Class of 2011 Abstract / OBJECTIVES: The purpose of this study is to assess three published aminoglycoside dosing protocols (large-dose extended interval), to predict peak and trough concentrations of these protocols and to determine the percentage of patients with peak and trough concentrations within each protocol’s specified ranges. METHODS: This study is a retrospective analysis of clinical data. A database of 515 patients is used to analyze the three different protocols. The variables in this database encompass patients’ age, height, actual body weight (ABW), sex, k, Vd, and dose. From these data, patients' peak and trough concentrations were determined using the three large large, extended interval dosing protocols. RESULTS The results showed Nicolau protocol with the most potential of the three protocols. It had the highest percentages of patients with peak above 15 mg/L and a trough less than 0.5 mg/L. It also had the highest average peak of 19.1 mg/L with 69.9% of patients meeting the protocol’s specified peak range of 13 to 23 mg/L. CONCLUSION: The three examined protocols all showed a percentage of patients within the desired range. Of the three, Nicolau protocol I showed promising results with highest average peak, lowest average trough and high percentage of patients with concentrations within desired ranges. Its percentages above 15 mg/L and less than 0.5 mg/L are greater than protocols II and III. Nicolau dosing protocol may be best in achieving high peak and low trough concentrations.

No description available.

Class of 2015 Abstract / Objectives: The purpose of the study was to analyze the effect of a network wide computer system and the implementation of weight based dosing on heparin alert rates. Our central hypotheses was that the implementation of a network wide computer system will decrease alert rates for heparin infusions on smart pump infusion systems. Our rationale for this study was to evaluate methods to improve patient safety for high alert medications such as heparin. Methods: This was a before-after study design evaluating the effect of the intervention using data obtained by a smart pump infusion system. Heparin infusions at the university campus were analyzed for the effect of a network wide computer system, administered in the adult ICU or Med/Surg unit between July 2013-September 2013 and from January 2014-March 2014. Pump data from before the implementation of the network wide computer system was compared to the pump data obtained after the network wide computer system. Results: After the implementation of a hospital wide computerized physician order entry system, there was a statistically significant increase in heparin alert rates from 15.7 alerts per 100 infusions of heparin to an alert rate of 20.2 alerts per 100 infusions of heparin (P=0.001). Conclusions: The implementation of a network wide computerized physician order entry was associated with an increase in alert generation rate on smart pump infusion systems. Further studies are needed to elucidate this unexpected increase in alerts.

Class of 2011 Abstract / OBJECTIVES: To design and evaluate a dosing schedule pictogram in an elderly population. To identify possible reasons for misunderstanding of a dosing schedule pictogram and, if appropriate, redesign the pictogram to reflect reasons for misunderstanding. METHODS: Through a modified focus group analysis involving residents of a retirement community in Tucson, Arizona, the understandability of a morning-noon-night color pictogram was assessed. Residents’ interpretation of the pictogram as correct or incorrect was assessed using a decision-tree analysis. The percentage of correct responses was calculated and compared to established pictogram criteria for acceptability. Lastly, potential reasons for misunderstanding were assessed. RESULTS: Thirteen residents, six males and seven females, participated in the study. The rate of correct interpretation was 84.6%, which nearly satisfies the ANSI criterion of 85% correct and far exceeds the ISO criterion of 67% correct. Two participants incorrectly interpreted the pictogram, but their comments, however, indicated good comprehension of time of day. CONCLUSION: The dosing schedule pictogram was correctly interpreted by a majority of study participants satisfying industry standards. Further analysis of this design is warranted.

