Off-Label Drug Uses

from Hospital Pharmacy Journal Dec 09

Gabapentin: Cholestatic Pruritis
in adults with chronic, severe, refractory cholestatic pruritus
Initial dose at 100mg tid for 3 days then adjust dose based on tolerance and efficacy
Max dose = 2400mg per day in divided doses.
Total duration of therapy = 4 weeks

Drug/Substance Abuse

Drug abuse is a serious public health problem that affects almost every community and family in some way. Each year drug abuse results in around 40 million serious illnesses or injuries among people in the United States.


Factors


Trends in Drug Abuse (Ref: NIDA)

The National Survey on Drug Use and Health (NSDUH) supported by the Substance Abuse and Mental Health Services Administration also tracks drug use in populations aged 12 and older. Both surveys (MTF and NSDUH) indicate that disturbing patterns in overall drug use are still evident.

• An estimated 19.5 million Americans aged 12 or older were current users of an illicit drug in 2003. This estimate represents 8.2 percent of the population.²
  
• Over half (51%) of America’s teenagers have tried an illicit drug by the time they finish high school.¹
  
• An estimated 71 million Americans reported being current users of a tobacco product in 2003, a prevalence rate of 30% for the population 12 years and older.²
  
• Marijuana is the most widely used illicit substance in this country. In 2003, 14.6 million people were current users of marijuana.²
  
• For the second year in a row inhalant use has increased in 8th graders with 17.3% reporting use at least once in their lifetime. These drugs are particularly dangerous because they can damage the nervous system even after a single use, and they can be fatal.

Reference Cards : Hematology Lab Differentials

http://www.med-ed.virginia.edu/pda/refcards/HemLab/index.htm

All basic info about lab values.

Antibiotic dosing in CRRT patients

Continuous renal replacement therapy or CRRT is frequently used to treat patients with acute renal failure or chronic renal failure.

Ref: University of Pennsylvania Health System - Renal Electrolyte and Hypertension Division
http://www.uphs.upenn.edu/renal/important%20pdf%20II/CRRT%20antibiotic%20dosing.pdf

UCSF: Infectious Diseases Management Program

Updated antimicrobial guideline in Adults, Pediatrics.
Latest updated 03/06/09

Very good for quick reference. Click Here

The Heart dot Org - part of WebMD

contains anything from ACS, HTN, HF to surgery guideline
plus related news update quite often

http://www.theheart.org/

good for practical guidelines and cool Video CME lectures

U of Penn - Department of Medicine - Educational Resources

http://www.uphs.upenn.edu/medicine/education/residents/educationalResources/index.html [not working]
http://pennfm.pbworks.com/Intern-Survival-Guide

Intern Survival Guide
Clinical Guidelines
Textbooks and Journals
Other Links


2006

L-Carnitine in VPA overdose

L-carnitine supplementation is recommended for patients with CNS depression, evidence of hepatic dysfunction, and hyperammonemia with dosing ranging from 50 to 100 mg/kg/day up to a maximum dose of 2 g/day.
L-carnitine's mechanism of action is thought to be related to its ability to decrease elevated ammonia levels, which may contribute to development of coma in VPA toxicity. Its use remains investigational but can be considered in patients (such as ours) with coma, elevated ammonia levels, and hepatic dysfunction.[1] In our patient, we elected to start her on L-carnitine at 100 mg/kg/day in an attempt to correct her hyperammonemia and encephalopathy. This therapy was continued until her serum ammonia and VPA levels had normalized.

Other Tx for VPA overdose;
Supportive, naloxone, hemodialysis, hemoperfusion

Ref: Medscape
http://www.medscape.com/viewarticle/445062_print