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{"sheet":"Calculations","index":0,"n_rows":250,"n_cols":25,"rows_kept":250,"cut":false,"hidden":false,"merged":[]}
[null,"Input Last Name of Patient","",null,null,null,null,null,"Adult Digoxin Dosing "]
[null,"Input First Name of Patient","",null,null,null,null,null,"Bayesian and Non-Bayesian Data Fitting of Steady State or Non Steady State Dosing and Serum Levels"]
[null,"Input Unique Patient Identifier",null,null,null,null,null,null,"Using Standard One Compartment Pharmacokinetic Equations"]
[null,"Input Age (Years)",null,null,null,"Vd Multiplier","Clearance Multiplier",null,"Marshall Pierce Pharm.D. "]
[null,"Select Height Units (Drop Down Box)","Inches"," Drug & Disease State Interaction (Drop Down Box)","None",{"$f":"VLOOKUP(E5,'Drop Down Boxes'!P2:R13,3,TRUE)","v":1},{"$f":"VLOOKUP(E5,'Drop Down Boxes'!P2:R13,2,TRUE)","v":1}]
[null,"Input Height",null,{"$f":"IF(C7>84,\"Verify that correct height units are being used\",\"\")","v":""}]
[null,"Height Used (Inches)",{"$f":"IF(C5=\"Centimeters\",C6/2.54,C6)","v":0},0,"Left Arm Amputation","Right Arm Amputation","Paralysis"]
[null,"Select Weight Units (Drop Box Box)","Kgs",null,"Not Applicable","Not Applicable","Not Applicable"]
[null,"Input Weight",null,null,"Not Applicable","Not Applicable","Not Applicable"]
[null,"Weight Used (kgs)",{"$f":"IF(C8=\"Lbs\",C9/2.2,C9)","v":0},0,"Left Leg Amputation","Right Leg Amputation","Creatinine Multiplier"]
[null,"Select Sex (Drop Down Box)","Male","Male","Not Applicable","Not Applicable",1]
[null,"Input Most Recent Actual Serum Creatinine (mg/dl)",null,null,"Not Applicable","Not Applicable"]
[null,"Input Previous Actual Serum Creatinine (mg/dl)",null,null,"Malnutrition",null,"Vd Multipliers","Clearance Multipliers"]
[null,"Time Between Serum Creatinines (hours)",null,null,"Not Applicable",null,"Quinidine  0.7","Amiodarone  0.5"]
[null,"Systolic Dysfunction? (Drop Down Box)","Yes","Yes","Not Applicable",null,"Hypothyroid 0.7","Canaglifozin 0.8 "]
[null,"Input Infusion Period (hours)",0.25,{"$f":"IF(C16>3, \"Verify that infusion period is correct\",\"\")","v":""},null,null,"Hyperthyroid  1.3","Carvedilol  0.75"]
["Hide","Lean Body Weight < 18 or 48 inches",{"$f":"IF(C7<22,C10,IF(OR(C4<18,C7<48),IF(C11=\"Male\",(-59.6035+(5.2878*C7)-(0.123939*C7^2)+(0.00128936*C7^3))/2.2,(-77.55796+(6.93728*C7)-(0.171703*C7^2)+(0.001726*C7^3))/2.2)))","v":0}," ",null,null,null,"Dronedarone  0.5"]
["Hide","Lean Body Weight Calculated",{"$f":"IF(OR(C4<18,C7<48),C17,IF(C11=\"Female\", (C7-60)*2.3+45.5,(C7-60)*2.3+50))","v":0},null,null,null,null,"Ketoconazole/Itraconazole  0.5"]
[null,"Calculated Lean Body Weight (kg)",{"$f":"IF(C18<=C10,C18,C10)","v":0},null,null,null,null,"Dronedarone 0.5"]
["Hide","Dosing Weight Aminoglycosides",{"$f":"IF(C19<C10,(C10-C19)*0.4+C19,C10)","v":0}]
[null,"Calculated Dosing Weight (kg)",{"$f":"IF(C15=\"Vancomycin\",C10,C20)","v":0},null,null,null,null,"Ketoconazole/Itra 0.5"]
[null,"Calculated Vd (Liters)",{"$f":"((4.5+(0.028*C24)*1.73/C23)*C19)*F5","v":{"$error":"#DIV/0!"}},{"$f":"IF(OR(C12<>D12,C13<>D13,C14<>D14,E9<>E8,F9<>F8,G9<>G8,E12<>E11,F12<>F11,E15<>E14,C4<>D4,C7<>D7,C10<>D10,C11<>D11,C15<>D15),\"Remember to press the Calculated Creatinine Clearance Button\",\"\")","v":""},null,null,null,"Propafenone  0.75"]
[null,"Body Surface Area Calculated Meters2",{"$f":"(C10^0.425)*((C7*2.54)^0.725)*71.84/10000","v":0},null,null,null,null,"Quinidine 0.5 "]
[null,"Calculated Creatinine Clearance (ml/min)",{"$f":"CreatinineClearanceCalculation!E19","v":0},"Based on Levels","Based on Levels",null,null,"Ranolazine  0.67"]
[null,"Calculated T1/2 (Hours) for Creatinine",{"$f":"IF(LEN(D22)<>0,\"\",CreatinineClearanceCalculation!E20)","v":{"$error":"#DIV/0!"}},"Solver Based Calulations","Volume of Distribution (Liters)",null,null,"Verapamil  0.75   "]
[null,"Calc. Eliminaton Rate Constant (hr-1) Drug",{"$f":"IF(C15=\"Yes\",((0.33*C19+0.9*C24)*60/1000)*G5/C22,((0.8*C19+C24)*60/1000*G5/C22))","v":{"$error":"#DIV/0!"}},{"$f":"C26","v":{"$error":"#DIV/0!"}},{"$f":"C22","v":{"$error":"#DIV/0!"}},null,null,"Hypothyroid  0.7"]
[null,"Calculated Half-Life (Hours) for Drug",{"$f":"0.693/C26","v":{"$error":"#DIV/0!"}},{"$f":"0.693/D26","v":{"$error":"#DIV/0!"}},null,null,null,"Hyperthyroid  1.3"]
["Hide","Input Desied Peak From Loading Dose  Level (mcg/L)",1]
["Hide","Calculated IV Loading Dose (mcg)",{"$f":"C28*C22","v":{"$error":"#DIV/0!"}},null,null,null,"Dosage Form","Fraction Absorbed","Salt"]
[null,"Input Maintance Dosage Form ","Injection",null,null,null,"Capsule",1,1]
["Hide","Bioavailability of Dosage Form",{"$f":"VLOOKUP(C30,'Drop Down Boxes'!S2:T5,2,TRUE)","v":1},{"$f":"IF($C15=\"Gentamicin/Tobramycin Traditional\", (LN(6/1)/D26)+0.5, IF((((LN(20/0.3))/D26)+0.5)<24,24,IF((((LN(20/0.3))/D26)+0.5)<36,36,IF((((LN(20/0.3))/D26)+0.5)<48,48,\"\"))))","v":{"$error":"#DIV/0!"}},null,null,"Elixir",0.8,1]
["Hide","Input Desired Average Level (mcg/L)",1,{"$f":"IF($C15=\"Amikacin Traditional\", LN(30/2)/D26+0.5,IF((((LN(60/0.9))/D26)+0.5)<24,24,IF((((LN(60/0.9))/D26)+0.5)<36,36,IF((((LN(60/0.9))/D26)+0.5)<48,48,\"\"))))","v":{"$error":"#DIV/0!"}},null,null,"Injection",1,1]
[null,null,null,{"$f":"IF(LEN($D22)<>0,\"\",IF($C15=\"Vancomycin\",(((LN(30/15))/D26)+2),IF(OR($C15=\"Amikacin Traditional\",$C15=\"Amikacin Pulse\"),D32,D31)))","v":{"$error":"#DIV/0!"}},null,null,"Tablets",0.7,1]
[null,"Input Dosage Interval (Days)",null,{"$f":"C34","v":0}]
[null,"Calculated Daily Maintenance Dose (mcg)",{"$f":"C32*C34*24*(C26*C22)/C31","v":{"$error":"#DIV/0!"}},{"$f":"C32*C34*24*D26*E26/C31","v":{"$error":"#DIV/0!"}}]
[null,"Input Rounded MaintenanceDose (mcg)",null,{"$f":"C36","v":0},null,null,null,null,{"$f":"IF(ISERROR(H36),\"\",IF(H36>=18,\"A lower dose, 10-17.5 mg/kg, is recommeneded\",\"\"))","v":""}]
[null,"Calculated Peak (mcg/L)",{"$f":"IF(LEN(D22)<>0,\"\",C36*C31*(1-EXP(-C26*$C16))/($C22*C26*$C16*(1-EXP(-C26*C34*24))))","v":{"$error":"#DIV/0!"}},{"$f":"D36*C31*(1-EXP(-D26*$C16))/($E26*D26*$C16*(1-EXP(-D26*D34*24)))","v":{"$error":"#DIV/0!"}}]
[null,"Calculated Trough (mcg/L)",{"$f":"IF(LEN(D22)<>0,\"\",C37*EXP(-C26*(C34*24-$C16)))","v":{"$error":"#DIV/0!"}},{"$f":"D37*EXP(-D26*(D34*24-$C16))","v":{"$error":"#DIV/0!"}},"Dose 1 after starting level",null,null,"Dose 2 after starting level",null,null,"Dose 3 after starting level",null,null,"Dose 4 after starting level",null,null,"Dose 5 after starting level",null,null,"Dose 6 after starting level",null,null,"Dose 7 after starting level"]
[null,"Calcualted Average (mcg/L)",{"$f":"IF(LEN(D22)<>0,\"\",C31*C36/(C26*C22*C34*24))","v":{"$error":"#DIV/0!"}},{"$f":"C31*D36/(D26*E26*D34*24)","v":{"$error":"#DIV/0!"}},"Injection",null,"Dosage Form","Injection",null,"Dosage Form","Injection",null,"Dosage Form","Injection",null,"Dosage Form","Injection",null,"Dosage Form","Injection",null,"Dosage Form","Injection"]
[null,null,null,null,{"$f":"VLOOKUP(E39,'Drop Down Boxes'!$S2:$T5,2)","v":1},null,"Biavailability",{"$f":"VLOOKUP(H39,'Drop Down Boxes'!$S2:$T5,2)","v":1},null,"Biavailability",{"$f":"VLOOKUP(K39,'Drop Down Boxes'!$S2:$T5,2)","v":1},null,"Biavailability",{"$f":"VLOOKUP(N39,'Drop Down Boxes'!$S2:$T5,2)","v":1}," ","Biavailability",{"$f":"VLOOKUP(Q39,'Drop Down Boxes'!$S2:$T5,2)","v":1},null,"Biavailability",{"$f":"VLOOKUP(T39,'Drop Down Boxes'!$S2:$T5,2)","v":1},null,"Biavailability",{"$f":"VLOOKUP(W39,'Drop Down Boxes'!$S2:$T5,2)","v":1}]
[null,null,null,"Dose (mcg)",null,null,"Dose (mcg)",null,null,"Dose (mg)",null,null,"Dose (mcg)",null,null,"Dose (mcg)",null,null,"Dose (mcg)",null,null,"Dose (mcg)"]
[null,null,null,"Dose Date &Time ",null,null,"Dose Date &Time ",null,null,"Dose Date &Time ",null,null,"Dose Date &Time ",null,null,"Dose Date &Time ",null,null,"Dose Date &Time ",null,null,"Dose Date &Time "]
[null,"Current Date","2022-01-31T17:20:47"]
[null,"Date Therapy Initiated (Month/Day/Year)"]
[null,null,null,null,null,null,null,null,null," ",null,null," ",null,null," "]
[null,null,"Starting Level (mcg/L) Before Dose 1 ",null,"Serum Levels (mcg/L)",null,null,"Serum Levels (mcg/L)",null,null,"Serum Levels (mcg/L)",null,null,"Serum Levels (mcg/L)",null,null,"Serum Levels (mcg/L)",null,null,"Serum Levels (mcg/L)",null,null,"Serum Levels (mcg/L)"]
[null,null,"Starting Level Date &Time",null,"Serum Level Date &Time",null,null,"Serum Level Date &Time",null,null,"Serum Level Date &Time",null,null,"Serum Level Date &Time",null,null,"Serum Level Date &Time",null,null,"Serum Level Date &Time",null,null,"Serum Level Date &Time"]
[]
[null,null,null,null,"Trough Before Dose 1",null,null,"Trough Before Dose 2",null,null,"Trough Before Dose 3",null,null,"Trough Before Dose 4",null,null,"Trough Before Dose 5"]
[null,null,null,"Expected Levels (mcg/L)",{"$f":"D46*EXP(-$D58*(E42-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D46*EXP(-$F58*(F47-$D47)*24)+($E41*E40*(1-EXP(-$F58*$C16))*(EXP(-$F58*(((F47-$E42)*24)-$C16)))/($E26*$C16*$F58))","v":{"$error":"#DIV/0!"}},{"$f":"$D46*EXP(-$F58*(G47-$D47)*24)+($E41*E40*(1-EXP(-$F58*$C16))*(EXP(-$F58*(((G47-$E42)*24)-$C16)))/($E26*$C16*$F58))","v":{"$error":"#DIV/0!"}},{"$f":"$D46*EXP(-$F58*(H42-$D47)*24)+($E41*E40*(1-EXP(-$F58*$C16))*(EXP(-$F58*(((H42-$E42)*24)-$C16)))/($E26*$C16*$F58))","v":{"$error":"#DIV/0!"