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MKSAP Questions

on July 30, 2024

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Vancomycin Dosing

hi this is Elissa critical care pharmacy resident and my clinical pearl today we'll cover vancomycin monitoring and the transition from traful new monitoring to monitoring of the AUC or area under the curve briefly vancomycin Vancomycin is a glycol pop type antibiotic and it's been FDA approved now for more than five decades banco Meissen is used mainly for broad-spectrum gram-positive coverage especially of more resistant microorganisms such as methicillin-resistant Staph aureus the main side effect I want to pull out is nephrotoxicity and this generally occurs when vancomycin is used at higher doses so when we target a trough of 15 to 20 when vancomycin is used for a long period of time or when a patient is also receiving other nephrotoxic medications such as pepper cilenti's of Actium we're all familiar with vancomycin trough only monitoring as this is really what we've done in recent years targeted trough anywhere from 10 to 20 but typically 15 to 20 when we...

PHEWAS

PHEWAS today we're talking about genome-wide Association so first we're gonna start with why multi phenotype associations what is motivation and then we're going to look at different ways of dealing with multiple phenotypes on one hand dealing with G was and epigenomics across many phenotypes looking at if genomics or feliz and then looking at meta phenotype inference image and imputation from the clinic correct so first of all why multi phenotype analysis so basically what are they trying to do on one hand you know associations Association testing has been typically between you know genetic variants and a single trait every single example we looked at so far it was basically looking at a single variable and how it varies across hundreds of thousands of individuals but that one single variable as opposed to an increasing trend to have really truly much richer in note a big data so instead of measuring a single variable across individuals what you can do is actually measur...

Valproic Acid Toxicity

Summary: VPA - VPA lvls nml 50-125, Hyperammonemia, hyperNa, HypoCa, AGMA. SE: Seizures / intubation w/ lorazepam 2mg IV. Txt: Activated charcoal 1g/kg. Naloxone / L carnitine supplementation 100mg/kg IV loading dose, 300 BID, HD VPA > 1300, cerebral edema, shock, coma + VPA > 900, pH < 7.10 SUMMARY AND RECOMMENDATIONS ●Clinical features – Valproic acid (VРA) is widely used to treat seizures and other disorders. The majority of patients with acute VРΑ poisoning experience mild to moderate lethargy and recover uneventfully. Central nervous system (CNS) dysfunction is the most common manifestation of VPΑ toxicity, ranging in severity from mild drowsiness to сomа or fatal cerebral edema. The onset and progression of CNS depression is usually rapid, but may be delayed with ingestion of delayed release preparations. A summary table to facilitate the emergency management of VΡΑ overdose is provided (table 1). Other clinical findings following overdose can include:Vital signs – Respi...

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