Objectives: Upon completion of the chapter and exercises, the student pharmacist will be able to
Recognize the role of deductive reasoning in the drug monitoring process.
Know what a patient database is and how it is used to monitor drug therapy.
Be able to extract appropriate patient information and integrate it with drug information to formulate a process for monitoring drug therapy.
Utilize common calculations when monitoring drug therapy in a patient, for example, creatinine clearance, modification of diet in renal disease (MDRD), body mass index (BMI).
Discuss the importance of a chief complaint (CC) and history of present illness (HPI) in monitoring drug therapy.
Back at the hospital the attending pharmacist has collected additional information.
One week since his accident, the patient is in the ICU and mechanically ventilated. You are preparing for rounds with the ICU service and notice in the chart an order for levofloxacin 500 mg IV q24h, first dose stat. You obtain the following information from the chart:
Height 70 in.
Weight 70 kg
Scr 1.7 (baseline on admission 1.0 mg/dL)
WBC = 12% neutrophils
Tmax = 101°F
BP = 100/60
HR = 85 PATIENT ENCOUNTER: DISCUSSION
There are a number of questions that the student should ask about the patient's medication regimen.
Is the drug being used for an appropriate diagnosis or indication? Knowing the diagnosis establishes a basis for selection of an appropriate medication.
Is the dose of the medication appropriate for this specific patient? Take into account patient characteristics such as age, weight, sex, ethnic background, and allergies as well as concurrent disease states and medications used.
You know nothing about VAP or how to treat it. What resources should you access to determine if the treatment with levofloxacin 500 mg IV q24h is appropriate?
How will you determine if the dose of levofloxacin is appropriate for patient X, especially since his Scr is increasing? What calculation should you use to determine patient X's renal function?
What are the most likely adverse effects caused by this medication? Does the patient exhibit any of these adverse effects?
Are there any patient-specific barriers to taking this medication?
What proof do you have that the medication is effective?
The purpose of this chapter is to provide some direction primarily for the student who will be beginning his or her first exposure to direct patient care. It will also be helpful for those individuals who already have some experience in this area.
To get the most out of this chapter, prepare yourself to ...