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Evaluate 04 01 Who
Calculation
03 02
How What
Objectives
1. Using a hospital protocol, accurately calculate the following:
a. Vancomycin dosing
b. Aminoglycoside dosing
2. Using a hospital protocol, optimize a patient’s medication based on renal function
3. Using a hospital protocol, initiate a TPN and make adjustments based on labs
4. Calculate a patient’s corrected calcium
5. Convert a patient opioid regimen to an alternative equivalent
6. Using a hospital protocol, calculate the rate in mL/hr of 3% sodium chloride to correct a patient’s
sodium level.
7. Calculate a patient’s body surface area
8. Calculate a patient’s etoposide dose
9. Calculate a carboplatin dose using the Calvert Equation
Materials Posted on Canvas
● Clinical Calculations presentation
● Clinical Calculations worksheet
● Formula sheet 1 and 2
● Pharmacokinetic Protocol
● Adult Medication Dosing Optimization Protocol
● Total Parenteral Nutrition Order Set
● Sodium Chloride 3%-BMH
● Small Cell Lung Cancer Carboplatin/Etoposide
● NCCN Carboplatin Dosing Guide
Format
● Workshop
○ Work independently on calculations
○ Check calculations with neighbors
● Ask questions
● Plan 5-10 min per calculation
● Review each calculation as a group
Vancomycin Dosing
***Refer to: Pharmacokinetic Protocol***
Objective 1a
Body Mass Index (BMI)
● Formula
○ BMI= weight (kg)/[height (m)]2
○ BMI= weight (pounds)/ ([height (inches)]2 x 703)
● Interpretation for Adults
BMI Weight Status
25-29.9 Overweight
● Dosing weight:
● CrCl:
● Piperacillin/tazobactam regimen:
Worksheet JC
● Ideal body weight:
● Dosing weight:
● CrCl:
● Trough level:
Aminoglycoside Dosing
***Refer to: Pharmacokinetic Protocol***
Objective 1b
Aminoglycoside Dosing
● Conventional dosing
○ Dosing depends on indication
● Extended interval dosing
○ Gentamicin/tobramycin 7 mg/kg
○ Amikacin 15 mg/kg
○ Preferred method for suspected or confirmed gram negative infection
○ Nomogram
Worksheet JS
● BMI:
● Dosing Weight:
● Creatinine Clearance:
Methadone Methadone
(diphenylheptane)
Morphine 10 30
Oxycodone - 20
Hydrocodone - 30
Fentanyl 0.1
Meperidine 75 300
Oxymorphone 1 10
Opioid Conversion Process
1. Calculate total 24 hour dose requirement
2. Use ratio-conversion to calculate dose of new drug
3. Calculate 24 hour dose of new drug
a. Reduce dose by at least 25%
4. Divide to attain appropriate interval and dose for new drug
5. Example:
30 mg of morphine PO x mg morphine PO
_____________________ = ____________________
30 mg of morphine PO x mg morphine PO
_____________________ = ____________________
● What dosing regimen of fentanyl would you recommend to control the pain?
Worksheet AJ
● Morphine 24 mg IV is equivalent to _____ mg of morphine PO
IVFE 20 % 2 kcal/mL
● Calories from amino acids and how many mL assuming a 15% amino acid solution
● Calories from dextrose and how many mL assuming a 70% dextrose solution
● Calories from lipids and how many mL of lipids using a 10% formula
● Calculate the sum of calcium and phosphate (units must be normalized). HINT: 2
mEq/mmol of phosphate
Hyponatremia
Refer to: Sodium Chloride 3%-BMH
Objective 5
Sodium Chloride 3%-BMH
● Calculate the following
○ How many mEq of Na are in 500 mL of 3% NaCl?
concentration):
● Final Concentration:
JD-Etoposide
● Etoposide dose:
● Final Concentration:
Wrapping Up
● Personal stories
● Rotations
○ Advice
● Life after pharmacy school
○ Community Pharmacy
○ Industry
○ Inpatient Pharmacy
○ Residency
■ PGY-1
■ PGY-2
Looking Ahead
● April 25th
○ Community pharmacy calculations
○ Inpatient pharmacy calculations
● Workshop format
Questions
● What questions do you have?