}},{"$f":"$H50*EXP(-$I58*(I47-$H42)*24) + ($H41*H40*(EXP(-$I58*(((I47-$H42)*24)-$C16)))*(1-EXP(-$I58*$C16))/($E26*$I58*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$H50*EXP(-$I58*(J47-$H42)*24) + ($H41*H40*(EXP(-$I58*(((J47-$H42)*24)-$C16)))*(1-EXP(-$I58*$C16))/($E26*$I58*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$H50*EXP(-$I58*(K42-$H42)*24) + ($H41*H40*(EXP(-$I58*(((K42-$H42)*24)-$C16)))*(1-EXP(-$I58*$C16))/($E26*$I58*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$K50*EXP(-$L58*(L47-$K42)*24) + ($K41*K40*(EXP(-$L58*(((L47-$K42)*24)-$C16)))*(1-EXP(-$L58*$C16))/($E26*$L58*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$K50*EXP(-$L58*(M47-$K42)*24) + ($K41*K40*(EXP(-$L58*(((M47-$K42)*24)-$C16)))*(1-EXP(-$L58*$C16))/($E26*$L58*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$K50*EXP(-$L58*(N42-$K42)*24) + ($K41*K40*(EXP(-$L58*(((N42-$K42)*24)-$C16)))*(1-EXP(-$L58*$C16))/($E26*$L58*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$N50*EXP(-$O58*(O47-$N42)*24) + ($N41*N40*(EXP(-$O58*(((O47-$N42)*24)-$C16)))*(1-EXP(-$O58*$C16))/($E26*$O58*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$N50*EXP(-$O58*(P47-$N42)*24) + ($N41*N40*(EXP(-$O58*(((P47-$N42)*24)-$C16)))*(1-EXP(-$O58*$C16))/($E26*$O58*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$N50*EXP(-$O58*(Q42-$N42)*24) + ($N41*N40*(EXP(-$O58*(((Q42-$N42)*24)-$C16)))*(1-EXP(-$O58*$C16))/($E26*$O58*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$Q50*EXP(-$R58*(R47-$Q42)*24) + ($Q41*Q40*(EXP(-$R58*(((R47-$Q42)*24)-$C16)))*(1-EXP(-$R58*$C16))/($E26*$R58*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$Q50*EXP(-$R58*(S47-$Q42)*24) + ($Q41*Q40*(EXP(-$R58*(((S47-$Q42)*24)-$C16)))*(1-EXP(-$R58*$C16))/($E26*$R58*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$Q50*EXP(-$R58*(T42-$Q42)*24) + ($Q41*Q40*(EXP(-$R58*(((T42-$Q42)*24)-$C16)))*(1-EXP(-$R58*$C16))/($E26*$R58*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$T50*EXP(-$U58*(U47-$T42)*24) + ($T41*T40*(EXP(-$U58*(((U47-$T42)*24)-$C16)))*(1-EXP(-$U58*$C16))/($E26*$U58*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$T50*EXP(-$U58*(V47-$T42)*24) + ($T41*T40*(EXP(-$U58*(((V47-$T42)*24)-$C16)))*(1-EXP(-$U58*$C16))/($E26*$U58*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$T50*EXP(-$U58*(W42-$T42)*24) + ($T41*T40*(EXP(-$U58*(((W42-$T42)*24)-$C16)))*(1-EXP(-$U58*$C16))/($E26*$U58*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$W50*EXP(-$X58*(X47-$W42)*24) + ($W41*W40*(EXP(-$X58*(((X47-$W42)*24)-$C16)))*(1-EXP(-$X58*$C16))/($E26*$X58*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$W50*EXP(-$X58*(Y47-$W42)*24) + ($W41*W40*(EXP(-$X58*(((Y47-$W42)*24)-$C16)))*(1-EXP(-$X58*$C16))/($E26*$X58*$C16))","v":{"$error":"#DIV/0!"}}]
[]
[null,null,null,null,"Square of Errors",{"$f":"IF(ISNUMBER(F50),(F50-F46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(G50),(G50-G46)^2,\"\")","v":""},null,{"$f":"IF(ISNUMBER(I50),(I50-I46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(J50),(J50-J46)^2,\"\")","v":""},null,{"$f":"IF(ISNUMBER(L50),(L50-L46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(M50),(M50-M46)^2,\"\")","v":""},null,{"$f":"IF(ISNUMBER(O50),(O50-O46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(P50),(P50-P46)^2,\"\")","v":""},null,{"$f":"IF(ISNUMBER(R50),(R50-R46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(S50),(S50-S46)^2,\"\")","v":""},null,{"$f":"IF(ISNUMBER(U50),(U50-U46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(V50),(V50-V46)^2,\"\")","v":""},null,{"$f":"IF(ISNUMBER(X50),(X50-X46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(Y50),(Y50-Y46)^2,\"\")","v":""}]
[null,null,null,null,"Sum of Square of Errors",{"$f":"SUM(F52:Y52)","v":0}]
[]
[null,null,"Input Serum Ceatinine (mg/dL)",null,"Input Serum Ceatinine",null,null,"Input Serum Ceatinine",null,null,"Input Serum Ceatinine",null,null,"Input Serum Ceatinine",null,null,"Input Serum Ceatinine",null,null,"Input Serum Ceatinine",null,null,"Input Serum Ceatinine"]
[null,null,"Creatinine Clearance (ml/min)",{"$f":"IF(ISBLANK(D55),$C24,IF($C11=\"Male\",(140-$C4)*$C19/(72*D55*$G11),(140-$C4)*$C19*0.85/(72*D55*$G11)))","v":0},null,{"$f":"IF(ISBLANK(F55),$C24,IF($C11=\"Male\",(140-$C4)*$C19/(72*F55*$G11),(140-$C4)*$C19*0.85/(72*F55*$G11)))","v":0},null,null,{"$f":"IF(ISBLANK(I55),$C24,IF($C11=\"Male\",(140-$C4)*$C19/(72*I55*$G11),(140-$C4)*$C19*0.85/(72*I55*$G11)))","v":0},null,null,{"$f":"IF(ISBLANK(L55),$C24,IF($C11=\"Male\",(140-$C4)*$C19/(72*L55*$G11),(140-$C4)*$C19*0.85/(72*L55*$G11)))","v":0},null,null,{"$f":"IF(ISBLANK(O55),$C24,IF($C11=\"Male\",(140-$C4)*$C19/(72*O55*$G11),(140-$C4)*$C19*0.85/(72*O55*$G11)))","v":0},null,null,{"$f":"IF(ISBLANK(R55),$C24,IF($C11=\"Male\",(140-$C4)*$C19/(72*R55*$G11),(140-$C4)*$C19*0.85/(72*R55*$G11)))","v":0},null,null,{"$f":"IF(ISBLANK(U55),$C24,IF($C11=\"Male\",(140-$C4)*$C19/(72*U55*$G11),(140-$C4)*$C19*0.85/(72*U55*$G11)))","v":0},null,null,{"$f":"IF(ISBLANK(X55),$C24,IF($C11=\"Male\",(140-$C4)*$C19/(72*X55*$G11),(140-$C4)*$C19*0.85/(72*X55*$G11)))","v":0}]
[null,"hide","Intercept Constant (van & Amino)",{"$f":"IF(C15=\"Vancomycin\", 0.005216005,0.014)","v":1.4E-2}]
[null,"hide","K (1/hour)",{"$f":"(($D26-$D57)*(D56/$C24))+$D57","v":{"$error":"#DIV/0!"}},null,{"$f":"(($D26-$D57)*(F56/$C24))+$D57","v":{"$error":"#DIV/0!"}},null,null,{"$f":"(($D26-$D57)*(I56/$C24))+$D57","v":{"$error":"#DIV/0!"}},null,null,{"$f":"(($D26-$D57)*(L56/$C24))+$D57","v":{"$error":"#DIV/0!"}},null,null,{"$f":"(($D26-$D57)*(O56/$C24))+$D57","v":{"$error":"#DIV/0!"}},null,null,{"$f":"(($D26-$D57)*(R56/$C24))+$D57","v":{"$error":"#DIV/0!"}},null,null,{"$f":"(($D26-$D57)*(U56/$C24))+$D57","v":{"$error":"#DIV/0!"}},null,null,{"$f":"(($D26-$D57)*(X56/$C24))+$D57","v":{"$error":"#DIV/0!"}}]
[null,"Marshall Pierce PharmD",null,null,"Square of Errors Bayesian",{"$f":"IF(ISNUMBER(F50),(F46-F50)^2/(0.1*F46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(G50),(G46-G50)^2/(0.1*G46)^2,\"\")","v":""},null,{"$f":"IF(ISNUMBER(I50),(I46-I50)^2/(0.1*I46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(J50),(J46-J50)^2/(0.1*J46)^2,\"\")","v":""},null,"","",null,"","",null,"","",null,"","",null,"",""]
[null,"Copyright. No Warranties Are Expressed or Implied. Educational Use",null,null,"Sum of Square of Errors Bayesian",{"$f":"((C26-D26)^2/(C26*0.3)^2)+((C22-E26)^2/(C22*0.3)^2)+SUM(F59:Y59)","v":{"$error":"#DIV/0!"}}]
[null,"hide",null,null,"SSE Vd & Ke original",{"$f":"((C26-D26)^2/(C26*0.1)^2)+((C22-E26)^2/(C22*0.1)^2)","v":{"$error":"#DIV/0!"}}]
[null,"hide",null,null,"SSE Clearance",{"$f":"(C26*C22-D26*C22)^2/(C26*C22*0.1)^2","v":{"$error":"#DIV/0!"}}]
[null,"hide",null,null,"SSE Vd",{"$f":"(C22-E26)^2/(C22*0.1)^2","v":{"$error":"#DIV/0!"}}]
[]
[null,"Initial Level",null,{"$f":"D46","v":0},{"$f":"$D65*EXP(-$F58*(E42-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$F58*(F47-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$F58*(G47-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$F58*(H42-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$I58*(I47-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$I58*(J47-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$I58*(K42-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$L58*(L47-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$L58*(M47-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$L58*(N42-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$O58*(O47-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$O58*(P47-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$O58*(Q42-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$R58*(R47-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$R58*(S47-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$R58*(T42-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$U58*(U47-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$U58*(V47-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$U58*(W42-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$X58*(X47-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D65*EXP(-$X58*(Y47-$D47)*24)","v":{"$error":"#DIV/0!"}}]
[null,"Dose1",null,null,null,{"$f":"$E41*(1-EXP(-$F58*$C$16))*EXP(-$F58*(((F47-$E42)*24)-$C16))/($E26*$F58*$C16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$F58*$C$16))*EXP(-$F58*(((G47-$E42)*24)-$C$16))/($E26*$F58*$C$16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$F58*$C$16))*EXP(-$F58*(((H42-$E42)*24)-$C$16))/($E26*$F58*$C$16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$I58*$C16))*EXP(-$I58*(((I47-$E42)*24)-$C16))/($E26*$I58*$C$16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$I58*$C16))*EXP(-$I58*(((J47-$E42)*24)-$C16))/($E26*$I58*$C$16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$I58*$C16))*EXP(-$I58*(((K42-$E42)*24)-$C16))/($E26*$I58*$C$16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$L58*$C16))*EXP(-$L58*(((L47-$E42)*24)-$C16))/($E26*$L58*$C16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$L58*$C16))*EXP(-$L58*(((M47-$E42)*24)-$C16))/($E26*$L58*$C16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$L58*$C16))*EXP(-$L58*(((N42-$E42)*24)-$C16))/($E26*$L58*$C16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$O58*$C16))*EXP(-$O58*(((O47-$E42)*24)-$C16))/($E26*$O58*$C16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$O58*$C16))*EXP(-$O58*(((P47-$E42)*24)-$C16))/($E26*$O58*$C16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$O58*$C16))*EXP(-$O58*(((Q42-$E42)*24)-$C16))/($E26*$O58*$C16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$R58*$C16))*EXP(-$R58*(((R47-$E42)*24)-$C16))/($E26*$R58*$C16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$R58*$C16))*EXP(-$R58*(((S47-$E42)*24)-$C16))/($E26*$R58*$C16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$R58*$C16))*EXP(-$R58*(((T42-$E42)*24)-$C16))/($E26*$R58*$C16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$U58*$C16))*EXP(-$U58*(((U47-$E42)*24)-$C16))/($E26*$U58*$C16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$U58*$C16))*EXP(-$U58*(((V47-$E42)*24)-$C16))/($E26*$U58*$C16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$U58*$C16))*EXP(-$U58*(((W42-$E42)*24)-$C16))/($E26*$U58*$C16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$X58*$C16))*EXP(-$X58*(((X47-$E42)*24)-$C16))/($E26*$X58*$C16)","v":{"$error":"#DIV/0!"}},{"$f":"$E41*(1-EXP(-$X58*$C16))*EXP(-$X58*(((Y47-$E42)*24)-$C16))/($E26*$X58*$C16)","v":{"$error":"#DIV/0!"}}]
[null,"Dose2",null,null,null,null,null,"start",{"$f":"$E42*(1-EXP(-$I59*$C$16))*EXP(-$I59*(((I47-$H42)*24)-$C$16))/($E$26*$I59*$C$16)","v":{"$error":"#VALUE!"}},{"$f":"$E42*(1-EXP(-$I59*$C$16))*EXP(-$I59*(((J47-$H42)*24)-$C$16))/($E$26*$I59*$C$16)","v":{"$error":"#VALUE!"}},{"$f":"$E42*(1-EXP(-$F59*$C17))*EXP(-$F59*(((K43-$E43)*24)-$C17))/($E27*$D27*$C17)","v":{"$error":"#VALUE!"}}]
[null,"Dose3"]
[null,"Dose4"]
[null,"Dose5"]
[null,"Dose6"]
[null,"Dose7"]
[null,"Dose8"]
[null,"Dose9"]
[null,"Dose10"]
[null,"Dose11"]
[null,"Dose12"]
[null,"Dose13"]
[null,"Dose14"]
[null,"Dose15"]
[null,"Dose16"]
[null,"Dose17"]
[null,"Dose18"]
[null,"Dose19"]
[null,"Dose20"]
[null,"Dose21"]
[null,"Dose22"]
[null,"Dose23"]
[null,"Dose24"]
[null,"Dose25"]
[null,"Dose26"]
[null,"Dose27"]
[null,"Dose28"]
[null,"Dose29"]
[null,"Dose30"]
[]
[null,"Instructions For Use"]
[null,"1. Enter the data required in the blue colored cells in column C, (C1-C16)."]
