Therapeutic drug monitoring
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This laboratory developed a simple and efficient solid-phase extraction method that is combined with high-performance liquid chromatography for rapid and precise therapeutic monitoring of risperidone (Risperdal) in blood concentrations. The solid-phase extraction uses a mixed bed column. ⋯ Advantages of this approach include enhanced speed, sensitivity, and efficiency. A high level of sensitivity may be achieved because of the absence of interference from other drugs, metabolites, or serum components.
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The authors describe a case of furosemide possibly inhibiting the hypoprothrombinemic effect of warfarin. The initiation of furosemide dosing in a patient receiving a stable dose of warfarin was associated with an 28% decrease in the international normalized ration (INR). ⋯ Consistent with this hypothesis, the authors found that their patient's hematocrit (believed to reflect hydration status) correlated with the INR: r2 = 0.78, p < 0.05. This case provides further evidence suggesting that acute diuresis can decrease the hypoprothrombinemic effect of warfarin.
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Randomized Controlled Trial Clinical Trial
Amikacin Bayesian forecasting in critically ill patients with sepsis and cirrhosis.
This study was designed to determine the population pharmacokinetic parameters of amikacin in two subpopulations of intensive care unit patients with sepsis and cirrhosis and sepsis without cirrhosis. The authors evaluated the usefulness of the obtained parameters to forecast the serum amikacin concentrations in a validation group of patients with sepsis and cirrhosis when used as a priori distribution in a Bayesian forecaster. ⋯ The model derived for patients with cirrhosis used as a priori distribution, with and without feedback, was superior to the model derived for patients with sepsis in forecasting amikacin serum concentrations. The results show the relevance of using the specific model for the subgroup with cirrhosis as a priori distribution in a Bayesian forecaster to obtain a nonbiased prediction with an acceptable precision.