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Steroid pharmacokinetics: An “overlooked” issue of steroid metabolism in acute and chronic disease

References 1. Sefar S, Degoricija V. About drug dialyzability. Acta Clin Croat 2003;42:257-26. 2. Al-Habet SM, Rogers HJ. Methylprednisolone pharmacokinetics after intravenous and oral administration. Br J Clin Pharmacol 1989;27:285-90. 3. Venkatesh B, Myburgh J, Finfer S, Webb SA, Cohen J, Bellomo R, et al. The ADRENAL study protocol: Adjunctive corticosteroid treatment in critically ill patients with septic shock. Crit Care Resusc 2013;15:83-8. 4. Frey BM, Frey FJ. Clinical pharmacokinetics of

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Treatment of ventilator-associated pneumonia with high-dose colistin under continuous veno-venous hemofiltration

the 1970s because of significant renal and neurological toxicity. [ 4 ] At present, COL is increasingly put forward as salvage or first-line treatment for severe MDR-GNB infections, particularly in the ICU. [ 5 ] COL is administered intravenously as the inactive prodrug colistimethate sodium (CMS) that is hydrolyzed to COL. From a pharmacodynamic/pharmacokinetic (PK/PD) viewpoint, COL possesses rapid concentration-dependent bacterial killing against susceptible strains, but the ratio of the area under the concentration time curve of the unbound fraction to the

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Vitamin C dosing during continuous renal replacement therapy: The last word is not said!

To the editor Pharmacokinetic and dose-response data suggest a vitamin C (vit C) dose largely exceeding 3 g daily in critically ill patients. We recently proposed higher vit C dosing in cardiac arrest patients who require continuous renal replacement therapy (CRRT).[ 1 ] In a reaction, Spoelstra-de Man et al . rebutted that increasing the vit C dose above 2 g/day during continuous veno-venous hemofiltration (CVVH) was unnecessary when normal plasma vit C concentrations are targeted. They based their standpoint on calculating less vit C removal during CVVH

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Continuous renal replacement therapy allows higher colistin dosing without increasing toxicity

References 1. Spapen HD, Jacobs R, Van Gorp V, Troubleyn J, Honoré PM. Renal and neurological side effects of colistin in critically ill patients. Ann Intensive Care 2011;1:14. 2. Bergen PJ, Li J, Rayner CR, Nation RL. Colistin methanesulfonate is an inactive prodrug of colistin against Pseudomonas aeruginosa.Antimicrob Agents Chemother 2006;50:1953-8. 3. Couet W, Grégoire N, Marchand S, Mimoz O. Colistin pharmacokinetics: The fog is lifting. Clin Microbiol Infect 2012;18:30-9. 4. Yahav D

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Direct acting anti-hepatitis C virus drugs: Clinical pharmacology and future direction

approved in combination with PegIFN-alpha and ribavirin for the treatment of chronic HCV genotype 1 infection in 2011. [7] However, these drugs have been reported to have several drug-drug interactions, and are largely replaced with newer DAA including Simeprevir, Paritaprevir, Daclatasvir, Ledipasvir, Ombitasvir, Sofosbuvir and Dasabuvir. Table 3 summarizes the pharmacokinetics of all approved DAA with special reference to the sites of drug-drug interaction. Clinical pharmacology of the newer DAA will be discussed in the next section. Table 3 Pharmacokinetics

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Multidisciplinarity in emergency and critical care medicine: Specific care is best care!

. Endocrinology in Intensive Care Medicine: New Insights and Therapeutic Consequences. Verh K Acad Geneeskd Belg 2002;64:167-87. 16. Amer MR, Akhras NS, Mahmood WA, Al-Jazairi AS. Antimicrobial Stewardship Program Implementation in a medical intensive care unit in a tertiary hospital in Saudi Arabia. Ann Saudi Med 2013;33:547-54. 17. Honore PM, Jacobs R, Spapen HD. Impact of altered antimicrobial pharmacokinetics on antimicrobial dosing during extracorporeal membrane oxygenation. Annu Update Intensive Care Emerg Med 2014;34 [In Press

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Current status of in vitro and in vivo antifungal activities of posaconazole

posaconazole in experimental models of invasive fungal infections. Mycoses 2006;49:S7-16. 14. Petraitiene R, Petraitis V, Groll AH, Sein T, Piscitelli S, Candelario M, et al. Antifungal activity and pharmacokinetics of posaconazole (SCH 56592) in treatment and prevention of experimental invasive pulmonary aspergillosis: Correlation with galactomannan antigenemia. Antimicrob Agents Chemother 2001;45:857-69. 15. Graybill JR, Hernandez S, Bocanegra R, Najvar LK. Antifungal therapy of murine Aspergillus terreus infection. Antimicrob Agents

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Timing of anticoagulation for portal vein thrombosis in liver cirrhosis: An Italian internist’s perspective

favorable data on the DOACs but they are not licensed for this indication yet. However, it should be remembered that rivaroxaban is contraindicated in patients with advanced cirrhosis (Child class B and C), after a pharmacokinetic study showed increased rivaroxaban concentrations in patients with moderate hepatic impairment;[ 32 , 33 ] while apixaban has the highest percentage of hepatic metabolism (up to 73%) and therefore should be used with caution in patients with mild or moderate liver impairment (Child class A and B), it is not recommended in patients with severe

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Aspirin resistance in coronary heart disease: Current understandings and strategies

the definition, mechanism, clinical impacts, detection, and intervention of aspirin resistance. Definition of Aspirin Resistance The concept of aspirin therapy response variability is mainly based on specific pathophysiological mechanisms, pharmacokinetics, and/ or pharmacodynamics by which aspirin works. aspirin resistance may be simply one of potential causes leading to interindividual variability in the response to aspirin. [ 1 ] In 2009, the Working Group on Thrombosis of the European Society of Cardiology released a position paper on interindividual

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Successful pharmacotherapy for multiple acute decompensation events in a cirrhotic patient with acute-on-chronic liver failure: A case report

Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis Indian J Crit Care Med 1992 20 864 74 11 Seymour CW, Rosengart MR. Septic Shock: Advances in Diagnosis and Treatment. JAMA 2015; 314: 708-17. 10.1001/jama.2015.7885 Seymour CW Rosengart MR Septic Shock: Advances in Diagnosis and Treatment JAMA 2015 314 708 17 12 Wiseman LR, Wagstaff AJ, Brogden RN, Bryson HM. Meropenem. A review of its antibacterial activity, pharmacokinetic properties and clinical efficacy. Drugs 1995

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