[null,"2. Select the patients treatment condition in cell E5."]
[null,"3. Select the values in cells E8 through G8, E11 through F11, and E14 if the patient has amputation(s), paralysis, or malnutrition."]
[null,"4. Press the \"Calculate Creatinine Clearnance or Dose\" button. This will calculate the patient's creatinine clearance and suggested dose and frequency."]
[null,"5. Enter a rounded dosage interval and rounded dose in cells C34 and C36 respectively."]
[null,"6. Population based parameters (elimination rate constant and volume of distribution) are used to calculate the peak and trough in C37 and C38 respectively."]
[null,"7. Change the values in C34 and C36 to obtain your desired predicted peak and trough in cells C37 and C38."]
[]
[null,"Population Based Equations Using Standard One Compartment Pharmacokinetic Equations"]
[null,"Digoxin"]
[null,"Volume of Distribution (liters) = (4.5  + 0.028 *Clcr ml/min/1.73 m2)* Lean Body Weight * Multiplier, Paulson and Welling Equation"]
[null,"Clearance (L/hour) Non CHF = (0.8 * LBW + Creatinine clearance (ml/min)) *60/1000 * Multiplier, Sheiner Equation"]
[null,"Clearance (L/hour) CHF = (0.33*LBW +0.9 Creatinine clearance (ml/min) *60/1000 * Multiplier, Sheiner Equation"]
[null," Elimination Rate Constant (1/hours) = Clearance (L/hr) / Vd(L)"]
[null,"Ideal body weight (IBW(kg)) Adults"]
[null,"Males(kg) =   50(kg) + 2.3(kg) * (height in inches - 60)"]
[null,"Females(kg) = 45.5(kg) + 2.3(kg) * (height in inches - 60)"]
[null,"Lean Body Weight for Children  or height < 48 inches (Peck Formula)"]
[null,"Female < 18 years = -77.55796 + (6.93728 * height in inches) -(0.171703 * Height2) + (0.001726* Height3)"]
[null,"Male < 18 years = -59.6035 + (5.2878 * Height) - (0.123939 * Height2) + 0.00128936 * Height3)"]
[null,"If height < 22 inches, lean weight = total weight"]
[null,"Adjusted body weight, aminoglycosides only, if actual weight > IBW."]
[null,"Adjusted Body Weight(kg) = LBW(kg) + 0.4 * (Actual Weight(kg) – IBW(kg))"]
[null,"Creatinine Clearance Equations"]
[null,"Adults Cockcroft Gault Equation "]
[null,"Males(ml/min) = (140-age) * ( Use Ideal Body Weight(kg) or actual weight if less than IBW(kg)) / (Serum Creatinine *72)"]
[null,"Females(ml/mn): above x 0.85"]
[null,"Pediatic Schartz Equation"]
[null,"ClCr(ml/min/1.73 m2) = Factor* HeightCentimeters / Serum Creatinine"]
[null,"Factor: 0.45 < 1 year, 0.55 1-12 years,  > 12 years 0.55 female, > 12 years males 0.7"]
[null,"Amputation and Paralysis Serum Creatiine Multiplication Factors"]
[null,"Entire Leg Amputation (1.2269), AKA (1.1764), BKA (1.0638), Entire Arm Amputation (1.0695), AEA (1.0526), BEA (1.0309), Functional Palegia (1.4), Paraplegia (1.4), Quadraplegia(1.6)"]
[null,"Minimal Serum Creatinine: 0.5 mg/dL in patients with functional, para or quadraplegia, or malnutrition; 0.7 in other adults."]
[null,"Data Fitting: The program employees non steady state one compartment equations and uses the method of superposition to determine the expected level(s) from the input dosing history, "]
[null,"starting serum level, and and estimated pharmacokinetic parameters."]
[null,"CpT = Cp0e(-K(T-to)) + [D1(1-e(-KT’))*e(-K(T-Td1-T’))/(VKT’)]  +  [D2(1-e(-KT’))*e(-K(T-Td2-T’))/(VKT’)]……."]
[null,"The expected levels, displayed in the data fitting section, are calculated using the population elimination rate constant (C26) and volume of distribtution (C22) initially. "]
[null,"Once the data (dosing and serum levels) is fit the patient specific values of elimination rate constant and volume of distribution, D26 and E26,  are used. "]
[]
[null,"Objective Function to Minimize"]
[null,"Sum of the Square of Errors = (Predicted Level1 – Actual Level1)2  + (Predicted Level2 – Actual Level2)2    for all input levels"]
[]
[null,"Analyzing steady state levels using a trough drawn after a know steady state dose (this is our usual practice)"]
[null,"8. Steps 1-7 must be completed, enter the current frequency  and dose in C34 and C36."]
[null,"9. Enter the date therapy was started in cell C44."]
[null,"10. Enter the steady state trough in cell G46 and the date and time of the trough in G47."]
[null,"11. Enter the date and time of the dose which was given before the trough in E42. "]
[null,"12. Press the \"Assume Steady State: Trough drawn after dose 1\". This will copy the entered trough to cell D46, place the calculated time of the predose trough in cell D47, and the dose to E41."]
[null,"This is for your convience, if you choose to you can enter the data manually without pressing the \"Assume Steady State\" button."]
[null,"By placing the same trough around a single dose you are creating steady state conditions. This is the definition of steady state, levels are unchange dose to dose.  "]
[null,"13. Press \"Fit Data (Elimination Rate Constant Optimization)\" button. The program will determine the elimination rate constant that miniminzes the difference between the actual and predicted level."]
[null,"14. The calculated patient specific elimination rate constant is displayed in cell D26 after data fitting."]
[null,"15. The predicted state state levels using the patient specific elimination rate constant are displayed in cells D37 and D38 respectively."]
[null,"16. You may adjust the dosage frequency and dose in D34 and D36 to obtain your desired levels."]
[]
[null,"Steady State Levels with the trough drawn post dose past the time the next dose was due as next dose was held, the dose was given late, or a random level was ordered."]
[null,"Trough at time of Dose1 displayed in E50 = Trough PredoseD46*Exp(-K*(Time of Dose1 E42- Time of Predose Trough D47)*24)"]
[null,"The trough in D46 will show a time in D47 that is after the time of the dose1 in E42, but the equation above back extrapolates the calculated trough displayed in E50 to the time of Dose 1."]
[null,"The programs calculations are correct though the displayed values in D46 and D47 look incorrect. The value in E50 is the value used in the further calculations. "]
[]
[null,"Analyzing steady state levels using a trough drawn before a known steady state dose. This will be rarely use, but is included for flexible. "]
[null,"8. Steps 1-7 must be completed, enter the current frequency  and dose in C34 and C36."]
[null,"9. Enter the date therapy was started in cell C44."]
[null,"10. Enter the steady state trough in cell D46 and the date and time of the trough in D47."]
[null,"11. Enter the date and time of the dose which was given in E42. "]
[null,"12. Press the \"Assume Steady State: Trough drawn before dose 1\". This will copy the entered trough to cell G46, place the calculated time of the post dose trough in cell G47, and the dose to E41."]
[null,"This is for your convience, if you choose to you can enter the data manually without pressing the \"Assume Steady State\" button."]
[null,"By placing the same trough around a single dose you are creating steady state conditions.  This is the definition of steady state, levels are unchanging dose to dose."]
[null,"13. Press \"Fit Data (Elimination Rate Constant Optimization)\" button. The program will determine the elimination rate constant that miniminzes the difference between the actual and predicted level."]
[null,"14.The calculated patient specific elimination rate constant is displayed in cell D26 after data fitting."]
[null,"15. The predicted state state levels using the patient specific elimination rate constant are displayed in cells D37 and D38 respectively."]
[null,"16. You may adjust the dosage frequency and dose in D34 and D36 to obtain your desired levels."]
[]
[null,"Analyzing steady state levels using a trough drawn before a known steady state dose and a peak after the same dose (Traditional Dosing for Aminoglycosides)"]
[null,"8. Steps 1-7 must be completed, enter the current frequency  and dose in C34 and C36."]
[null,"9. Enter the date therapy was started in cell C44."]
[null,"10. Enter the steady state trough in cell D46 and the date and time of the trough in D47."]
[null,"11. Enter the steady state peak in cell F46 and time of the peak in F47."]
[null,"12. Enter the date and time of the dose which was given in E42. "]
[null,"13. Press the \"Assume Steady State: Trough drawn before dose 1\". This will copy the entered trough to cell G46, place the calculated time of the post dose trough in cell G47, and the dose to E41."]
[null,"This is for your convience, if you choose to you can enter the data manually without pressing the \"Assume Steady State\" button."]
[null,"By placing the same trough around a single dose you are creating steady state conditions. This is the definition of steady state. "]
[null,"14. Press \"Fit Data (Elimination Rate Constant & Vd Optimization)\" button. The program will determine the elimination rate constant and volume of distribution that miniminzes the difference "]
[null,"between the actual and predicted levels."]
