Clinical Pharmacokinetic Service Research Articles

A computer system for the storage and retrieval of clinical pharmacokinetic data

A computer system is described which stores patient data relating to clinical pharmacokinetic assessments made by clinical pharmacists, who are participating in a clinical pharmacokinetics service. The system was developed to assist in the documentation of service activities and storage of patients' pharmacokinetic data. An additional component of the system is the ability for retrospective review of the stored data. Applications of this system to the derivation of new information on drug pharmacokinetics and drug efficacy/toxicity in various patient groups is discussed. The implications for Phase IV drug studies and toxicity screening studies is also described.

Collaborative clinical pharmacokinetic services

A program for routine pharmacokinetic interpretation of serum analyses of gentamicin, tobramycin, amikacin, phenytoin, phenobarbital, theophylline, lidocaine, digoxin, quinidine, and procainamide at the Medical University of South Carolina Hospital is described. Results of all analyses of serum for the drugs listed are evaluated by a pharmacist trained in clinical pharmacokinetics. Patient variables relevant to the determination of drug serum concentrations, drug elimination, distribution, and dosage are given appropriate consideration in each evaluation. A summary of the pharmacokinetic interpretation and any necessary modification of drug dosage regimens are then written into the progress notes of the patients' medical records. Approximately 12 patients and 20 drug concentrations are evaluated each day. The average charge for te service is +35. This service, which is reimbursed by third-party carriers, has resulted in improved use of laboratory personnel, equipment, and time and has provided a framework for education and research as well as a mechanism for direct contributions to patient care by the pharmacist.

Automated pharmaceutical assistance systems. I. Clinical pharmacokinetics. II. Drug interference with laboratory tests results.

The function of the clinical pharmacokinetic service (CPS) in University Hospital is described. A methodological procedure was developed for routine interpretation of specified drug serum levels. Work lists that identify analytical procedures to be included for clinical pharmacokinetic evaluation are prepared daily. The results of all analyses of serum drug levels are evaluated by a pharmacist who is trained in clinical pharmacokinetics. Patient variables that influence serum levels of drugs are mathematically manipulated by program logic. Projections of expected drug levels as a result of dosing regimens are made and compared to measured laboratory results. Iterative programming that modifies projections on the basis of actual measurements is employed to determine individual drug dosing regimens that provide therapeutic/nontoxic serum levels of drugs. The drug/test interference system, which accesses the CPS data base, provides information concerning the potential physiologic, therapeutic, or toxic effect of drugs on biochemical substances. The system allows display of data concerning each drug before it is administered. Information concerning the date and time of initiation and termination of drug therapy allows for a warning comment to be attached automatically to the appropriate laboratory test result if interference is indicated.

Cost of individualizing aminoglycoside dosage regimens

The estimated annual costs associated with operating a clinical pharmacokinetics service within a 450-bed, metropolitan county hospital were studied. Using three aminoglycoside serum level determinations, a computer program estimates the patient's pharmacokinetic variables and calculates a dosage regimen which will maintain serum concentrations in the desired range. Pharmacists are involved in assessing the patient's initial clinical condition and in recommending doses and dosing intervals. Fixed costs included the costs of the physical facility and office equipment ($778/yr). Operating costs included salaries, equipment leasing fees, journal subscription fees and medical supplies ($73,915/yr). The estimated cost per blood sample analyzed for aminoglycoside content was $17.35/sample (4,305 samples/yr). The study provides a basis for comparing the cost of operating a pharmacokinetics service with the cost of other innovative pharmaceutical services.

Clinical Pharmacokinetic Service and Research — Present Status and Future Goals at SUNY-Buffalo

Clinical Pharmacokinetic Service and Research — Present Status and Future Goals at SUNY-Buffalo

Pharmacokinetics in Clinical Practice

The pharmacokinetic concepts introduced and defined in a preceding article are now applied to the management of drug therapy for the individual patient. The factors that affect the time course of drug concentrations in plasma produced by repetitive administration include the dosing rate, total clearance, biologic half-life, and systemic availability of the drug. A clinical pharmacokinetics service can monitor drug concentrations in biologic fluids, design individualized drug-dosing regimens, and carry out pharmacokinetic diagnostic work-ups to help determine the reasons for a patient's unusual response to drug therapy.