Clinical Pharmacy: Case Studies

  title={Clinical Pharmacy: Case Studies},
  author={Margaret M. McCarron and Ben J. Devine},
This series of case studies has been prepared by the faculty of the Department of Clinical Education and Services at U.S.C. School of Pharmacy as a continuing education course for pharmacists. The cases are meant to be studied in sequence; concepts and laboratory test evaluations presented in one case will be used in subsequent cases. All normal laboratory test values will be those used at the Los Angeles County/U.S.C. Medical Center; values may differ at other hospitals depending on the method… 

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Gentamicin and Tobramycin Dosing Guidelines: An Evaluation

The goal is to promote consistent interpretation and application of clinical and kinetic data by the members of the aminoglycoside dosing service to provide a structured yet adaptive approach to the clinical use of gentamicin and tobramycin.

Clinical Pharmacist Intervention in an Extended Care Facility

Clinical pharmacist intervention with the use of Jelliffe's method for digoxin dosing yielded a statistically significant decrease in toxicity and a decreased incidence of digoxin underdosage in Phase II as compared with Phase I, without any compromise in therapy.

Improving dosing of gentamicin in the obese patient: a 3-cycle drug chart and case note audit

Online tools can be used to improve prescribing for the complex dosing policies that will increasingly been required to tailor prescribing in obese patients and turnaround time of blood sampling to dose delivery in an NHS hospital is assessed.

Creation and evaluation of a cancer chemotherapy order review guide for use at a community hospital

  • Alexandra P PunkeJ. Waddell
  • Medicine
    Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners
  • 2019
A step-by-step chemotherapy order evaluation guide with a detailed explanation for each step was created to evaluate non-oncology trained pharmacists' ability to accurately review simulated chemotherapy orders post-education using the guide.

Assessment of renal function in clinical practice at the bedside of burn patients.

Renal function was assessed using serum creatinine, 24 h urinary CL(CR), and the Cockcroft-Gault, Robert, Kirkpatrick and simplified MDRD equations and it was shown that the formulae currently used to calculate creat inine clearance on the basis of serum creatInine are inadequate for use in burn patients, and they should be abandoned in favour of direct measurement from a 24 h urine collection.

Basic elements of applied pharmacology in the intensive care unit

The care of critically ill patients often requires the use of many sophisticated techniques, including mechanical ventilation, invasive cardiac monitoring, continuous renal replacement, and a variety

Evaluation of a Digoxin Pharmacokinetic Monitoring Service in a Community Hospital

Clinical pharmacist intervention was found to be associated with significant changes in patient outcomes, including length of stay and morbidity, and the cost of the PKS was offset by savings resulting from the reduction in digoxin assays alone.

Optimizing antimicrobial dosing in the critically ill patient

Some of the principles required to optimize antimicrobial dosing are discussed and recently obtained data regarding its application to the critically ill patient is discussed.

A pre–postintervention study to evaluate the impact of dose calculators on the accuracy of gentamicin and vancomycin initial doses

It is suggested that gentamicin and vancomycin dose calculators significantly improved the prescribing of initial doses of these agents, and healthcare organisations should consider using such CDS tools to support the prescribe of these high-risk drugs.

Dosing of medications in morbidly obese patients in the intensive care unit setting

There is a paucity of data upon which to make recommendations for dosing commonly used medications in the morbidly obese patient in the ICU, although recommendations were provided based on the available information.



Dosage of gentamicin for pseudomonas infections.

Since acceptance on the obstetric list for new applicants is now almost entirely confined to those with postgraduate obstetric experience, it is clear that the future general-practitioner maternity service will show an increasing proportion of general- Practitioner obstetricians with special interest and skill.

Renal insufficiency associated with gentamicin therapy.

The results suggest that all patients treated with gentamicin deserve more adequate monitoring of renal function and point out the need for large scale studies to identify those patients with the greatest risk of nephrotoxicity.

Ototoxicity of gentamicin in man: a survey and controlled analysis of clinical experience in the United States.

The risk of ototoxicity should not prevent proper treatment with gentamicin and the dose (in mg/kg per day) was the major factor in treatment and the only significant one in patients with normal renal function.

Parenteral administration of gentamicin in renal failure: patients undergoing intermittent haemodialysis.

Thus in normal subjects or patients with impaired renal function injection of 40 mg. of gentamicin fails in the majority of cases to produce serum levels reaching the minimum inhibitory concentration

Possible nephrotoxicity of gentamicin.

Although clinical evidence suggests that Gentamicin adversely effects the kidneys, the nephrotoxicity of gentamicin could not be reproduced in experiments and a common physiologic setting or interaction of drugs that might contribute to the renal failure was defined.

Elimination of tritiated gentamicin in normal human subjects and in patients with severely impaired renal function

Evidence is presented that a certain amount of intravenously administered gentamicin is excreted as a coniugated metabolite, and Pharmacokinetic considerations indicate that usage of such nomograms in patients with moderately reduced or normal renal function may lead to inadequate serum concentrations of the drug.


A laboratory and clinical evaluation was made of gentamicin sulfate which is a new antibiotic produced by a species of the genus Micromonospora . It has a broad spectrum that includes both

Correlation of serum creatinine concentration and gentamicin half-life.

Kinetic analysis predicts that repetition of this loading dose every third half-life will result in therapeutic, nontoxic serum levels in patients with renal failure and an alternate approach using a constant dose interval but varying the quantity of drug can be predicted from a nomogram.

Nephrotoxicity of aminoglycosides and gentamicin.

Gentamicin is a new antibiotic in a category with the aminoglycoside antibiotics kanamycin and neomycin as well as streptomycin, colistimethate and polymyxin B. For this reason its potential toxicity