[null,"15. The calculated patient specific elimination rate constant is displayed in cell D26 and volume of distribution in cell E26 after data fitting."]
[null,"16. The predicted state state levels using the patient specific K and Vd are displayed in cells D37 and D38 respectively."]
[null,"17. You may adjust the dosage frequency and dose in D34 and D36 to obtain your desired levels."]
[]
[null,"Analyzing Non Steady State Levels"]
[null,"8. Steps 1-7 must be completed, enter the current frequency  and dose in C34 and C36."]
[null,"9. Enter the date therapy was started in cell C44."]
[null,"10. Enter a starting level and time of the level in cells D46 and D47 respectively. This level may be 0 if no drug is on board or any known level before the doses you wish to analyze."]
[null,"11. Enter all doses and the dates and times given from the time of the starting level through the last dose administered before the last level to be analyzed in chronological order, "]
[null,"oldest to most recent left to right. The doses are numbered 1-5, chronological after the starting level."]
[null,"12. Enter all levels and the times drawn to be analyzed in chronlogical order, oldest to most recent left to right."]
[null,"13. Press the appropriate data fitting button, \"Fit Data (Elimination Rate Constant Optimization)\" if only troughs have been drawn, and"]
[null,"\"Fit Data (Elimination Rate Constant & Vd Optimization) if a peak(s) and trough(s) have been drawn."]
[null,"14. The calculated patient specific elimination rate constant is displayed in cell D26 and volume of distribution in cell E26 after data fitting."]
[null,"15. The predicted state state levels using the patient specific K and Vd are displayed in cells D37 and D38 respectively."]
[null,"16. You may adjust the dosage frequency and dose in D34 and D36 to obtain your desired levels."]
[]
[]
[null,"When to assume levels are Non Steady State Levels"]
[null,"1. If you are ordering levels before 5 half lives of have passed from the start of therapy."]
[null,"2. If you order levels after the 1st maintenance dose with or with out a loading dose."]
[null,"3. The patients doses or dosage intervals are not consistent."]
[]
[null,"Note: the predicted levels for input dosage regimens in column C (population) and D (patient specific) are independent from one another after data fitting."]
[]
[null,"Creatinine Clearance Calculation"]
[null,"How is creatinine clearance calculated when the serum creatinines is changing?"]
[null,"Most creatinine clearance equations assume stable renal function. "]
[null,"Creatinine clearance individualized (Clcr) Cockcroft Gault equation:"]
[null,"Males(ml/min) = (140-age) * ( Use Ideal Body Weight(kg) or actual weight if less than IBW(kg)) / (Serum Creatinine *72)"]
[null,"Females(ml/mn): above x 0.85"]
[null,"In the simplified form:   Creatinine Clearance = Creatinine rate of production / Serum Creatinine"]
[null,"Rate of production is constant for a patient and is determined by age, height, weight and sex. The rate of production is built "]
[null,"into the Cockcroft Gault equation and other creatinine clearanace equations. When renal function has changed the following  equation may be used to "]
[null,"calculate creatinine clearance before steady state serum creatinine levels are achieved. This is the most accurate method of "]
[null,"numerous published equations. An iterative method is used to determine clearnace as there is no direct solution to the equation."]
[null,"Serum Creatinine2 = Serum Creatinine1 * e(-KT) +  Rate of Production (1-e(-KT)) / Clearance of Creatinine"]
[null,"T is the time between serum two known creatinines (creatinine1 and creatinine2). "]
[null,"K is the elimination rate constant for creatinine."]
[null,"This equation accounts for the elimination of creatinine already present and the fraction of steady state achieved during the "]
[null,"time between the creatinines. "]
[null,"Assumptions of the non steady state equation:"]
[null,"All of the change in renal function has occurred at or before the time of the oldest creatinine (creatinine1)."]
[null,"The change in creatinines is due to renal function changes and is not due to tissue destruction or hydration changes."]
[null,"The serum creatinines are accurately determined and the time between them is known."]
[]
[null,"Data Storage"]
[null,"The program stores patient demographic information, current dose and frequency, along with calculated values including population and"]
[null," patient specfic elimination rate constant and volume of distribution  in a separate file. The file is password protected and the data is hidden."]
[null,"This allows analysis of predicted versus actual levels to optimize the parameters used in the program."]
[]
[null,"Program Requirements"]
[null,"Excel 2010"]
[null,"A shared drive with a copies of the program in separate folders if multiple users will be dosing patients at the same time or the program will have to be installed on multiple computers."]
[null,"A copy of the program should be placed in individual folders on the shared drive for each functional area of use along with the patient data file."]
[]
[null,"References"]
[null,"1. Chiou WL, Hsu FH. A new simple and rapid method to monitor the renal function  based on pharmacokinetic consideration of endogeneous creatinine. Res Commun Chem Pathol Pharmacol. 1975 Feb;10(2):315-30. PubMed PMID: 1153839."]
[null,"2. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41. PubMed PMID: 1244564."]
[null,"3. Devine BJ. Gentamicin therapy. Drug Intell Clin Pharm. 1974;8:650–655."]
[null,"4. Lau AH, Berk SI, Prosser T, Stonich T. Estimation of creatinine clearance in malnourished patients. Clin Pharm. 1988 Jan;7(1):62-5. PubMed PMID: 3126017."]
[null,"5. Gilbaldi M, Perrier D Pharmacokinetics Marcel Kekker, Inc New York 1975"]
[null,"6. Winter, Michael E. Basic Clinical Pharmacokintics 2nd Edition Applied Therapeutics Inc 1988"]
[null,"7. Murphy John E, Clinical Pharmacokinetics Third Edition American Society of Health Systems Pharmacists, Inc 2005"]
[null,"8. Schwartz GJ, Haycock GB, Edelmann CM, et al. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics. 1976;58:259-63"]
[null,"9. Schwartz GJ, Feld LG, Langford DJ. A simple estimate of glomerular fultration rate in full-term infants during the first year of life. Pediatrics 1984;104:849-54"]
[null,"10. Chow MS, Schweizer R. Estimation of renal creatinine clearance in patients with unstable serum creatinine concentrations: comparison of multiple methods. Drug Intell Clin Pharm. 1985 May;19(5):385-90. PubMed PMID: 4006730."]
[null,"11. Lener, Peck, Brown, Perlin. One compartment forecaster reference materials. Technical Report Number 10. Division of Clinical Pharmacology Uniformed Service university of Health Science Bethesda, Maryland"]
[null,"12. University of Virginia Health System Adult Enteral and Parenteral Nutrition Handbook"]

{"sheet":"Drop Down Boxes","index":1,"n_rows":36,"n_cols":21,"rows_kept":36,"cut":false,"hidden":true,"merged":[]}
[null,"Systolic Dysfunction","Drug","Height Units","Weight Units","Sex","Unit","Diagnosis","Leg","Arm","Paralasis","Malnutrition","Dosage Form","Fraction","Salt","Drug Interaction Clearnarance Multiplier","Cl","Vd","Dosage Form","Fraction","Salt"]
[null,"Yes","Vancomycin","Inches","Kgs","Female","Critical Care","Abcess","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Capsule",1,1,"Amiodarone",0.5,1,"Capsule",1,1]
[null,"No","Amikacin Pulse","Centimeters","Lbs","Male","Orthopedics","Bacteremia","AKA","AEA","Functional","Yes","Elixir",0.8,1,"Canaglifozin",0.8,1,"Elixir",0.8,1]
[null,null,"Gentamicin/Tobramycin Pulse",null,null,null,"Oncology","Bronchitis","BKA","BEA","Paraplegia",null,"Injection",1,1,"Carvedilol",0.75,1,"Injection",1,1]
[null,null,"Amikacin Traditional",null,null,null,"Renal","Brain Abcess","Entire Leg Amputation","Entire Arm Amputation","Quadraplegia",null,"Tablets",0.7,1,"Dronedarone",0.5,1,"Tablets",0.7,1]
[null,null,"Gentamicin/Tobramycin Traditional",null,null,null,null,"CV Implanted Device infection",null,null,null,null,null,null,null,"Hyperthyroidism",1.3,1.3]
[null,null,null,null,null,null,null,"Cellulitis",null,null,null,null,null,null,null,"Hypothyroidism",0.7,0.7]
[null,null,null,null,null,null,null,"Central Line Infection",null,null,null,null,null,null,null,"Ketoconazole/Itraconazole",0.5,1]
[null,null,null,null,null,null,null,"Decubitis Ulcer",null,null,null,null,null,null,null,"None",1,1]
[null,null,null,null,null,null,null,"Diabetic Foot",null,null,null,null,null,null,null,"Propafenone",0.75,1]
[null,null,null,null,null,null,null,"Discitis",null,null,null,null,null,null,null,"Quinidine",0.5,0.7]
[null,null,null,null,null,null,null,"Empyema",null,null,null,null,null,null,null,"Ranolazine",0.67,1]
[null,null,null,null,null,null,null,"Endocarditis",null,null,null,null,null,null,null,"Verapamil",0.75,1]
[null,null,null,null,null,null,null,"Fever of Unknown Origin"]
[null,null,null,null,null,null,null,"Gangrene",null,null,null,null,null,null,null,"Volume of Distribution Multiplier"]
[null,null,null,null,null,null,null,"Gastroenteristis",null,null,null,null,null,null,null,"Hypothyroidism",0.7,0.7]
[null,null,null,null,null,null,null,"Intra-abdominal",null,null,null,null,null,null,null,"Hyperthyroidism",1.3,1.3]
[null,null,null,null,null,null,null,"Mediastinitis",null,null,null,null,null,null,null,"Quinidine",0.7]
[null,null,null,null,null,null,null,"Meningitis"]
[null,null,null,null,null,null,null,"Necrotizing Fascitis"]
[null,null,null,null,null,null,null,"Neutropenia"]
[null,null,null,null,null,null,null,"Osteomyelitis"]
[null,null,null,null,null,null,null,"Pancreatitis"]
[null,null,null,null,null,null,null,"Parotitis"]
[null,null,null,null,null,null,null,"Pneumonia (Aspiration)"]
[null,null,null,null,null,null,null,"Pneumonia (CAP)"]
[null,null,null,null,null,null,null,"Pneumonia(HCAP)"]
