Background/Aims: Pharmacotherapy in critically ill patients receiving continuous renal replacement therapies (CRRT) is challenging due to the lack of published information to base dosing regimens. Methods: Daptomycin’s transmembrane clearance during continuous hemofiltration and hemodialysis was assessed using an in vitro model with AN69 and polysulfone hemodiafilters at varying ultrafiltrate and dialysate flow rates (1, 2, 3 and 6 l/h). Results: During continuous hemofiltration, mean daptomycin sieving coefficient ranged from 0.14 to 0.20. Transmembrane clearances were significantly different between filter types for ultrafiltration rates of 2, 3 and 6 l/h. For continuous hemodialysis, mean daptomycin saturation coefficient ranged from 0.05 to 0.15. AN69-based daptomycin clearances were significantly lower than polysulfone values at dialysate flow rates of 2, 3 and 6 l/h. Conclusion: The extent of daptomycin’s transmembrane clearance is dependent on hemodiafilter type, dialysate and ultrafiltration rates. CRRT with high ultrafiltrate or dialysate rates may result in substantial daptomycin clearances.

Background. Continuous renal replacement therapy (CRRT) increasingly is being used to treat critically ill patients with renal disease. CRRT removes waste products but also nutrients. Our understanding of trace element CRRT clearance has been limited by poor assay sensitivity. The development of inductively coupled plasma mass spectrometry (ICP–MS) allows for the measurement of CRRT trace element removal.

While pharmacy education updates learning as new information arises, changes to learning experiences can trail behind current practices and technology. There have been multiple calls for radical changes in how health professions education is delivered in order to ensure patients are receiving high-quality care. Competency-based education (CBE) has been one way discussed in the literature for how to handle this need to develop students who have a willingness to learn and can problem solve. The goal of this review is to examine whether CBE is needed to drive the profession of pharmacy forward. To address, we collaboratively to identified stakeholder perspectives to evaluate the need. The following stakeholders achieved consensus among the committee members: patients/society, learners, workplace/profession, and academic institutions. Based on those perspectives, needs and gaps to address those needs were identified and are presented in this review.

Background. In 2006, there were 16 796 toxic exposures attributed to valproic acid (VPA), carbamazepine (CBZ) and phenytoin (PHT) reported to the US Toxic Exposure Surveillance System. Of these, 30% (5046) were treated in a health care facility with 12 cases resulting in death. These drugs are highly protein bound and poorly dialyzable; however, it has been suggested that albumin-supplemented dialysate may enhance dialytic clearance. We investigated whether the addition of albumin to dialysate affects dialytic clearance of VPA, CBZ and PHT.

Purpose The physical compatibility of 4% sodium citrate with vancomycin, gentamicin, tobramycin, daptomycin, and linezolid was evaluated. Methods Admixtures were prepared by mixing 4% sodium citrate with clinically relevant concentrations of antimicrobial agents (vancomycin 5 mg/mL, vancomycin 10 mg/mL, vancomycin 20 mg/mL, daptomycin 5 mg/mL, gentamicin 2.4 mg/mL, tobramycin 2.4 mg/mL, and linezolid 1 mg/mL). Three samples of each admixture were incubated (1) at 22–23 °C and exposed to light, (2) in a water bath at 37 °C and exposed to light, (3) at 22–23 °C and protected from light, and (4) in a water bath at 37 °C and protected from light. Visual compatibility, spectrophotometric absorbance, and pH were evaluated immediately after mixing (baseline) and at 8, 24, and 48 hours. Physical compatibility was defined as the absence of visible precipitation, a pH value at 48 hours that did not vary by more than 10% from baseline, and an absorbance value of <0.015. Results There was no visual evidence of precipitation and no clinically important changes in pH observed during the 48-hour study period in any admixture. However, turbidity, based on absorbance, was noted with vancomycin 20 mg/mL at each time point. Conclusion No evidence of incompatibility was observed when vancomycin 5 mg/ mL, vancomycin 10 mg/mL, daptomycin 5 mg/mL, gentamicin 2.4 mg/mL, tobramycin 2.4 mg/mL, or linezolid 1 mg/mL was mixed with 4% sodium citrate as might occur in an antimicrobial lock. Vancomycin 20 mg/mL mixed with 4% sodium citrate displayed spectrophotometric evidence of incompatibility.