Pharmacokinetics - equations and therapeutic ranges mostly
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| goal range for flucytosine | 50-100 mcg/ml
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| goal range for digoxin | 0.8-2.0 mcg/L [typically 1.2 is the upper limit]
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| goal range for valproic acid | 50-100 mg/L
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| Formula for loading dose | [Peak] * Vd / bioavailability
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| formula for the elimination rate constant or slope | [ln (y1)- ln (y2)] / x1-x2
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| formula for volume of distribution | dose/change in concentration = bioavailability * dose / peak conc (bolus) = rate of infusion / k* Css
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| formula for peak concentration | peak conc = concentration / e^kt
t=time from peak for concentration.
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| formula for bioavailability | F= [DOSEiv * AUCpo] / [DOSEpo * AUCiv]
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| relationship between the elimination constant k, VD and clearance | Cl=k*VD
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| formula for half life | t1/2=0.693/k
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| in what way do isozymes affect fluconazole | at doses above 400 mg/day you get 3A4 inhibition but lower doses only have 2C9
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| Cockcroft -Gault formula for CrCl | CrCl=[(140-age)*TBW]/Scr*72
Women get 80% of total
AdjBW if BMI >25
actualBW if BMI <18.5
all others use IBW
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| formula for IBW | men=50+2.3 for each inch over 5 ft
women 45.5 +2.3 for each inch over 5 ft
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| what population is the schwartz eqn designed for | peds
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| what GFR equations work for pts with renal dysfunction | MDRD and CKDepi. MDRD is limited to pts with CrCl < 60 only.
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| drugs that compete with creatinine for secretion in pts resulting in false elevations in Creatinine clearance | trimethoprim, cimetidine, fibric acid derivatives OTHER than gemfibrozil, dronedarone
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| what does the hill eqn measure | relationship btn drug response and concentration
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| hysteresis | conc late after dose has diff effect than early with same conc
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| causes of counterclockwise hysteresis loop | delayed equilibrium between plasma and site of action, active metabolite, sensitization, Ex: digoxin
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| causes of clockwise hysteresis loop | tolerance, formation of inhibitory metabolite, faster equilibrium between arterial blood supply and site of action than venous and site of action. Ex: cocaine and pseudoephedrine
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| goal ranges, free and total for phenytoin | free=1-2
total=10-20
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| calculation for phenytoin adjustment in changing albumin | Cp=[Cp' / (0.9*Alb/4.4)]+1
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| calculation for phenytoin adjustment in CKD AND changing albumin | Cp=Cp' / [(0.48*0.9*Alb/4.4)+1]
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| calculation for phenytoin adjustment in CKD | Cp=Cp'/0.5
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| what is the effect on digoxin in pts with renal insufficiency | Vd decreases. need to decrease BOTH loading dose and maintenance dose. typically loading doses ok to keep same but not in this case due to lower VD for digoxin.
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| therapeutic range for aminoglycosides | peak 4-10, trough <2
amikacin 20-30
trough amikacin <10
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| phenobarbital therapeutic range | 15-40 mg/L
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| therapeutic range for lithium | 0.3-1.3 mmol/L
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| therapeutic range for carbamazepine | 4-12 mg/L
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| therapeutic range for cyclosporine | 100-250 mcg/L
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| theophylline therapeutic range | 10-20 mg/L
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| concentration or time dependent killing for aminoglycosides | concentration
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| concentration or time dependent killing for vancomycin | time dependent though some concentration dependence as well
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