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[null,null,null,null,null,null,null,"UTI (Lower)"]
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{"sheet":"Patient Data","index":3,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":true,"merged":[]}

{"sheet":"CreatinineClearanceCalculation","index":4,"n_rows":22,"n_cols":177,"rows_kept":22,"cut":false,"hidden":true,"merged":[]}
[]
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[null,null,"AUC SS Sum of AUCs for Dosage Interval Single Interval from above",{"$f":"SUM(E8:DT8)","v":0}]
[null,"works","AUC SS per Day (above times 24/Tau)",{"$f":"D10*24/B27","v":{"$error":"#DIV/0!"}}]
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[null,"works","AUC(Dose/Vd*K) Single Dose Non SS",{"$f":"B20/(B21*B22)","v":{"$error":"#DIV/0!"}}]
[null,"works- 2nd best","AUC(Dose/Vd*K) Single Dose Non SS * (24)/Tau",{"$f":"D13*(24)/B27","v":{"$error":"#DIV/0!"}}]
[null,null,"Peak (D/Vd)",{"$f":"B20/B22","v":{"$error":"#DIV/0!"}}]
[null,"Works 2nd best","AUC =((Peak +Trough)*T'/2 + AUC(Cmax/k - Cmin/k))24/Tau",{"$f":"((B32+B33)/2*B26+(B32/B21-B33/B21))*24/B27","v":{"$error":"#DIV/0!"}},"These are same equation"]
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[null,"Works","AUC if Constant infusion = sfD*24/(tau*cl)",{"$f":"IF(B27=B26,B20*(24/B27)/(B21*B22),\"\")","v":""}]
[null,null,"AUC=cave*Tau",{"$f":"D9*B27","v":{"$error":"#DIV/0!"}}]
["Dose",{"$f":"Calculations!C36","v":0}]
["K",{"$f":"Calculations!C26","v":{"$error":"#DIV/0!"}}]
["Vd",{"$f":"Calculations!C22","v":{"$error":"#DIV/0!"}}]
["1-exp(-ktau)",{"$f":"1-EXP(-B21*B27)","v":{"$error":"#DIV/0!"}}]
["Accumulation  Factor",{"$f":"1/B23","v":{"$error":"#DIV/0!"}}]
["1-exp(-kt')",{"$f":"1-EXP(-B21*B26)","v":{"$error":"#DIV/0!"}}]
["t'",{"$f":"Calculations!C16","v":0.25}]
["Tau",{"$f":"Calculations!C34","v":0}]
["exp(-K*(Tau-t')",{"$f":"EXP(-B21*(B27-B26))","v":{"$error":"#DIV/0!"}}]
["Post Dose exp(-k*time)"]
["Half life",{"$f":"0.693/B21","v":{"$error":"#DIV/0!"}}]
["5 Half Lives",{"$f":"5*B30","v":{"$error":"#DIV/0!"}}]
["Peak SS",{"$f":"B20*B25/(B21*B22*B26*B23)","v":{"$error":"#DIV/0!"}}]
["Trough SS",{"$f":"B32*EXP(-B21*(B27-B26))","v":{"$error":"#DIV/0!"}}]
["Peak SS Single Dose Diff",{"$f":"B32-B33","v":{"$error":"#DIV/0!"}}]
["Peak Single Dose",{"$f":"B20/B22","v":{"$error":"#DIV/0!"}}]
["Cavg =sfd/(kvTau) works best",{"$f":"B20/(B21*B22*B27)","v":{"$error":"#DIV/0!"}}]
["Cavg =( Cmax+Cmin)/2",{"$f":"(B32+B33)/2","v":{"$error":"#DIV/0!"}}]
["Time to Cavg from start of Infusion",{"$f":"(LN(B32/D9)/B21)+B26","v":{"$error":"#DIV/0!"}}]
["caverag/peak",{"$f":"B36/B32","v":{"$error":"#DIV/0!"}}]

{"sheet":"Pediatric Info","index":7,"n_rows":56,"n_cols":20,"rows_kept":56,"cut":false,"hidden":true,"merged":[[37,3,38,3],[52,3,53,3],[52,6,53,6]]}
[null,"Age",null,"Cl (l/kg/hr)","VD (l/kg)","K (hr-1)","K=","m*clcr +","b"]
["Aminoglycosides","<=4 weeks","Neonates",0.05,0.5,{"$f":"D2/E2","v":0.1},null,{"$f":"F2*(1-0.0429)/120","v":7.9758333333333341E-4},{"$f":"F2*0.0429","v":4.2900000000000004E-3}]
[null,">4wk-1year","Infant",0.1,0.4,{"$f":"D3/E3","v":0.25},null,{"$f":"F3*(1-0.0429)/120","v":1.9939583333333333E-3},{"$f":"F3*0.0429","v":1.0725E-2}]
[null,">1<=13","Children",0.1,0.35,{"$f":"D4/E4","v":0.28571428571428575},null,{"$f":"F4*(1-0.0429)/120","v":2.2788095238095241E-3},{"$f":"F4*0.0429","v":1.2257142857142859E-2}]
[null,">13<=18","Adolescents",0.09,0.3,0.3,null,2.3927499999999999E-3,1.2869999999999999E-2]
[null,null,"Adult",{"$f":"E6*F6","v":8.1500000000000003E-2},0.25,{"$f":"0.0026*120 +0.014","v":0.32600000000000001},null,2.6001216666666663E-3,1.39854E-2]
[null,"Reference Clinical Pharmacokinetics Pocket Reference John E. Murphy"]
[null,null,"Assumes normal Clcr is 120","need to double check vaules for ages"]
[]
[null,null,"2000 CDC Growth charts "]
[null,null,"Age (Years)",2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18]
[null,"Age 2-20 years","Height (Centimeters) Females",86,94.5,101,107.5,115,121.5,127.5,133,138,144,151,157,160.5,162,162.5,163]
[null,null,"Weight (kg) Females",12,13.8,16,18,20,23,25.5,29,33,37,41.5,46,49.5,52,54,55]
[null,null,"Lener, Peck, Brown, Perlin Formula",{"$f":"(-77.55796+(6.93728*D12/2.54)-(0.171703*(D12/2.54)^2)+(0.001726*(D12/2.54)^3))/2.2","v":12.492228958451628},{"$f":"(-77.55796+(6.93728*E12/2.54)-(0.171703*(E12/2.54)^2)+(0.001726*(E12/2.54)^3))/2.2","v":14.435519583994061},16.056094406887606,17.880239616709005,20.341032713657576,22.871574698620403,25.607175630495128,28.506410377183144,31.508594770367242,35.624116425075528,41.211159912437395,46.744379178560983,50.315648656535664,51.927636820076216,52.476088738919067,53.030161768136146]
[null,null,"Height (centimeters) Males",87.5,96,102,109,115,122,127.5,133.5,138.5,143.5,149,156,163.5,170,173.5,175," "]
[null,null,"Weight (kg) Males",12.6,14.3,16,18.5,21,23,26,28.5,32,36,40.5,45.5,51,56,61,64.5," "]
[null,null,"Lener, Peck, Brown, Perlin Formula",{"$f":"(-59.6035+(5.2878*D15/2.54)-(0.123939*(D15/2.54)^2)+(0.00128936*(D15/2.54)^3))/2.2","v":12.811110586457943},{"$f":"(-59.6035+(5.2878*E15/2.54)-(0.123939*(E15/2.54)^2)+(0.00128936*(E15/2.54)^3))/2.2","v":14.91729232710076},16.532650456814881,18.621764059970499,20.640746305522683,23.327682396198718,25.734748047190251,28.703268629256499,31.482603422625406,34.568338462832109,38.348552857857342,43.799204813903557,50.51174637398578,57.127767989211684,61.019256677123813,62.760625542417905]
[]
[]
[null,null,"Clcr Schwartz Equation ml/min/1.73",133,133,133,133,133,133,133,133,133,133,133,140,140,140,140,140]
[null,null,"< 2"]
[null,"Scr males",">=2-<13",{"$f":"0.55*D15/D20","v":0.36184210526315796},0.39699248120300756,0.42180451127819552,0.45075187969924813,0.47556390977443613,0.5045112781954888,0.52725563909774431,0.55206766917293237,0.57274436090225578,0.59342105263157907,0.61616541353383458]
[null,"Scr males",">=13-<18",null,null,null,null,null,null,null,null,null,null,null,{"$f":"O15*0.7/O20","v":0.77999999999999992},{"$f":"P15*0.7/P20","v":0.81749999999999989},{"$f":"Q15*0.7/Q20","v":0.84999999999999987},{"$f":"R15*0.7/R20","v":0.86749999999999994},{"$f":"S15*0.7/S20","v":0.87499999999999989}]
[]
[]
[null,null,"Clcr Schwartz Equation ml/min/1.73",133,133,133,133,133,133,133,133,133,133,133,126,126,126,126,126]
[null,null,"< 2"]
[null,"Scr females",">=2-<13",{"$f":"0.55*D12/D26","v":0.35563909774436092},0.39078947368421052,0.41766917293233086,0.44454887218045119,0.47556390977443613,0.50244360902255636,0.52725563909774431,0.55000000000000004,0.57067669172932334,0.59548872180451129,0.62443609022556401]
[null,"Scr females",">=13-<18",null,null,null,null,null,null,null,null,null,null,null,{"$f":"O12*0.55/O26","v":0.68531746031746044},{"$f":"P12*0.55/P26","v":0.70059523809523816},{"$f":"Q12*0.55/Q26","v":0.70714285714285718},{"$f":"R12*0.55/R26","v":0.70932539682539697},{"$f":"S12*0.55/S26","v":0.71150793650793653}]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,"ent=bicarb+dissolved CO2)","Cordblood","15-20","mEq/l"]
[null,null,null,null,"Child","18-27","mEq/l"]
[null,null,null,"Creatinine","Premature","0.3-1.o","mg/dL"]
[null,null,null,null,"Neonates","0.2-0.9","mg/dL"]
[null,null,null,"Note: There are gender-specific ranges only for ages 16 years and older.","2-12 months","0.2-0.4","mg/dL"]
[null,null,null,null,"1-2 years","0.2-0.5","mg/dL"]
[null,null,null,null,"3-4 years","0.3-0.7","mg/dL"]
[null,null,null,null,"5-6 years","0.3-0.7","mg/dL"]
[null,null,null,null,"7-8 years","0.2-0.6","mg/dL"]
[null,null,null,null,"9-10 years","0.3-0.7","mg/dL"]
[null,null,null,null,"11-12 years","0.3-0.9","mg/dL"]
[null,null,null,null,"13-15 years","0.4-0.9","mg/dL"]
[]
[null,null,null,null,"Males 16 years +","0.6-1.2","mg/dL"]
[null,null,null,null,"Females 16 years+","0.5-1.0","mg/dL"]
[null,null,null,"Glucose","0-1 month","40-99","mg/dL"]
[null,null,null,null,"1 month-adult","65-99"]
[]
[null,null,null,"http://www.healthcare.uiowa.edu/path_handbook/Appendix/Heme/PEDIATRIC_NORMALS.html"]

{"sheet":"Vanco","index":8,"n_rows":213,"n_cols":19,"rows_kept":213,"cut":false,"hidden":true,"merged":[]}
[null,"Input Last Name of Patient","",null,null,null,"Adult and Pediatric Vancomycin and Aminoglycoside Dosing "]
[null,"Input First Name of Patient","",null,null,null,"Data Fitting of Steady State or Non Steady State Dosing History and Serum Levels"]
[null,"Input Medical Record Number",null,null,null,null,"Using Standard One Compartment Pharmacokinetic Equations"]
[null,"Input Age (Years)",null,null,null,null,"Marshall Pierce Pharm.D. "]
[null,"Select Height Units (Drop Down Box)","Inches"," Select Treatment Diagnosis (DB)","Cellulitis"]
[null,"Input Height",null,{"$f":"IF(C7>84,\"Verify that correct height units are being used\",\"\")","v":""}]
[null,"Height Used (Inches)",{"$f":"IF(C5=\"Centimeters\",C6/2.54,C6)","v":0},0,"Left Arm Amputation","Right Arm Amputation","Paralysis"]
[null,"Select Weight Units (Drop Box Box)","Kgs",null,"Not Applicable","Not Applicable","Not Applicable"]
[null,"Input Weight",null,null,"Not Applicable","Not Applicable","Not Applicable"]
[null,"Weight Used (kgs)",{"$f":"IF(C8=\"Lbs\",C9/2.2,C9)","v":0},0,"Left Leg Amputation","Right Leg Amputation","Creatinine Multiplier",null,"Minimum Creatinine"]
[null,"Select Sex (Drop Down Box)","Male","Male","Not Applicable","Not Applicable",1,null,{"$f":"IF(C4>=18,IF(OR(G8=\"Functional\",G8=\"Paraplegia\",G8=\"Quadraplegia\"),0.5,0.7))","v":false}]
[null,"Input Most Recent Actual Serum Creatinine (mg/dl)",null,null,"Not Applicable","Not Applicable"]
[null,"Input Previous Actual Serum Creatinine (mg/dl)",null,null,"Malnutrition"]
[null,"Time Between Serum Creatinines (hours)",null,null,"Not Applicable"]
[null,"Select Drug (Drop Down Box)","Vancomycin","Vancomycin","Not Applicable"]
[null,"Input Infusion Period (hours)",null,{"$f":"IF(C16>3, \"Verify that infusion period is correct\",\"\")","v":""}]
