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cyclosporine t 1/2
- adults no liver failure = 10
- adults w/ liver failure = 20
- children < 16 yo = 6
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which body weight do you use for cyclosporine
all the normal body weight calculations
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how is cyclosporine dosed
BID
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tacrolimus Vd & F
- adults = 1L/Kg
- < 16 yo = 2.6L/Kg
- 0.25
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which body weight do you use for tacrolimus
actual body weight
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tacrolimus t 1/2
- adults no liver failure = 12
- adults w/ liver failure = 60
- children < 16 yo = 12
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what strengths does cyclosporine come in
25 & 100 mg
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what strengths does tacrolimus come in
0.5,1,5mg
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which body weight do you use for lithium
actual
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therapeutic range of carbamazapine
4-12 mg/L
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which weight do you use for carbamazapine
ideal body weight
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therapeutic range of phenytoin
10-20 mg/L
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formula for adjusted concentration of phenytoin w/ altered albumin w/o renal failure
measured total concentration/ [(0.2 x albumin) + 0.1]
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formula for adjusted concentration of phenytoin w/ altered albumin w/ renal failure (CrCl < 10 ml/min)
measured total concentration / [(0.1 x albumin) + 0.1]
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therapeutic range of valproic acid
50 - 100 mg/L
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Dose related adverse reactions of cyclosporine
- hypertension
- neurotoxicity
- nephrotoxicity
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other adverse reactions of cyclosporine
- nausea
- gingival hyperplasia
- hirsutism
- opportunistic infections
- malignancies
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what 3 meds could cause compounding nephrotoxicity with cyclosporine
- NSAIDS
- aminoglycosides
- tacrolimus
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effects of food on cyclosporine
increased fat in meals = increased absorption
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another name for tacrolimus
FK506
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4 dose related adverse effects of tacrolimus
- nephrotoxocity
- neurotoxicity
- hypertension
- post-transplant diabetes (20%)
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4 other adverse reactions of tacrolimus
- hyperkalemia
- hypomagnesemia
- myocardial hypertrophy
- alopecia
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effects of antacids on tacrolimus
decrease concentrations
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effects of food on tacrolimus
decreases rate and extent of absorption
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affects of renal failure on cyclosporine and tacrolimus
none
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lithium onset of action and complete therapeutic effect
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what effects on lithium for
dehydration
diuretics
NSAIDs
Theophylline
- increase reabsorption
- decrease clearance
- decrease clearance
- increase clearance
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typical starting dose of lithium
900-2400 mg/day given TID
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black box warning for carbamazapine
- serious dermatologic reactions
- HLA-B 1502 allele
- aplastic anemia
- agranulocytosis
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most common adverse effects from carbamazapine
- CNS
- nystagmus
- ataxia
- blurred vision
- drowsiness
teratogenic
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affect of uremic pts on carbamazapine
significant increase in free concentrations
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what enzymes does carbamazepine induce
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affects of carbamazepine on warfarin
induces metabolism
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affects of carbamazepine on simvastatin
greatly decreases concentration
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when is autoinduction usually assumed to be done with carbamazapine
5-7 days
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how often do you increase the maintenance of carbamazapine
1-2 week intervals
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long term side affects not related to plasma phenytoin concentrations
- gingival hyperplasia
- folate deficiency
- peripheral neuropathy
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CNS side effects related to phenytoin levels
- far lateral nystagmus > 20mg/L
- ataxia & diminished mental capacity>30-40mg/L
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3 factors that significantly alter the plasma protein binding of phenytoin
- hypoalbunemia
- renal failure
- displacement of other drugs
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3 suggestions for phenytoin dose increases based on Css levels
- <7mg/L = 100mg/day
- 7-<12 mg/L = 50mg/day
- >12 mg/L
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what is the dose limiting affect for valproic acid
GI - N/V, diarrhea, abdominal cramps
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what are elevated levels of valproic acid associated with
hepatotoxicity
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what affect does food have on valproic acid
slow the rate of absorption
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what happens when valproic acid levels exceed 50mg/L
binding to albumin is saturated
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therapeutic range of digoxin for HF
0.5-0.9 ng/ml
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therapeutic range of digoxin for Afib
0.5-2.0 ng/ml
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bioavailability of digoxin dose forms
- IV - 1
- tablet - 0.7
- elixir - 0.8
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explain the distribution of digoxin
equate with cardiac and skeletal muscles but not so much in to adipose tissue
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average Vd of digoxin
7 L/kg
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primary elimination route of valproic acid
hepatic
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primary elimination route of digoxin
renal - 70%
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average half life of digoxin
1-2 days - 36 + 8 hrs
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loading doses of digoxin are useful for what state
AFib
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what strengths does digoxin come in
- tabs - 125,250
- IV - 250 mcg/ml
- elixir - 50 mcg/ml
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loading dose of digoxin
- rapid = PO - 500mcg: 250mcg, wait 4-6 hrs, 125mcg, wait 4-6 hrs, 125 mcg
- rapid = IV - 375 mcg: 125mcg wait 4-6 hrs, 125mcg, wait 4-6 hrs, 125 mcg
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what meds would you 1/2 the dose of digoxin in
- quinidine
- verapamil
- amiodarone
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what would decrease Vd in digoxin
- renal disease
- hypothyroidism
- quinidine
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what would increase Vd in digoxin
hyperthyroidism
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what would decrease Cl in digoxin
- hypothyroidism
- amiodarone
- quinidine
- verapamil
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what would increase Cl in digoxin
hyperthyroidism
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what would decrease toxicity in digoxin
- hyperkalemia
- hyperthyroidism
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what would increase toxicity in digoxin
- hypocalemia
- hypomagneseia
- hypothyroidism
- hypercalcemia
- renal dysfunction
- quinidine
- amiodarone
- verapamil
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affects of food on digoxin
- decreased peak concentrations
- meals containing high fiber or pectin may decrease oral absorption
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