Class of 2011 Absrtact / OBJECTIVES: The purpose of this study was to analyze various published gentamicin dosing protocols in a neonate population to determine the percentage of patients that fell within defined concentration ranges, and determine which protocol was the most efficient at being within the desired concentration ranges. METHODS: Data from three published studies were used to create a database of 331 neonates who were up to seven days old and received gentamicin. Pharmacokinetic data was obtained and applied to specific dosing protocols from six published studies. The protocols were used to simulate peak and trough concentrations for each neonate. Desired trough concentrations include < 0.5 mg/L or < 1 mg/L and peak concentrations within 7-10 mg/L. Results were analyzed for frequency of achieving pre-specified concentration ranges based on dosing protocols from the study. RESULTS: The Begg protocol was adjusted for a desired Cmax of 8.5 mg/L and an estimated volume of distribution based on weight and was found to be the most efficient at achieving the highest percentage of patients achieving peaks of 7-10 mg/L and a trough of < 1 mg/L and < 0.5 mg/L, 63.0% and 61.5%, respectively. Also, other protocols which adjusted the dose based primarily on weight or gestational age such as the Fullas, Blackmer and Darmstadt protocols frequently achieved their desired trough however the average peak varied significantly, and was higher than the pre-specified concentration range. CONCLUSION: Achieving acceptable concentration ranges was suboptimal with much variability between each protocol requiring therapeutic drug monitoring and adjusting accordingly until a more efficient protocol is developed for this patient population.

Class of 2005 Abstract / Objectives: First, to evaluate five recent gentamicin dosing protocols that are specific for neonates and determine how frequently each protocol yields desirable peak and trough concentrations. Second, to make our evaluation more robust, we included AUC as one of the pharmacokinetic parameters and compared it to traditional parameters. Finally, to evaluate a fixed dosing protocol (3 mg/kg Q24-hours) that is currently being used at one Arizona hospital (UMC). Methods: This retrospective evaluation involved datasets from three independent sources. Dataset 1 was from a previously published study, while datasets 2 and 3 were derived for this study. Datasets 1 and 2 were pooled to evaluate the five dosing protocols, while dataset 3 was used to evaluate the fixed dosing protocol used at UMC. For all subjects, demographic and laboratory data was obtained from hospital databases or charts. The data collected was used to construct pharmacokinetic values, which in turn were used in simulations with the five protocols. Dataset 3 was evaluated as a whole for frequency of desired peaks and troughs, then for subsets based on weight, gestational age, and Apgar scores. Results: Of the five evaluated, the Avent protocol yielded the fewest potentially toxic troughs. The Murphy-Carter protocol stood out in that it was the easiest to use, most universally applicable, and it yielded only slightly fewer desired troughs then the Avent protocol. AUC values proved to be a novel and exceptionally useful tool in evaluating the dosing protocols. The fixed dosing protocol used at UMC was shown to consistently produce favorable trough concentrations as a whole as well as in our subset analyses. Implications: The multitude of dosing protocols that have been offered can create confusion among health care professionals and lead to discrepancies in dosing. The primary goal of any of these protocols is to minimize the risk of toxicity while avoiding subtherapeutic doses. A dosing protocol that can consistently meet these criterion, yet offer simplicity and wide applicability, then we can come that much closer to a universal standard.

Class of 2007 Abstract / Objectives: To create a nomogram that can accurately predict dosing intervals for aminoglycoside dosing in neonates based on one concentration measurement. Methods: Pooled pharmacokinetic data from previous studies were used (n=341) to create a nomogram that would accurately predict dosing intervals for aminoglycosides. The population value for volume of distribution (0.45 L/kg) was used to formulate a nomogram to select a dosing interval for neonates that would achieve a trough concentration of < 0.5 mg/L one hour prior to the next scheduled dose. The fixed dose of 4 mg/kg was used to simulate concentration elimination profiles all neonates in the study group. The data from the study group elimination profile was then compared against the nomogram and evaluated for the number of correct dosing intervals the nomogram predicted from hour 6 to 22 at 1 hour intervals. The trough concentration cutoff was < 0.5 mg/L with neonates not achieving this concentration prior to the next dose to be deemed dosed incorrectly. The nomogram was considered to have failed at any time point where the nomogram indicated an interval that would not have achieved the desired trough concentration of < 0.5 mg/L or if the interval chosen by the nomogram was longer then necessary. Results: The simulated data from the test group showed that from 15 to 21 hours post infusion 81.0 to 92.1% of neonates had the correct interval predicted by the nomogram. Greater accuracy was achieved the longer time that elapsed before a concentration is drawn, with the greatest accuracy (92.1%) at 21 hours post infusion. However, this was close to the next dose recommending a concentration draw time at 18 hours post infusion to maximize the combination of accuracy and time remaining before the next scheduled dose. This gives the lab time to report the concentration before the next dose is scheduled and achieves an accuracy rate of 87.6%. Conclusions: The use of this nomogram is a valid tool to predict dosing intervals for aminoglycosides in neonates and can aid in saving hospital resources by needing only one concentration measurement to determine dosing interval.

