Based on input from one of our visitors (below), a new vancomycin
program was created:
Loren Trager, PharmD, BCPS, CDE
Advanced Practice Pharmacist
Tuba City Regional Health Care Corporation
Tuba City, AZ
This new program can be used to determine when to administer the
next dose of vancomycin after a supratherapeutic trough is
obtained. An estimated elimination rate constant is
generated from the creatinine clearance which is then used to
determine the timing of the next dose based on the desired target
I also updated our current trough calculator to
also generate an estimated vancomycin kel value based on the creatinine
clearance. Use this program if the vancomcyin level is drawn early and you want to
estimate the actual trough just before the next dose to
determine if the current regimen is appropriate -
link to new program.)
New calculators/tools have been released that focus on the latest
cholesterol treatment protocols as well as the calculation of the
estimated 10 year and lifetime risks for atherosclerotic cardiovascular
(ASCVD). Actually much of the work for these new programs was
completed in 2013, however, the final development was wrapped up this
Oxalate Content Calc -
Lists the oxalate content of multiple food items to help manage
overall oxalate intake.
April 30, 2014
Several updates will be released in the coming weeks including
significant revisions and additions to the infectious disease drug list.
A new index page was created
for the infectious disease drug tables.
April 26, 2014
A quick access page was created for
the multiple drug tables. It should be much easier to find the needed
In the coming weeks, a quick review of the current infectious
disease section will be completed. Also, some
modifications will likely be made to the hypocalcemia calculator.
New navigation scheme: a possible quick access tool may be created
for the multiple drug tables to help facilitate the location of a
specific drug category.
June 25, 2013
1] Comments were unintentionally omitted from the Multi-CRCL calc
regarding handling of underweight patients (ABW<IBW). Omission was
reported by Dr. Sudduth --> Heather Sudduth, PharmD, CGP,
Clinical pharmacy specialist at the Richmond VAMC.
The following comments will appear in the 'Warnings' section whenever
this condition is met:
[Program used ACTUAL weight in the calculation of the Cockcroft and
Gault - IBW equation since it is LESS than the IBW. - Notice below that
the result for this equation is the same as the Cockcroft and Gault -
actual body weight].
April 13, 2013
Significant improvements have been made to our very popular
opioid conversion calc. Users will
now be able to modify the dosing factors that are associated with
methadone conversions. We also added additional dosing schemes
including the Friedman/McPherson and Fudin approaches. The Fudin
equation significantly reduces the dramatic fluctuations in the converted
methadone dose that can occur around the breakpoints in the most common
nomograms - e.g. Ayonrinde, Ripamonte, etc.
Mathematical Model For Methadone
Fudin Factor graphically
compared to Ripamonte, Ayonrinde, and
Last month we created a new
page that should help locate a particular drug table.
Site-wide search capability:
Occasionally, the large search bar at the top of page may not provide
links to recently developed material. Alternatively, users may
find the Google search functionality much more effective:
Google Site Search
October 01, 2012
Basal Metabolic Rate (BMR) Calculators:
Several of these calculators may be particularly useful for dieters. Just about every single MAJOR calorie/ energy equation that has been released over the last 90 years is included below. Each calculator has a customized printout option for easy analysis. Recommendation: Try each calculator - print out the results - then compare!
Estimated 'Calorie' Calculators
Estimation of total calories needed. MOST widely used equation for calculating basal metabolic rate and total calories.
Revised Harris-Benedict Equation: The original Harris Benedict equation was revised in 1984. This updated equation can be used to calculate the basal metabolic rate and total calories.
RESTING Metabolic Rate (RMR)
Resting Metabolic Rate Calc - This equation can be used to calculate the RESTING metabolic rate and total calories. Mifflin-St Jeor equation. Schofield equation (BMR)
This equation was part of the previous government guidelines to formulate RDA's and can be used to calculate the basal metabolic rate and total calories needed.
Institute of Medicine Equation- LATEST EQUATION:
IOM Equation-Estimated Energy Requirement (EER) Estimation of total calories needed. This equation is behind the 2005 Dietary Guidelines for Americans and the new food pyramid, MyPyramid.
exp [0.613 + (0.425 x BSA) - (0.0075 x
age) + (0.156 x African-American race) + (0.216
x target INR) - (0.257 x amiodarone) + (0.108 x smokes) + 0.0784 x DVT/PE ]
Reference: Gage BF, Eby C, Johnson JA, Deych E, Rieder MJ, et al.
Use of pharmacogenetic and clinical factors to predict the therapeutic
dose of warfarin. Clin Pharmacol Ther. 2008 Sep;84(3):326-31.
Epub 2008 Feb
New vancomycin single level analysis tool that allows the user
to enter the time that has elapsed since the last dose was given. This updated
version is especially useful if the current dosing schedule was not
adhered to (dose was administered early or late).
Link to program. The original program
requested the time that the trough was drawn prior to the next dose.
New epidural concentration/recipe guide.
Also contains a link to a pop-up calculator for non-standard
concentrations of bupivacaine and/or fentanyl.
A reporting function was added to the bottom of the vancomycin
single level analysis tool based on feedback from a clinical
pharmacist. This section allows the user to copy a detailed
note based on the previous entries and then paste it into an
significant updates to the current web site layout. Our last major
update of the web site (page layout) was in 2007. Our
home page will be updated first and the rest of the site will use a
September 5th, 2011
Several new drugs were added to the renal dosing section.
Check it out....
We have also moved to a new server! The new
server has four times the capacity of our current traffic levels.
The new environment should improve page load times and errors seen with
some of our programs during extremely busy periods.
April 22, 2011
Several updates were just released (See the medical calculator section).
Also in the coming months, significant upgrades to the
Internal Medicine - Reference section
will be completed.
You will notice that all of the individual
Internal medicine disciplines were added to the left column navigation
section on the home page for easy access.
I will also be reviewing the potential for additional disease state
management calculators... Several beta versions are currently in the
If you have any ideas for new calculators, let me know....
Several new calculators will be created in the coming months...
If time permits, a few new disease state management tools will also
Preliminary research has been completed on a new
fiber analysis tool. Look
for this important release hopefully before the
end of the year. Analysis of
specific soluble fibers can impact
recommendations given to patients with elevated
cholesterol levels or as general nutritional
information. More to come.....
The missing link in
This topic is extremely important to not only
healthcare professionals, but also the general
public. Future articles will be added to
the nutrition section..... in the meantime,
please research the IMPORTANCE of the ratio
of the omega-6/omega-3 essential fatty acids.
"Several sources of information suggest that
human beings evolved on a diet with a ratio of
omega-6 to omega-3 essential fatty acids (EFA)
of approximately one whereas in Western
diets the ratio is 15/1-16.7/1."
"Excessive amounts of omega-6 polyunsaturated
fatty acids (PUFA) and a very high
omega-6/omega-3 ratio, as is found in today's
Western diets, promote the pathogenesis
of many diseases, including cardiovascular
disease, cancer, and inflammatory and autoimmune
diseases, whereas increased levels of
omega-3 PUFA (a low omega-6/omega-3 ratio) exert
suppressive effects. In the secondary
prevention of cardiovascular disease, a ratio of
4/1 was associated with a 70% decrease in total
mortality. A ratio of 2.5/1 reduced rectal cell
proliferation in patients with colorectal cancer,
whereas a ratio of 4/1 with the same amount of
omega-3 PUFA had no effect."
Simopoulos AP. The importance of the ratio of omega-6/omega-3 essential
fatty acids. Biomed Pharmacother. 2002 Oct;56(8):365-79.