cause. Known causes include, COPD, carbon monoxide exposure (long-term like smoking), tumor of the kidney. In this patient case, the carbon monoxide from smoking attachs to the Hb allowing less oxygen transport to the tissue causing hypoxia at the tissue. This signals the body to increase erythropoietin production from the kidney, causing an increase in RBC production from the bone marrow. In COPD patients, inadequate oxygen exchange at the alveoli causes hypoxia at the tissue resulting in the same upregulation of erythropoietin production. Tumors in the kidney or malfuction in the bone marrow may also lead to polycythemia but have different etiologies.
Adcirca (Tadalafil, aka Cialis) was recently approved for treatment of pulmonary arterial hypertension at 40mg po Daily. Revatio (Sildenafil) is also used for treatment of PAH.
Sodium bicarbonate drips are used as renal protectants for patients undergoing procedures requiring a contrast dye. I knew about acetylcysteine, but not sodium bicarb.
Most importantly: If you drop a stent on the floor during an angioplasty, you lose $3000 and hopefully not your job.
We had a gentlemen with a Hb=17.9 The range for men is 13.8 to 17.2
Polycythemia is the condition and in this case, it is smoker's polycythemia. There are multiple forms. Primary is of unknown cause. Secondary, has a known cause. Known causes include, COPD, carbon monoxide exposure (long-term like smoking), tumor of the kidney. In this patient case, the carbon monoxide from smoking attachs to the Hb allowing less oxygen transport to the tissue causing hypoxia at the tissue. This signals the body to increase erythropoietin production from the kidney, causing an increase in RBC production from the bone marrow. In COPD patients, inadequate oxygen exchange at the alveoli causes hypoxia at the tissue resulting in the same upregulation of erythropoietin production. Tumors in the kidney or malfuction in the bone marrow may also lead to polycythemia but have different etiologies.
Adcirca (Tadalafil, aka Cialis) was recently approved for treatment of pulmonary arterial hypertension at 40mg po Daily. Revatio (Sildenafil) is also used for treatment of PAH.
Sodium bicarbonate drips are used as renal protectants for patients undergoing procedures requiring a contrast dye. I knew about acetylcysteine, but not sodium bicarb.
Most importantly: If you drop a stent on the floor during an angioplasty, you lose $3000 and hopefully not your job.
Saturday, September 5, 2009
aleplase equivalent to urokinase
Had fun with Dr. Misery tonight. He needed to "uncork" a cerebral shunt with a lytic. Had wanted 25,000 units of Urokinase. Us old folks have used it but it hasn't been on the market for several years. During the second phone call we had he did say he had used it in Canada. Then came the zinger "So what is the equivalent to alteplase?". After a lot of research, I found an article in Radiology journal that said "so approximately 31,000 units of Urokinase is equal to 1 mg of alteplase". After another talk, he decided on 2 mg of alteplase should do it. Who says nights are dull? (At the same time, ER wanted a STAT antibiotic and OR wanted a STAT Hemabate.)
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