Class of 2008 Abstract / Objectives: This was a retrospective chart review and survey of pediatric residents. This study aimed to examine standards for aminoglycosides in obese pediatrics; increase awareness of drug monitoring in obese populations; and reduce medication errors. Methods: 101 patients aged three to seventeen that received aminoglycoside treatment were included. Subjects were divided into three groups based on weight and height percentiles as defined by growth charts. Collecting retrospective data provided measured concentrations of aminoglycosides in order to evaluate pharmacokinetics. Data collected included: dose and frequency; time dose was given; length of infusion; two measured concentrations (peak and trough); and time concentration was measured. ANOVA allowed comparisons between aminoglycoside volumes of distribution to weight (based on specific weight groups). Tukey’s post hoc analysis further tested the significance of the pair-wise comparisons (p<0.05). Secondly, a questionnaire was administered to 26 pediatric medical residents at University Medical Center to assess current treatment protocols and attitudes towards medication dosing in obese pediatric patients. Results: The volume of distribution was not significantly different between normal weight and overweight patients (p=0.927); normal weight and obese patients (p=0.174); or overweight and obese patients (p=0.211). Most (81.8%) study participants have some difficulty finding references on dosing in overweight and obese patients. Conclusions: The positive correlation between volume of distribution and total body weight was not statistically significant. Pediatric residents agree that there is a lack of resources regarding obese pediatric medication dosing. Further research is warranted to ensure the reliability and validity of aminoglycoside dosing in obese children.

Inaccurate dosing of children’s liquid medication is a major problem that causes adverse effects for children every year. In order to prevent these errors, education for at risk parents is essential. A survey and observational study was done in order to identify parents/caregivers who make dosing errors when measuring out liquid medication for their children. A total of 25 parents/caregivers with children admitted to Arnold Palmer Hospital were included in this study. Study participants completed a survey that included demographic data as well as parenting experience. The parents were directly observed measuring a dose of corn syrup using Children’s liquid Tylenol® dosing instructions. The research participants were offered a variety of common measuring devices and they chose the one they most often used at home. Data indicated a high incidence of dosing errors made by a variety of participants. Of the 25 research participants, 13 (52%) made an error greater than 20% when measuring out the dose based on the provided instructions and their child’s weight. This data suggests nurses need to include dosing education for all parents at discharge. This study has shown that many parents are at risk for making errors when measuring medication. Effective discharge education on the importance of measuring medication accurately can prevent these errors and the adverse effects they cause.

Yes / Background: Presently, there is limited guidance on the maximal dosing of psychosis drugs that is based on effectiveness rather than safety or toxicity. Current maximum dosing recommendations may far exceed the necessary degree of dopamine D2 receptor blockade required to treat psychosis. This may lead to excess harm through cognitive impairment and side effects. Aims: This analysis aimed to establish guidance for prescribers by optimally dosing drugs for psychosis based on efficacy and benefit. Methods: We used data from two dose–response meta-analyses and reviewed seven of the most prescribed drugs for psychosis in the UK. Where data were not available, we used appropriate comparison techniques based on D2 receptor occupancy to extrapolate our recommendations. Results: We found that the likely threshold dose for achieving remission of psychotic symptoms was often significantly below the currently licensed dose for these drugs. We therefore recommend that clinicians are cautious about exceeding our recommended doses. Individual factors, however, should be accounted for. We outline potentially relevant factors including age, ethnicity, sex, smoking status and pharmacogenetics. Additionally, we recommend therapeutic drug monitoring as a tool to determine individual pharmacokinetic variation. Conclusions: In summary, we propose a new set of maximum target doses for psychosis drugs based on efficacy. Further research through randomised controlled trials should be undertaken to evaluate the effect of reducing doses from current licensing maximums or from doses that are above our recommendations. However, dose reductions should be implemented in a manner that accounts for and reduces the effects of drug withdrawal.