["Hide","Lean Body Weight < 18 or 48 inches",{"$f":"IF(C7<22,C10,IF(OR(C4<18,C7<48),IF(C11=\"Male\",(-59.6035+(5.2878*C7)-(0.123939*C7^2)+(0.00128936*C7^3))/2.2,(-77.55796+(6.93728*C7)-(0.171703*C7^2)+(0.001726*C7^3))/2.2)))","v":0}," "]
["Hide","Lean Body Weight Calculated",{"$f":"IF(OR(C4<18,C7<48),C17,IF(C11=\"Female\", (C7-60)*2.3+45.5,(C7-60)*2.3+50))","v":0}]
[null,"Calculated Lean Body Weight (kg)",{"$f":"IF(C18<=C10,C18,C10)","v":0}]
["Hide","Dosing Weight Aminoglycosides",{"$f":"IF(C19<C10,(C10-C19)*0.4+C19,C10)","v":0}]
[null,"Calculated Dosing Weight (kg)",{"$f":"IF(C15=\"Vancomycin\",C10,C20)","v":0}]
[null,"Calculated Vd (Liters)",{"$f":"IF(C15=\"Vancomycin\",0.65*C21,IF(C4<=13,0.35*C21,IF(C4<=18,0.3*C21,0.25*C21)))","v":0},{"$f":"IF(OR(C12<>D12,C13<>D13,C14<>D14,E9<>E8,F9<>F8,G9<>G8,E12<>E11,F12<>F11,E15<>E14,C4<>D4,C7<>D7,C10<>D10,C11<>D11,C15<>D15),\"Remember to press the Calculated Creatinine Clearance Button\",\"\")","v":""}]
[null,"Body Surface Area Calculated Meters2",{"$f":"(C10^0.425)*((C7*2.54)^0.725)*71.84/10000","v":0}]
[null,"Calculated Creatinine Clearance (ml/min)",{"$f":"CreatinineClearanceCalculation!E19","v":0}]
[null,"Calculated T1/2 (Hours) for Creatinine",{"$f":"IF(LEN(D22)<>0,\"\",CreatinineClearanceCalculation!E20)","v":{"$error":"#DIV/0!"}},"Solver Based Calulations","Volume of Distribution (Liters)"]
[null,"Calc. Eliminaton Rate Constant (hr-1) Drug",{"$f":"IF($C15=\"Vancomycin\",0.00107*$C24*(1.73/$C23)+0.005216005,IF(C4<=13,0.002279*C24+0.012257,IF(C4<=18,0.002393*C24+0.01287,0.0026*$C24+0.014)))","v":{"$error":"#DIV/0!"}},{"$f":"C26","v":{"$error":"#DIV/0!"}},{"$f":"C22","v":0}]
[null,"Calculated Half-Life (Hours) for Drug",{"$f":"0.693/C26","v":{"$error":"#DIV/0!"}},{"$f":"0.693/D26","v":{"$error":"#DIV/0!"}}]
["Hide","Loading Dose Aminoglycosides",{"$f":"IF(C24>=28.6,IF(C15=\"Amikacin\",60*C$22*C$26*C$16/(1-EXP(-C$26*C$16)),20*C22*C26*C16/(1-EXP(-C26*C16))),IF(C15=\"Amikacin\", 30*C22*C26*C16/(1-EXP(-C26*C16)),8*C22*C26*C16/(1-EXP(-C26*C16))))","v":{"$error":"#DIV/0!"}}]
["Hide","Loading Dose Vancomycin",{"$f":"30*C$22*C$26*C$16/(1-EXP(-C$26*C$16))","v":{"$error":"#DIV/0!"}},null,"Hours to 15 mcg/ml from start LD",{"$f":"LN(30/15)/C26+2","v":{"$error":"#DIV/0!"}},"Hours to 20 mcg/ml",{"$f":"LN(30/20)/C26+C16","v":{"$error":"#DIV/0!"}}]
[null,"Calculated Loading Dose Calculated (mg)",{"$f":"IF(LEN(D22)<>0,\"\",IF(C15=\"Vancomycin\",C29,IF(C26<=LN(20/0.3)/47.5,C28,\"Pulse Dosing\")))","v":{"$error":"#DIV/0!"}},null,{"$f":"IFERROR(IF(C15=\"Vancomycin\",IF(C30>3000,\"Maximum Vancomycin Loading Dose is 3 grams\",\"\"),\"\"),\"\")","v":""}]
["Hide","Aminoglycoside Interval Gentamicin",{"$f":"IF((((LN(20/0.3))/C26)+0.5)<24,24,IF((((LN(20/0.3))/C26)+0.5)<36,36,IF((((LN(20/0.3))/C26)+0.5)<48,48,((((LN(6/1))/C26))+0.5))))","v":{"$error":"#DIV/0!"}},{"$f":"IF((((LN(20/0.3))/D26)+0.5)<24,24,IF((((LN(20/0.3))/D26)+0.5)<36,36,IF((((LN(20/0.3))/D26)+0.5)<48,48,((((LN(6/1))/D26))+0.5))))","v":{"$error":"#DIV/0!"}}]
["Hide","Aminoglycoside Interval Amikacin",{"$f":"IF((((LN(60/0.9))/C26)+0.5)<24,24,IF((((LN(60/0.9))/C26)+0.5)<36,36,IF((((LN(60/0.9))/C26)+0.5)<48,48,((((LN(30/3))/C26))+0.5))))","v":{"$error":"#DIV/0!"}},{"$f":"IF((((LN(60/0.9))/D26)+0.5)<24,24,IF((((LN(60/0.9))/D26)+0.5)<36,36,IF((((LN(60/0.9))/D26)+0.5)<48,48,((((LN(30/3))/D26))+0.5))))","v":{"$error":"#DIV/0!"}}]
[null,"Calculated Dosage Interval (Hours)",{"$f":"IF(LEN(D22)<>0,\"\",IF($C15=\"Vancomycin\",(((LN(30/15))/C26)+2),IF($C15=\"Amikacin\",C32,C31)))","v":{"$error":"#DIV/0!"}},{"$f":"IF($C15=\"Vancomycin\",(((LN(40/15))/D26)+2),IF($C15=\"Amikacin\",D32,D31))","v":{"$error":"#DIV/0!"}}]
[null,"Input Rounded Dosage Interval (Hours)",null,{"$f":"C34","v":0},{"$f":"IF(C34<>\"\",IF(D26<>C26,IF(D36*24/D34>1.5*(C36*24/C34),\"Total Daily Dose should not be increased by more than 50%.\",\"\"),\"\"),\"\")","v":""},null,{"$f":"IF(C34>168,\"Verify dosage Interval entered\",\"\")","v":""}]
[null,"Calculated Maintenance Dose (mg)",0,0,null,null,"Maintenance Dose"]
[null,"Input Rounded MaintenanceDose (mg)",null,{"$f":"C36","v":0},{"$f":"IF($C36<>\"\",IF($C15=\"Vancomycin\",IF(C36/$C21>20,\"The entered maintenance dose, C36, is too large: \"&ROUND(C36/$C21,1)&\" mg/kg\",\"\"),IF(AND($C15=\"Gentamicin/Tobramycin\",C26>LN(20/0.3)/47.5),IF(ABS(1-(C36/($C21*5)))>=0.1,\"The entered dose, C36, is >= 10% higher or lower than calculated maintenance dose. \",\"\"),IF(AND($C15=\"Amikacin\",C26>LN(20/0.3)/47.5),IF(ABS(1-(C36/($C21*15)))>=0.1,\"The entered dose, C36, is >=10% higher or lower than calculated maintenance dose. \",\"\"),\"\"))),\"\")","v":""},null,"Dose (mg/kg)",{"$f":"D36/C21","v":{"$error":"#DIV/0!"}},{"$f":"IF(ISERROR(H36),\"\",IF(H36>=18,\"A lower dose, 10-17.5 mg/kg, is recommeneded\",\"\"))","v":""}]
[null,"Calculated Peak (mcg/ml)",{"$f":"IF(LEN(D22)<>0,\"\",C36*(1-EXP(-C26*$C16))/($C22*C26*$C16*(1-EXP(-C26*C34))))","v":{"$error":"#DIV/0!"}},{"$f":"D36*(1-EXP(-D26*$C16))/($E26*D26*$C16*(1-EXP(-D26*D34)))","v":{"$error":"#DIV/0!"}},{"$f":"IF($C$36<>\"\",IF($C$15=\"Vancomycin\",IF($D$36/$C$21>20,\"The entered maintenance dose, D36, is too large: \"&ROUND($D$36/$C$21,1)&\" mg/kg\",\"\"),IF(AND($C$15=\"Gentamicin/Tobramycin\",$D$26>LN(20/0.3)/47.5),IF(ABS(1-($D$36/($C$21*5)))>=0.1,\"The entered dose, D36, is >= 10% higher or lower than calculated maintenance dose. \",\"\"),IF(AND($C$15=\"Amikacin\",$D$26>LN(20/0.3)/47.5),IF(ABS(1-($D$36/($C$21*15)))>=0.1,\"The entered dose, D36, is >=10% higher or lower than calculated maintenance dose. \",\"\"),\"\"))),\"\")","v":""},null,"Total Daily Dose",{"$f":"D36*24/D34","v":{"$error":"#DIV/0!"}}]
[null,"Calculated Trough (mcg/ml)",{"$f":"IF(LEN(D22)<>0,\"\",C37*EXP(-C26*(C34-$C16)))","v":{"$error":"#DIV/0!"}},{"$f":"D37*EXP(-D26*(D34-$C16))","v":{"$error":"#DIV/0!"}}]
[null,"AUC (mg/hour/liter per day)",{"$f":"IF(LEN(D22)<>0,\"\",IF(C37<>C38,(C37+C38)*(C16/2)*24/C34+(C37-C38)*24/(C26*C34),C36*24/(C26*C22*C34)))","v":{"$error":"#DIV/0!"}},{"$f":"(D37+D38)*C16/2*24/D34+(D37-D38)*24/(D26*D34)","v":{"$error":"#DIV/0!"}},{"$f":"IF(ISERROR(C39),\"\",IF(C39>600,\"AUC is too high\",\"\"))","v":""}]
[null,null,null,null,"Dose 1 after starting level",null," ","Dose 2 after starting level",null," ","Dose 3 after starting level",null," ","Dose 4 after starting level"," ",null,"Dose 5 after starting level"]
[null,null,null,"Dose (mg)",null,null,"Dose (mg)",null,null,"Dose (mg)",null,null,"Dose (mg)",null,null,"Dose (mg)"]
[null,null,null,"Dose Date &Time ",null,null,"Dose Date &Time ",null,null,"Dose Date &Time ",null,null,"Dose Date &Time ",null,null,"Dose Date &Time "]
[null,"Current Date","2019-08-10T07:27:20"]
[null,"Date Therapy Initiated (Month/Day/Year)"]
[null,null,null,null,null,null,null,null,null," ",null,null," ",null,null," "]
[null,null,"Starting Level Before Dose 1 ",null,"Serum Levels (mcg/ml)",null,null,"Serum Levels (mcg/ml)",null,null,"Serum Levels (mcg/ml)",null,null,"Serum Levels (mcg/ml)",null,null,"Serum Levels (mcg/ml)"]
[null,null,"Starting Level Date &Time",null,"Serum Level Date &Time",null,null,"Serum Level Date &Time",null,null,"Serum Level Date &Time",null,null,"Serum Level Date &Time",null,null,"Serum Level Date &Time"]
[]
[null,null,null,null,"Trough Before Dose 1",null,null,"Trough Before Dose 2",null,null,"Trough Before Dose 3",null,null,"Trough Before Dose 4",null,null,"Trough Before Dose 5"]
[null,null,null,"Expected Levels (mcg/ml)",{"$f":"D46*EXP(-$D26*(E42-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D46*EXP(-$D26*(F47-$D47)*24)+($E41*(1-EXP(-$D26*$C16))*(EXP(-$D26*(((F47-$E42)*24)-$C16)))/($E26*$C16*$D26))","v":{"$error":"#DIV/0!"}},{"$f":"$D46*EXP(-$D26*(G47-$D47)*24)+($E41*(1-EXP(-$D26*$C16))*(EXP(-$D26*(((G47-$E42)*24)-$C16)))/($E26*$C16*$D26))","v":{"$error":"#DIV/0!"}},{"$f":"$D46*EXP(-$D26*(H42-$D47)*24)+($E41*(1-EXP(-$D26*$C16))*(EXP(-$D26*(((H42-$E42)*24)-$C16)))/($E26*$C16*$D26))","v":{"$error":"#DIV/0!"}},{"$f":"$H50*EXP(-$D26*(I47-$H42)*24) + ($H41*(EXP(-$D26*(((I47-$H42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$H50*EXP(-$D26*(J47-$H42)*24) + ($H41*(EXP(-$D26*(((J47-$H42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$H50*EXP(-$D26*(K42-$H42)*24) + ($H41*(EXP(-$D26*(((K42-$H42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$K50*EXP(-$D26*(L47-$K42)*24) + ($K41*(EXP(-$D26*(((L47-$K42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$K50*EXP(-$D26*(M47-$K42)*24) + ($K41*(EXP(-$D26*(((M47-$K42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$K50*EXP(-$D26*(N42-$K42)*24) + ($K41*(EXP(-$D26*(((N42-$K42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$N50*EXP(-$D26*(O47-$N42)*24) + ($N41*(EXP(-$D26*(((O47-$N42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$N50*EXP(-$D26*(P47-$N42)*24) + ($N41*(EXP(-$D26*(((P47-$N42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$N50*EXP(-$D26*(Q42-$N42)*24) + ($N41*(EXP(-$D26*(((Q42-$N42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$Q50*EXP(-$D26*(R47-$Q42)*24) + ($Q41*(EXP(-$D26*(((R47-$Q42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$Q50*EXP(-$D26*(S47-$Q42)*24) + ($Q41*(EXP(-$D26*(((S47-$Q42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}}]
[]
[null,null,null,null,"Square of Errors",{"$f":"IF(ISNUMBER(F50),(F50-F46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(G50),(G50-G46)^2,\"\")","v":""},null,{"$f":"IF(ISNUMBER(I50),(I50-I46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(J50),(J50-J46)^2,\"\")","v":""},null,{"$f":"IF(ISNUMBER(L50),(L50-L46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(M50),(M50-M46)^2,\"\")","v":""},null,{"$f":"IF(ISNUMBER(O50),(O50-O46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(P50),(P50-P46)^2,\"\")","v":""},null,{"$f":"IF(ISNUMBER(R50),(R50-R46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(S50),(S50-S46)^2,\"\")","v":""}]
[null,null,null,null,"Sum of Square of Errors",{"$f":"SUM(F52:S52)","v":0}]
[]
[null,"Marshall Pierce PharmD"]
[null,"No Warranties Are Expressed or Implied."]
