modelling and simulation group, school of pharmacy for clinical pharmacist clinical pharmacology
TRANSCRIPT
Modelling and Simulation Group, School of Pharmacy
Abbreviation Spoiler Alert
• PK = Pharmacokinetics
• PD = Pharmacodynamics
• PG = Pharmacogenomics
• PO = Per Os
• PM = Post Meridiem
• PC = Personal Computer
BARRY = Clinical Pharmacology
Modelling and Simulation Group, School of Pharmacy
Educational Objectives
• By the end of this session you should be able to: – Feel less daunted by Barry – Understand how Barry complements evidence
based practice– Provide rationale recommendations for
aminoglycoside monitoring
Modelling and Simulation Group, School of Pharmacy
OVERVIEW
• Who is Barry?
• What can Barry do for me?
• What does Barry want from me?
• How do I get the most out of Barry
Modelling and Simulation Group, School of Pharmacy
Barry as an equation
BARRY =
DISEASE PROGRESS
+
DRUG ACTION
Modelling and Simulation Group, School of Pharmacy
Concentration Time Profiles following administration of IV paracetamol to neonates
2011, Anderson and Holford et al.
Modelling and Simulation Group, School of Pharmacy
OVERVIEW
• Who is Barry?
• What can Barry do for me?
• What does Barry want from me?
• How do I get the most out of Barry
Modelling and Simulation Group, School of Pharmacy
What can Barry Do for me
• Understanding Barry can make you a better clinical pharmacist through improving evidence based practice.
www.homeopathyworldcommunity.com/
Modelling and Simulation Group, School of Pharmacy
Clinical Pharmacy
Sufficient Outcome for a patient
=
(Drug Action/Blah)Concordance
Warning Blah may contain traces of actual evidence, dosage
regimen,legislation, pharmacoeconomics, local policy, personal
preference, sales representative influence, health beliefs of the patient,
nocebo/placebo effect, stock availability, etc)
Modelling and Simulation Group, School of Pharmacy
OVERVIEW
• Who is Barry?
• What can Barry do for me?
• What does Barry want from me?
• How do I get the most out of Barry
Modelling and Simulation Group, School of Pharmacy
Starting a relationship with Barry
• PK– First Order Kinetics– AUC– Clearance– Half Life
Modelling and Simulation Group, School of Pharmacy
• PD
Chapter 8. Principles of Pharmacokinetics and PharmacodynamicsC. Lindsay DeVane, Pharm.D.
DOI: 10.1176/appi.books.9781585623860.408715
Modelling and Simulation Group, School of Pharmacy
OVERVIEW
• Who is Barry?
• What can Barry do for me?
• What does Barry want from me?
• How do I get the most out of Barry
Modelling and Simulation Group, School of Pharmacy
• Once daily dosing – from AMH
“Methods for monitoring drug concentration include graphical, trough plasma concentration and target AUC (area under the plasma concentration – time curve) methods. Not all are valid for use in renal impairment.
Although no method is proven to be clinically superior, the current preferred, but most complex, method is based on target AUC (can be used in renal impairment). It requires 2 samples: collect the first about 30 minutes after completing the infusion/injection and the second 6–14 hours later. The estimated 24-hour AUC is generally calculated using a computer program, eg the one available from TCIWorks at www.tciworks.info.”
Modelling and Simulation Group, School of Pharmacy
AMINOGLYCOSIDE MONITORING
• Trough Concentrations
• 6-14 Hour Nomogram
• Target AUC– Bayesian Forecasting
Modelling and Simulation Group, School of Pharmacy
Bayesian Forecasting
Disclamer regarding TCI works
Modelling and Simulation Group, School of Pharmacy
• You (as the junior doctor) are told by your consultant to write up gentamicin for Beryl. You haven’t met Beryl but you have seen that her sputum sample is positive for pseudomonas.
• What would you do next.
Modelling and Simulation Group, School of Pharmacy
Questions for Cases
• Later that day you are ask to provide advice regarding monitoring for gentamicin in a woman about to have a caesarean birth.
• What would you ask and recommend?
Modelling and Simulation Group, School of Pharmacy
• 5 days later Beryl from case 1 has a blood sample taken at 8:50pm, it is sent to the lab for assay. The next morning at 10:30 on the ward round the doctor reviews the result (1mg/L) and rings the pharmacist for advice.
• What do you do?