Let's start with a patient case. A patient on
hemodialysis (M/W/F) is admitted to the hospital with cellulitis who also meets
sepsis criteria. He has a history of an
MRSA infection during a previous admission so you want to initiate vancomycin
at this time. The patient is 76 kg and
still makes some urine. What dosing
strategy should you choose and when/should vancomycin concentrations be
monitored?
The management of
anticoagulant therapy is an important component of the treatment of various disease
states. Maintaining the narrow therapeutic range required for the safe and
effective use of warfarin is essential to avoid suboptimal dosing and adverse
events. Numerous drug interactions with warfarin are present due to alterations
in absorption, distribution, and metabolism.
The severity of interactions with warfarin varies greatly and dictates
very different recommendations for management and monitoring. In the most
insignificant interactions, no change in dosage or monitoring is necessary, whereas
some interactions require a significant empiric reduction in warfarin dosage
and close monitoring of INR.