[]
[]
[null,"Instructions For Use"]
[null,"1. Enter the data required in the blue colored cells in column C, (C1-C16)."]
[null,"2. Select the patients treatment condition in cell E5."]
[null,"3. Select the values in cells E8 through G8, E11 through F11, and E14 if the patient has amputation(s), paralysis, or malnutrition."]
[null,"4. Press the \"Calculate Creatinine Clearnance or Dose\" button. This will calculate the patient's creatinine clearance and suggested dose and frequency."]
[null,"5. Enter a rounded dosage interval and rounded dose in cells C34 and C36 respectively."]
[null,"6. Population based parameters (elimination rate constant and volume of distribution) are used to calculate the peak and trough in C37 and C38 respectively."]
[null,"7. Change the values in C34 and C36 to obtain your desired predicted peak and trough in cells C37 and C38."]
[]
[null,"Population Based Equations Using Standard One Compartment Pharmacokinetic Equations"]
[null,"Vancomycin"]
[null,"Volume of Distribution (liters) = 0.65 l/kg of total body weight"]
[null," Elimination Rate Constant (1/hours) = 0.00107 * Creatinine ClearanceIBW * 1.73/BSA +  0.0052"]
[null,"Aminoglycosides"]
[null,"Volume of Distribution (liters) = 0.25 l/kg of adjusted body weight"]
[null,"Elimination Rate Constant (1/hours) = 0.026 * Creatinine ClearanceIBW  + 0.014"]
[null,"Ideal body weight (IBW(kg)) Adults"]
[null,"Males(kg) =   50(kg) + 2.3(kg) * (height in inches - 60)"]
[null,"Females(kg) = 45.5(kg) + 2.3(kg) * (height in inches - 60)"]
[null,"Lean Body Weight for Children  or height < 48 inches (Peck Formula)"]
[null,"Female < 18 years = -77.55796 + (6.93728 * height in inches) -(0.171703 * Height2) + (0.001726* Height3)"]
[null,"Male < 18 years = -59.6035 + (5.2878 * Height) - (0.123939 * Height2) + 0.00128936 * Height3)"]
[null,"If height < 22 inches, lean weight = total weight"]
[null,"Adjusted body weight, aminoglycosides only, if actual weight > IBW."]
[null,"Adjusted Body Weight(kg) = LBW(kg) + 0.4 * (Actual Weight(kg) – IBW(kg))"]
[null,"Creatinine Clearance Equations"]
[null,"Adults Cockcroft Gault Equation "]
[null,"Males(ml/min) = (140-age) * ( Use Ideal Body Weight(kg) or actual weight if less than IBW(kg)) / (Serum Creatinine *72)"]
[null,"Females(ml/mn): above x 0.85"]
[null,"Pediatic Schartz Equation"]
[null,"ClCr(ml/min/1.73 m2) = Factor* HeightCentimeters / Serum Creatinine"]
[null,"Factor: 0.45 < 1 year, 0.55 1-12 years,  > 12 years 0.55 female, > 12 years males 0.7"]
[null,"Amputation and Paralysis Serum Creatiine Multiplication Factors"]
[null,"Entire Leg Amputation (1.2269), AKA (1.1764), BKA (1.0638), Entire Arm Amputation (1.0695), AEA (1.0526), BEA (1.0309), Functional Palegia (1.4), Paraplegia (1.4), Quadraplegia(1.6)"]
[null,"Minimal Serum Creatinine: 0.5 mg/dL in patients with functional, para or quadraplegia, or malnutrition; 0.7 in other adults."]
[null,"Data Fitting: The program employees non steady state one compartment equations and uses the method of superposition to determine the expected level(s) from the input dosing history, "]
[null,"starting serum level, and and estimated pharmacokinetic parameters."]
[null,"CpT = Cp0e(-K(T-to)) + [D1(1-e(-KT’))*e(-K(T-Td1-T’))/(VKT’)]  +  [D2(1-e(-KT’))*e(-K(T-Td2-T’))/(VKT’)]……."]
[null,"The expected levels, displayed in the data fitting section, are calculated using the population elimination rate constant (C26) and volume of distribtution (C22) initially. "]
[null,"Once the data (dosing and serum levels) is fit the patient specific values of elimination rate constant and volume of distribution, D26 and E26,  are used. "]
[]
[null,"Objective Function to Minimize"]
[null,"Sum of the Square of Errors = (Predicted Level1 – Actual Level1)2  + (Predicted Level2 – Actual Level2)2    for all input levels"]
[]
[null,"Analyzing steady state levels using a trough drawn after a know steady state dose (this is our usual practice)"]
[null,"8. Steps 1-7 must be completed, enter the current frequency  and dose in C34 and C36."]
[null,"9. Enter the date therapy was started in cell C44."]
[null,"10. Enter the steady state trough in cell G46 and the date and time of the trough in G47."]
[null,"11. Enter the date and time of the dose which was given before the trough in E42. "]
[null,"12. Press the \"Assume Steady State: Trough drawn after dose 1\". This will copy the entered trough to cell D46, place the calculated time of the predose trough in cell D47, and the dose to E41."]
[null,"This is for your convience, if you choose to you can enter the data manually without pressing the \"Assume Steady State\" button."]
[null,"By placing the same trough around a single dose you are creating steady state conditions. This is the definition of steady state, levels are unchange dose to dose.  "]
[null,"13. Press \"Fit Data (Elimination Rate Constant Optimization)\" button. The program will determine the elimination rate constant that miniminzes the difference between the actual and predicted level."]
[null,"14. The calculated patient specific elimination rate constant is displayed in cell D26 after data fitting."]
[null,"15. The predicted state state levels using the patient specific elimination rate constant are displayed in cells D37 and D38 respectively."]
[null,"16. You may adjust the dosage frequency and dose in D34 and D36 to obtain your desired levels."]
[]
[null,"Steady State Levels with the trough drawn post dose past the time the next dose was due as next dose was held, the dose was given late, or a random level was ordered."]
[null,"Trough at time of Dose1 displayed in E50 = Trough PredoseD46*Exp(-K*(Time of Dose1 E42- Time of Predose Trough D47)*24)"]
[null,"The trough in D46 will show a time in D47 that is after the time of the dose1 in E42, but the equation above back extrapolates the calculated trough displayed in E50 to the time of Dose 1."]
[null,"The programs calculations are correct though the displayed values in D46 and D47 look incorrect. The value in E50 is the value used in the further calculations. "]
[]
[null,"Analyzing steady state levels using a trough drawn before a known steady state dose. This will be rarely use, but is included for flexible. "]
[null,"8. Steps 1-7 must be completed, enter the current frequency  and dose in C34 and C36."]
[null,"9. Enter the date therapy was started in cell C44."]
[null,"10. Enter the steady state trough in cell D46 and the date and time of the trough in D47."]
[null,"11. Enter the date and time of the dose which was given in E42. "]
[null,"12. Press the \"Assume Steady State: Trough drawn before dose 1\". This will copy the entered trough to cell G46, place the calculated time of the post dose trough in cell G47, and the dose to E41."]
[null,"This is for your convience, if you choose to you can enter the data manually without pressing the \"Assume Steady State\" button."]
[null,"By placing the same trough around a single dose you are creating steady state conditions.  This is the definition of steady state, levels are unchanging dose to dose."]
[null,"13. Press \"Fit Data (Elimination Rate Constant Optimization)\" button. The program will determine the elimination rate constant that miniminzes the difference between the actual and predicted level."]
[null,"14.The calculated patient specific elimination rate constant is displayed in cell D26 after data fitting."]
[null,"15. The predicted state state levels using the patient specific elimination rate constant are displayed in cells D37 and D38 respectively."]
[null,"16. You may adjust the dosage frequency and dose in D34 and D36 to obtain your desired levels."]
[]
[null,"Analyzing steady state levels using a trough drawn before a known steady state dose and a peak after the same dose (Traditional Dosing for Aminoglycosides)"]
[null,"8. Steps 1-7 must be completed, enter the current frequency  and dose in C34 and C36."]
[null,"9. Enter the date therapy was started in cell C44."]
[null,"10. Enter the steady state trough in cell D46 and the date and time of the trough in D47."]
[null,"11. Enter the steady state peak in cell F46 and time of the peak in F47."]
[null,"12. Enter the date and time of the dose which was given in E42. "]
[null,"13. Press the \"Assume Steady State: Trough drawn before dose 1\". This will copy the entered trough to cell G46, place the calculated time of the post dose trough in cell G47, and the dose to E41."]
[null,"This is for your convience, if you choose to you can enter the data manually without pressing the \"Assume Steady State\" button."]
[null,"By placing the same trough around a single dose you are creating steady state conditions. This is the definition of steady state. "]
[null,"14. Press \"Fit Data (Elimination Rate Constant & Vd Optimization)\" button. The program will determine the elimination rate constant and volume of distribution that miniminzes the difference "]
[null,"between the actual and predicted levels."]
[null,"15. The calculated patient specific elimination rate constant is displayed in cell D26 and volume of distribution in cell E26 after data fitting."]
[null,"16. The predicted state state levels using the patient specific K and Vd are displayed in cells D37 and D38 respectively."]
[null,"17. You may adjust the dosage frequency and dose in D34 and D36 to obtain your desired levels."]
[]
[null,"Analyzing Non Steady State Levels"]
[null,"8. Steps 1-7 must be completed, enter the current frequency  and dose in C34 and C36."]
[null,"9. Enter the date therapy was started in cell C44."]
[null,"10. Enter a starting level and time of the level in cells D46 and D47 respectively. This level may be 0 if no drug is on board or any known level before the doses you wish to analyze."]
[null,"11. Enter all doses and the dates and times given from the time of the starting level through the last dose administered before the last level to be analyzed in chronological order, "]
[null,"oldest to most recent left to right. The doses are numbered 1-5, chronological after the starting level."]
[null,"12. Enter all levels and the times drawn to be analyzed in chronlogical order, oldest to most recent left to right."]
[null,"13. Press the appropriate data fitting button, \"Fit Data (Elimination Rate Constant Optimization)\" if only troughs have been drawn, and"]
[null,"\"Fit Data (Elimination Rate Constant & Vd Optimization) if a peak(s) and trough(s) have been drawn."]
[null,"14. The calculated patient specific elimination rate constant is displayed in cell D26 and volume of distribution in cell E26 after data fitting."]
[null,"15. The predicted state state levels using the patient specific K and Vd are displayed in cells D37 and D38 respectively."]
[null,"16. You may adjust the dosage frequency and dose in D34 and D36 to obtain your desired levels."]
