🛑 piperacillin tazobactam

✅Based on PK data and the prescribing information, patients on IHD should receive 2.25 g every 8 hours for nosocomial pneumonia and 2.25 g every 12 hours for all other indications. There have been case reports of neurotoxicity in patients on IHD receiving 2.25 g every 6 hours
✅ In patients on CRRT, the risk of treatment failure in patients receiving ≤ 9 g/day is increased
✅Total daily doses should exceed this amount when the MIC <32 mg/L.

✅Recent studies have established a link between higher rates of AKI when piperacillin/tazobactam and vancomycin are given concomitantly

🛑 Vancomycin

✅When dosing vancomycin in IHD patients, there are two general dosing methods that are employed: using mg/kg (intermittent) dosing when pre-IHD concentrations are in the therapeutic range and using fixed doses after each IHD based on defined ranges of pre-IHD vancomycin concentrations or the patients weight. Although intermittent dosing may be more convenient in the inpatient setting, fixed hemodialysis dosing may be more convenient for outpatients

🛑heparin

✅Heparin Kinetics
Heparin is metabolized in the liver and reticuloendothelial system
✅After subcutaneous administration, 20–44% of the dose is absorbed systemically and largely remains in the intravascular space
✅. At therapeutic IV doses, heparin is eliminated via nonrenal mechanisms. However, at very high doses, heparin is renally eliminated and the half-life is increased in patients with renal impairment


✅ No dosage adjustments are required due to the nonrenal elimination at therapeutic doses. In patients who are receiving heparin for treatment of VTE, activated partial thromboplastin time (aPTT) should be monitored without concern for renal impairment impacting the level.

Cardiovascular drugs in renal impairment

🛑Routine maintenance fluid

✅25–30ml/kg/day of water and approximately 1 mmol/kg/day of potassium[3], sodium and chloride and approximately 50–100g/day of glucose to limit starvation ketosis.

✅When prescribing for routine maintenance alone, consider using 25–30 ml/kg/ day sodium chloride 0.18% in 4% glucose with 27 mmol/l potassiumon day 1 (there are other regimens to achieve this)
✅. Prescribing more than 2.5 litres per day increases the risk of hyponatraemia.

✅Consider prescribing less fluid (for example, 20–25 ml/kg/day fluid) for patients who:
✅are older or frail
✅have renal impairment or cardiac failure
✅ are malnourished and at risk of refeeding syndrome

#NIC

#remember
✅Folate supplementation may help prevent hepatotoxicity in patients taking methotrexate but does not substitute for ongoing monitoring and appropriate MTX dose adjustments if transaminase elevation occurs

Medication dose for H .pylori treatment in children

#remember
#Drug-induced thrombocytopenia
✅Severity of thrombocytopenia – The thrombocytopenia in.Drug-induced thrombocytopen(DITP) is often severe, with a nadir platelet count <20,000/microL
✅ An exception is heparin-induced thrombocytopenia (HIT), in which the median nadir platelet count is approximately 60,000/microL and platelet counts <20,000/microL are rare
#Uptodate

🛑كيف نفرق بأن Thermbocytopenia في مريض العنايه انه ممكن بسبب DIC او drugs؟؟
✅طبعا اشهر  سبب ل DIC اما sepsis او Malignancy

✅ال thermbocytopenia التي بسبب DIC غالبا تكون مرافقة ل زياده في PT و PTT و D dimer مع نقص في fibrinogen  اضافه إلى نقص في الصفائح يكون mildly to moderately نادرا مايكون sever (الصفائح تكون أقل من 20000 وهذا على العكس اذا كان thermbocytopenia بسبب ادويه غالبا تكون sever thermbocytopenia  بإستثناء الهيبارين طبعا
#UpTodate2023

اللهم في يوم الجمعة وفي هذا اليوم المبارك احفظ أهلنا في غزة بحفظك
دعواتكم لغزة وأهل غزة

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دعواتكم لها ولجميع سكان غزه
والذي عنده خبر عنها يطمنا

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