Sunday, August 25, 2013

Foreign medication brand names

Let’s start with a patient case.  An elderly patient has recently arrived from Italy and you are performing the medication reconciliation from their home medication list.  Their medication list includes Flomax which may frequently be continued without hesitation.  In this example, however, Flomax is NOT the brand name for tamsulosin in Italy but rather the identical name for a different medication. 

Sunday, August 18, 2013

Interpreting serum phenytoin concentrations

Let’s start with a patient case.  Patient is an 80 year old female hospitalized for pneumonia with sepsis who during this admission experienced a seizure likely secondary to imipenem/cilastatin.  She has since been on phenytoin for one week and is currently extremely confused, pulling out IV lines, and striking out at the staff.  Serum total phenytoin concentration = 16.4 mg/L.  Her SCr = 2.3 (acutely elevated) and albumin = 1.8 g/dL.  At first glance this phenytoin concentration appears therapeutic (10-20 mg/L).  What is the issue with interpreting this lab?

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