課程進行方式

1. 課前看完本教材
Glycopeptides 2. 上課前分好組別
- Pharmacokinetics –  每組3人，最多只有2組是2或4人

Case Discussion 3. 上課時帶著

 計算公式
 計算機
Shu-Wen Lin, M.S., Pharm.D.
 筆電、手機、平板 (1組1台即可)
Graduate Institute of Clinical Pharmacy 4. 上課 一開始先小考
November 1, 2018 5. 課堂中完成2-3個案例
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Case 1: Q#1 Population Parameters: Vd

 P.K. is a 42 year old female with past medical history of  Normal patients: Vd = 0.17 (age in years) + 0.22 (TBW in kg)
asthma and psoriasis. Her height is 179 cm and total + 15
body weight (TBW) is 161 kg. She is admitted due to
 Normal or burn patients: Vd= 0.7 L/kg x TBW (range 0.5-1
MRSA infection on left lower extremity. Vancomycin L/kg)
starts on 7/13. What dosing regimen would you
 Obese patients
recommend?
Date 7/12 7/15 7/17 7/20 7/24
 Initial dosages based on ABW, then adjusted based
on serum vancomycin concentrations
CRP (mg/dl) 1.43
WBC(k/μL) 6.7  Vd = (0.17 x age) + (0.22 x TBW) + 15
Seg (%) 48.7  Vd = 0.7 L/kg x TBW
SCr (mg/dL) 0.8  Vd = 0.7 L/kg x IBW x 30/25; or
Peak(mg/L) -  Vd = 0.7 L/kg x IBW; or
Trough(mg/L) -  Vd = 0.7 L/kg x IBW (1+0.4 (TBW-IBW))

Altered vancomycin PK in obese

Population Parameters: CL
and morbidly obese pt’
 CLvanco (L/hr) =(0.79 x CrCr (ml/min) +15.7) x 60/1000; or  ↑ Vd
 CLvanco (L/hr) =
 ↑ certain circulating proteins (α1-acid
(0.695 x CrCr (ml/min)+0.05) x 60/1000 (old version:
0.65 x CrCr ); or glycoprotein)
 CLvanco (mL/min/kg) = 0.9 x CrCL x weight  altered free serum vancomycin concentration
 CLvanco (mL/min/kg) = CrCL x (lesser of IBW or TBW)  ↑Cl vanco (clearence)
 CLvanco  CrCL = Cockcroft and Gault ↑ blood flow or renal hypertrophy >↑ cardiac
 Obese patients: use ideal body weight output/ blood volume
 Ke= CL vanco / Vd vanco
J antimicrob Chemother 2012;67:1305-10

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 First Order Kinetic –Bolus Model: First Order Kinetic –Infusion Model:
Prediction of Cpeak and Ctrough via Prediction of Cpeak and Ctrough via
Population PK data Population PK data
 Infusion time > 1/6 x T1/2
 Infusion time < 1/6 x T1/2
 After LD
 After LD
Cpt = D/Vd x e-kt
 Steady State:
 Steady State

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First Order Kinetic –Bolus Model: First Order Kinetic –Infusion Model
Patient-Specific PK and Dosing Patient-Specific PK and Dosing
 Steady State:
 Steady State:
 Calculate patient-specific Vd and K
 Calculate patient-specific Vd and K
 Propose a new dose and  using calculated Vd & K
 Propose a new dose and  using calculated Vd & K
 Use new dose &  to predict Cp0 & Cpt (again!)
 Use new dose &  to predict Cp0 & Cpt (again!)
 Calculate expected targeted Cpeak & Ctrough to
 Calculate expected targeted Cpeak & Ctrough to
inform physicians & nurses
inform physicians & nurses

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