By Sandra Kane-Gill, Joseph Dasta
Serious Care Clinicians can use normal drug references (Micomedex, Lexicomp) for facts on dosing of high-alert medicinal drugs in particular sufferer populations yet those references usually are not to be had to all healthcare clinicians, they're pricey and they're now not particular to high-alert medicines or significantly unwell sufferers. medical professionals, nurses and pharmacists within the health facility environment will reap the benefits of having one source with all of this data. the aim of this reference handbook will be to steer serious care clinicians on dosing of high-alert medicinal drugs in specific sufferer populations. an important function of the ebook might be a precis of fundamental literature utilizing tables while attainable. this may be invaluable to readers simply because at present a reference publication doesn't exist that publications clinicians in those tricky dosing judgements.
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71 No mention of hepatic impairment is provided in the product information for either eptifibatide or abciximab. 97 The pharmacokinetics of GP IIb/ IIIa inhibitors have been investigated in an in vitro study of mild hypothermia (32–34°C). Blood samples from six healthy volunteers were used to analyze the effects of all three commercially available GP IIb/IIIa inhibitors. 98 The authors suggest that doses of eptifibatide and tirofiban may need to be modified but do not provide specific recommendations.
7% of abciximab patients. , mediated99 heparin) and give platelet transfusions as needed99 1 Thrombolytics/Anticoagulants 23 Safety concern Rationale Comments/recommendations Readministration Potential for antigenicity exists with abciximab, but not eptifibatide or tirofiban Human anti-chimeric IgG antibodies may develop in 6–7% of patients with abciximab Theoretical potential for hypersensitivity reactions including anaphylaxis, augmented thrombocytopenia, and/or decreased efficacy99 The GUSTO-IV ACS study of abciximab found no benefit among patients not planned for early revascularization100 Same recommendations with regard to platelet count monitoring apply as with initial administration.
13 Pharmacodynamic and clinical studies of LMWH for VTE prophylaxis in renal impairment CrCI, mL/min a Dosing Mild outcome Moderate (50–80) Severe (30–50) Reference LMWH Study n/N Design Pharmacodynamic outcomes Anti-Xa levels 20% higher (n = 21% higher (n = Sanderink Enoxaparin 36/48 Prospective 40 mg/day, Exposure vs. 61 (n = 58) cohort <10 days (mean) 1 Thrombolytics/Anticoagulants 35 LMWH Dalteparin Dalteparin Dalteparin Tincani (2006) Rabbat (2005) Douketis (2008) Dosing Mild outcome (<30) VTE or major bleeding Prospective 40 mg/day, ³8 Symptomatic None (n = 28) open-label days VTE Major bleeding 1 (n = 28) 4,500 IU/day, ³8 Symptomatic None (n = 27) days VTE Major bleeding 2 (n = 27) 40 mg/day, <10 Serious bleeding Anti-Xa levels similar between pts.