Understanding
and applying clinical pharmacokinetics and dosing medications safely and
appropriately are an essential role of the pharmacist in medication therapy
management. Ostensibly, pharmacokinetics and clinical pharmacokinetics are a
core part of doctorate of pharmacy program curriculums, and these skills are
further honed during pharmacy practice experiences in clerkships and in
postgraduate pharmacy residency training programs. Although in the last decade
pharmacy has undergone significant specialization, pharmacists are expected to
be the drug expert and maintain knowledge of a vast array of agents beyond
their area of specialty. Physicians and other prescribers expect the pharmacist
to be the expert in pharmacokinetics, drug interactions, and drug dosing. The
goal of Casebook in Clinical Pharmacokinetics and Drug Dosing is to provide
students and clinicians with real-world dosing case scenarios and a
step-by-step approach to determining dosing regimens.
Traditionally,
clinical pharmacokinetics courses and clinical pharmacokinetic textbooks focus
on drugs with readily available therapeutic serum levels such as
aminoglycosides, vancomycin, carbamazepine, phenytoin, phenobarbital, valproic
acid, lithium, digoxin, amiodarone, immunosuppressants, and antiarrhythmics
such as quinidine and procainamide. Many of these agents remain effective and
are highly utilized in today’s practice; hence, mastering how to dose these
agents is an expectation of today’s pharmacist. Casebook in Clinical
Pharmacokinetics and Drug Dosing will provide extensive reviews and cases for
these traditional agents with readily available serum levels that are used to
determine drug-dosing regimens.
Many
drugs in use today do not have readily available therapeutic serum levels, but
have narrow therapeutic indexes, sophisticated pharmacokinetics and
pharmacodynamics, extensive drug interactions, and complicated dosing schemes,
and are classified as high-alert agents. The risk of medication errors and
patient harm with these agents is high, but minimal guidance is provided for safely
utilizing and dosing these drugs in actual patient case scenarios. Such agents
include the newer second-generation antiepileptics, long-acting antipsychotics,
colistin and polymyxin B, dronedarone, direct thrombin inhibitors,
neuromuscular blocking agents, oncologic agents, antifungal agents, epoetin
alfa, warfarin, heparin and low-molecular-weight heparins, extended-infusion
beta-lactams, and opioids for pain management. Casebook in Clinical
Pharmacokinetics and Drug Dosing provides equal emphasis and focus with these
type of agents and traditionally dosed pharmacokinetic agents and offers
extensive reviews, cases, and answers to challenging dosing questions.
This
casebook is designed to teach and guide the pharmacy student, pharmacist, and
clinical pharmacist in dosing drugs and goes beyond agents with readily
available and applied therapeutic blood levels. Each drug chapter is written by
clinical pharmacists who have expertise and experience in drug dosing. Each
chapter provides an overview of the drug’s pharmacology including mechanisms of
action, indications, toxicities, and pharmacokinetics. A comprehensive review
and discussion of the drug’s bioavailability, volume of distribution,
clearance, half-life, therapeutic drug level monitoring (when applicable), drug
interactions, dosing, and availability are provided. Each chapter contains a
plethora of patient cases with clear step-by-step answers and explanations.
Calculations, equations, and dosing recommendations are provided for each case.
Loading doses and maintenance doses using population and actual
pharmacokinetics are depicted and reviewed. Challenging cases including drug
interactions, alterations in volume of distribution, reduced renal or hepatic
function, and overweight and underweight patients are covered extensively.
This
casebook is intended for teaching, learning, and clinical practice. The
casebook can be used in the classroom by faculty to teach drug dosing, by
pharmacy students to practice and learn drug dosing, and by the clinical
pharmacist practitioner for daily patient care needs. This casebook will be an
invaluable resource providing the clinician with assistance in both routine and
challenging drug-dosing cases.
