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Case studies of individual drug evaluation services

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14.6
Next, this is a prescribing of a wrong dilution fluid case of ertapenem in a male with urinary tract infection. Under subjective, this is a 53-year old male who had urinary tract infection. Currently, he was giving ertapenem 1000 mg IV QD and using dextrose 5% and half saline 500 ml intravenous drip QD as a diluent. Under objective, we found out that he was weighted 70 kilograms, and his serum creatinine was 0.8 mg/dl and his estimated creatinine clearance was about 105 ml/min. You may also want to include the result of blood cell count and culture and sensitivity data. Under assessment, we wrote evaluate the dilution fluid for ertapenem in urinary tract infection patient.
101.8
Ertapenem is not compatible with any dextrose fluid due to decreasing in potency. Under plan, according to Lexi-comp, ertapenem is not compatible with dextrose containing diluent due to decreasing potency. So, please consider to change to 0.9% normal saline or half saline intravenous dilution QD. Next, this is a prescribing of a wrong dose case of pyrazinamide in a male with pulmonary tuberculosis. Under subjective, this is a 53-year old male who had pulmonary tuberculosis. Currently, he was giving pyrazinamide 500 mg PO three times a week. Under objective, we found out that he is weighted 45 kilograms, and his serum creatinine was 0.8 mg/dl and his estimated creatinine clearance was about 68 ml/min.
188.5
You may also want to include the result of liver function test and sensitivity data. Under assessment, we wrote evaluate the dose for pyrazinamide in pulmonary tuberculosis patient. For a patient weighted 56-75 kilograms, the usual dose for pyrazinamide is 500 mg 3tablets PO every day. The maximum daily dose is 2000 mg. Under plan, according to Lexi-comp, if patient’s creatinine clearance is greater than 30 mi/min and weighted 40-55 kilograms, the usual dose for pyrazinamide is 500 mg 2 tablets PO every day. So, please consider to change to pyrazinamide 500 mg 2 tablets PO every day. I would like to present to you about a dose adjustment of ganciclovir in status post renal transplantation and suspected with cytomegalovirus (CMV) infection in lung.
288.6
Under subjective, this is a 53-year old male who received his renal transplantation and suspected that he might get infected with cytomegalovirus in lung. Currently, he was giving ganciclovir 250 mg IV Q12H. Under objective, we found out that he is weighted 50 kilograms, and his serum creatinine was 2.4 mg/dl and his estimated creatinine clearance was about 25 ml/min. You may also want to include the result of C-reactive protein or any culture or sensitivity data. Under assessment, we wrote evaluate induction therapy dose of ganciclovir for renal impairment patient. I would like to include this dosing chart. This chart shows how to adjust ganciclovir according to patient’s renal function.
376.7
If patient’s creatinine clearance is equal and above 70 ml/min, the induction therapy should choose 5 mg/kg and the frequency should give every 12 hours. The maintenance therapy should choose 5 mg/kg and the frequency should give every 24 hours. If patient’s creatinine clearance is between 50-69 ml/min, the induction therapy should choose 2.5 mg/kg and the frequency should give every 12 hours. The maintenance therapy should choose 2.5 mg/kg and the frequency should give every 24 hours. If patient’s creatinine clearance is between 25 to 49 ml/min, the induction therapy should choose 2.5 mg/kg and the frequency should give every 24 hours. The maintenance therapy should choose 1.25 mg/kg and the frequency should give every 24 hours.
466.5
If the patient’s creatinine clearance is between 10 to24 ml/min, the induction therapy should choose 1.25 mg/kg and the frequency should give every 24 hours. The maintenance therapy should choose 0.625 mg/kg and the frequency should give every 24 hours. If patient’s creatinine clearance is below 10 ml/min, the induction therapy should choose 1.25 mg/kg and the frequency should be three times a week is preferred after dialysis. The maintenance therapy should choose 0.625 mg/kg and the frequency should be three times a week, which is preferred after dialysis. If the patient is under hemodialysis, the induction therapy should choose 1.25 mg/kg and the frequency should give every 48 to 72 hours.
552.7
The maintenance therapy should choose 0.625 mg/kg and the frequency should give every 48 to72 hours. If the patient is under peritoneal dialysis, the induction therapy should choose 1.25 mg/kg and the frequency should give three times a week which is preferred after dialysis. The maintenance therapy should choose 0.625 mg/kg and the frequency should give three times a week and prefer after dialysis. Last, if the patient is under continuous venovenous hemofiltration (CVVH), the induction therapy should choose 2.5 mg/kg and the frequency should give every 24 hours. The maintenance therapy should choose 1.25mg/kg and the frequency should give every 24 hours.
628.1
Under plan, according to Lexi-comp, if creatinine clearance is between 25 to 49 ml/min, then we should choose 2.5 mg/kg IV every 24 hours as an induction therapy. Therefore, please consider to decrease ganciclovir to 125 mg IV QD for 7 to 14 days of induction therapy.

Ms Chao continues to give more SOAP examples and explains the different types of prescription errors. She also explains how dose adjustment is carried out, using Ganciclovir as an example.

Key concepts

Types of medication errors:

  • Wrong dilution fluid

  • Wrong dose

Share and learn:

  • In the SOAP-Dose Adjustment example, (Ganciclovir example), what are some of the patient information required to determine the dosage?
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Good Pharmacy Practice: Introduction to Clinical Pharmacy Services

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