Sunday, February 23, 2014

Vancomycin dosing and monitoring in hemodialysis

Let's start with a patient case.  A patient on hemodialysis (M/W/F) is admitted to the hospital with cellulitis who also meets sepsis criteria.  He has a history of an MRSA infection during a previous admission so you want to initiate vancomycin at this time.  The patient is 76 kg and still makes some urine.  What dosing strategy should you choose and when/should vancomycin concentrations be monitored?

Sunday, February 9, 2014

Drug interaction between warfarin and acetaminophen?

The management of anticoagulant therapy is an important component of the treatment of various disease states. Maintaining the narrow therapeutic range required for the safe and effective use of warfarin is essential to avoid suboptimal dosing and adverse events. Numerous drug interactions with warfarin are present due to alterations in absorption, distribution, and metabolism.  The severity of interactions with warfarin varies greatly and dictates very different recommendations for management and monitoring. In the most insignificant interactions, no change in dosage or monitoring is necessary, whereas some interactions require a significant empiric reduction in warfarin dosage and close monitoring of INR.

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