Casebook in Clinical Pharmacokinetics and Drug Dosing (Henry Cohen)

 

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.

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