[]
[]
[null,"When to assume levels are Non Steady State Levels"]
[null,"1. If you are ordering levels before 5 half lives of have passed from the start of therapy."]
[null,"2. If you order levels after the 1st maintenance dose with or with out a loading dose."]
[null,"3. The patients doses or dosage intervals are not consistent."]
[]
[null,"Note: the predicted levels for input dosage regimens in column C (population) and D (patient specific) are independent from one another after data fitting."]
[]
[null,"Creatinine Clearance Calculation"]
[null,"How is creatinine clearance calculated when the serum creatinines is changing?"]
[null,"Most creatinine clearance equations assume stable renal function. "]
[null,"Creatinine clearance individualized (Clcr) Cockcroft Gault equation:"]
[null,"Males(ml/min) = (140-age) * ( Use Ideal Body Weight(kg) or actual weight if less than IBW(kg)) / (Serum Creatinine *72)"]
[null,"Females(ml/mn): above x 0.85"]
[null,"In the simplified form:   Creatinine Clearance = Creatinine rate of production / Serum Creatinine"]
[null,"Rate of production is constant for a patient and is determined by age, height, weight and sex. The rate of production is built "]
[null,"into the Cockcroft Gault equation and other creatinine clearanace equations. When renal function has changed the following  equation may be used to "]
[null,"calculate creatinine clearance before steady state serum creatinine levels are achieved. This is the most accurate method of "]
[null,"numerous published equations. An iterative method is used to determine clearnace as there is no direct solution to the equation."]
[null,"Serum Creatinine2 = Serum Creatinine1 * e(-KT) +  Rate of Production (1-e(-KT)) / Clearance of Creatinine"]
[null,"T is the time between serum two known creatinines (creatinine1 and creatinine2). "]
[null,"K is the elimination rate constant for creatinine."]
[null,"This equation accounts for the elimination of creatinine already present and the fraction of steady state achieved during the "]
[null,"time between the creatinines. "]
[null,"Assumptions of the non steady state equation:"]
[null,"All of the change in renal function has occurred at or before the time of the oldest creatinine (creatinine1)."]
[null,"The change in creatinines is due to renal function changes and is not due to tissue destruction or hydration changes."]
[null,"The serum creatinines are accurately determined and the time between them is known."]
[]
[null,"Data Storage"]
[null,"The program stores patient demographic information, current dose and frequency, along with calculated values including population and"]
[null," patient specfic elimination rate constant and volume of distribution  in a separate file. The file is password protected and the data is hidden."]
[null,"This allows analysis of predicted versus actual levels to optimize the parameters used in the program."]
[]
[null,"Program Requirements"]
[null,"Excel 2010"]
[null,"A shared drive with a copies of the program in separate folders if multiple users will be dosing patients at the same time or the program will have to be installed on multiple computers."]
[null,"A copy of the program should be placed in individual folders on the shared drive for each functional area of use along with the patient data file."]
[]
[null,"References"]
[null,"1. Chiou WL, Hsu FH. A new simple and rapid method to monitor the renal function  based on pharmacokinetic consideration of endogeneous creatinine. Res Commun Chem Pathol Pharmacol. 1975 Feb;10(2):315-30. PubMed PMID: 1153839."]
[null,"2. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41. PubMed PMID: 1244564."]
[null,"3. Devine BJ. Gentamicin therapy. Drug Intell Clin Pharm. 1974;8:650–655."]
[null,"4. Lau AH, Berk SI, Prosser T, Stonich T. Estimation of creatinine clearance in malnourished patients. Clin Pharm. 1988 Jan;7(1):62-5. PubMed PMID: 3126017."]
[null,"5. Gilbaldi M, Perrier D Pharmacokinetics Marcel Kekker, Inc New York 1975"]
[null,"6. Winter, Michael E. Basic Clinical Pharmacokintics 2nd Edition Applied Therapeutics Inc 1988"]
[null,"7. Murphy John E, Clinical Pharmacokinetics Third Edition American Society of Health Systems Pharmacists, Inc 2005"]
[null,"8. Schwartz GJ, Haycock GB, Edelmann CM, et al. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics. 1976;58:259-63"]
[null,"9. Schwartz GJ, Feld LG, Langford DJ. A simple estimate of glomerular fultration rate in full-term infants during the first year of life. Pediatrics 1984;104:849-54"]
[null,"10. Chow MS, Schweizer R. Estimation of renal creatinine clearance in patients with unstable serum creatinine concentrations: comparison of multiple methods. Drug Intell Clin Pharm. 1985 May;19(5):385-90. PubMed PMID: 4006730."]
[null,"11. Lener, Peck, Brown, Perlin. One compartment forecaster reference materials. Technical Report Number 10. Division of Clinical Pharmacology Uniformed Service university of Health Science Bethesda, Maryland"]
[null,"12. University of Virginia Health System Adult Enteral and Parenteral Nutrition Handbook"]

{"sheet":"Amino","index":9,"n_rows":213,"n_cols":19,"rows_kept":213,"cut":false,"hidden":true,"merged":[]}
[null,"Input Last Name of Patient","",null,null,null,"Adult and Pediatric Vancomycin and Aminoglycoside Dosing "]
[null,"Input First Name of Patient","",null,null,null,"Data Fitting of Steady State or Non Steady State Dosing History and Serum Levels"]
[null,"Input Medical Record Number",null,null,null,null,"Using Standard One Compartment Pharmacokinetic Equations"]
[null,"Input Age (Years)",null,null,null,null,"Marshall Pierce Pharm.D. "]
[null,"Select Height Units (Drop Down Box)","Inches"," Select Treatment Diagnosis (DB)","Cellulitis"]
[null,"Input Height",null,{"$f":"IF(C7>84,\"Verify that correct height units are being used\",\"\")","v":""}]
[null,"Height Used (Inches)",{"$f":"IF(C5=\"Centimeters\",C6/2.54,C6)","v":0},0,"Left Arm Amputation","Right Arm Amputation","Paralysis"]
[null,"Select Weight Units (Drop Box Box)","Kgs",null,"Not Applicable","Not Applicable","Not Applicable"]
[null,"Input Weight",null,null,"Not Applicable","Not Applicable","Not Applicable"]
[null,"Weight Used (kgs)",{"$f":"IF(C8=\"Lbs\",C9/2.2,C9)","v":0},0,"Left Leg Amputation","Right Leg Amputation","Creatinine Multiplier",null,"Minimum Creatinine"]
[null,"Select Sex (Drop Down Box)","Male","Male","Not Applicable","Not Applicable",1,null,{"$f":"IF(C4>=18,IF(OR(G8=\"Functional\",G8=\"Paraplegia\",G8=\"Quadraplegia\"),0.5,0.7))","v":false}]
[null,"Input Most Recent Actual Serum Creatinine (mg/dl)",null,null,"Not Applicable","Not Applicable"]
[null,"Input Previous Actual Serum Creatinine (mg/dl)",null,null,"Malnutrition"]
[null,"Time Between Serum Creatinines (hours)",null,null,"Not Applicable"]
[null,"Select Drug (Drop Down Box)","Vancomycin","Vancomycin","Not Applicable"]
[null,"Input Infusion Period (hours)",null,{"$f":"IF(C16>3, \"Verify that infusion period is correct\",\"\")","v":""}]
["Hide","Lean Body Weight < 18 or 48 inches",{"$f":"IF(C7<22,C10,IF(OR(C4<18,C7<48),IF(C11=\"Male\",(-59.6035+(5.2878*C7)-(0.123939*C7^2)+(0.00128936*C7^3))/2.2,(-77.55796+(6.93728*C7)-(0.171703*C7^2)+(0.001726*C7^3))/2.2)))","v":0}," "]
["Hide","Lean Body Weight Calculated",{"$f":"IF(OR(C4<18,C7<48),C17,IF(C11=\"Female\", (C7-60)*2.3+45.5,(C7-60)*2.3+50))","v":0}]
[null,"Calculated Lean Body Weight (kg)",{"$f":"IF(C18<=C10,C18,C10)","v":0}]
["Hide","Dosing Weight Aminoglycosides",{"$f":"IF(C19<C10,(C10-C19)*0.4+C19,C10)","v":0}]
[null,"Calculated Dosing Weight (kg)",{"$f":"IF(C15=\"Vancomycin\",C10,C20)","v":0}]
[null,"Calculated Vd (Liters)",{"$f":"IF(C15=\"Vancomycin\",0.65*C21,IF(C4<=13,0.35*C21,IF(C4<=18,0.3*C21,0.25*C21)))","v":0},{"$f":"IF(OR(C12<>D12,C13<>D13,C14<>D14,E9<>E8,F9<>F8,G9<>G8,E12<>E11,F12<>F11,E15<>E14,C4<>D4,C7<>D7,C10<>D10,C11<>D11,C15<>D15),\"Remember to press the Calculated Creatinine Clearance Button\",\"\")","v":""}]
[null,"Body Surface Area Calculated Meters2",{"$f":"(C10^0.425)*((C7*2.54)^0.725)*71.84/10000","v":0}]
[null,"Calculated Creatinine Clearance (ml/min)",{"$f":"CreatinineClearanceCalculation!E19","v":0}]
[null,"Calculated T1/2 (Hours) for Creatinine",{"$f":"IF(LEN(D22)<>0,\"\",CreatinineClearanceCalculation!E20)","v":{"$error":"#DIV/0!"}},"Solver Based Calulations","Volume of Distribution (Liters)"]
[null,"Calc. Eliminaton Rate Constant (hr-1) Drug",{"$f":"IF($C15=\"Vancomycin\",0.00107*$C24*(1.73/$C23)+0.005216005,IF(C4<=13,0.002279*C24+0.012257,IF(C4<=18,0.002393*C24+0.01287,0.0026*$C24+0.014)))","v":{"$error":"#DIV/0!"}},{"$f":"C26","v":{"$error":"#DIV/0!"}},{"$f":"C22","v":0}]
[null,"Calculated Half-Life (Hours) for Drug",{"$f":"0.693/C26","v":{"$error":"#DIV/0!"}},{"$f":"0.693/D26","v":{"$error":"#DIV/0!"}}]
["Hide","Loading Dose Aminoglycosides",{"$f":"IF(C24>=28.6,IF(C15=\"Amikacin\",60*C$22*C$26*C$16/(1-EXP(-C$26*C$16)),20*C22*C26*C16/(1-EXP(-C26*C16))),IF(C15=\"Amikacin\", 30*C22*C26*C16/(1-EXP(-C26*C16)),8*C22*C26*C16/(1-EXP(-C26*C16))))","v":{"$error":"#DIV/0!"}}]
["Hide","Loading Dose Vancomycin",{"$f":"30*C$22*C$26*C$16/(1-EXP(-C$26*C$16))","v":{"$error":"#DIV/0!"}},null,"Hours to 15 mcg/ml from start LD",{"$f":"LN(30/15)/C26+2","v":{"$error":"#DIV/0!"}},"Hours to 20 mcg/ml",{"$f":"LN(30/20)/C26+C16","v":{"$error":"#DIV/0!"}}]
[null,"Calculated Loading Dose Calculated (mg)",{"$f":"IF(LEN(D22)<>0,\"\",IF(C15=\"Vancomycin\",C29,IF(C26<=LN(20/0.3)/47.5,C28,\"Pulse Dosing\")))","v":{"$error":"#DIV/0!"}},null,{"$f":"IFERROR(IF(C15=\"Vancomycin\",IF(C30>3000,\"Maximum Vancomycin Loading Dose is 3 grams\",\"\"),\"\"),\"\")","v":""}]
["Hide","Aminoglycoside Interval Gentamicin",{"$f":"IF((((LN(20/0.3))/C26)+0.5)<24,24,IF((((LN(20/0.3))/C26)+0.5)<36,36,IF((((LN(20/0.3))/C26)+0.5)<48,48,((((LN(6/1))/C26))+0.5))))","v":{"$error":"#DIV/0!"}},{"$f":"IF((((LN(20/0.3))/D26)+0.5)<24,24,IF((((LN(20/0.3))/D26)+0.5)<36,36,IF((((LN(20/0.3))/D26)+0.5)<48,48,((((LN(6/1))/D26))+0.5))))","v":{"$error":"#DIV/0!"}}]
["Hide","Aminoglycoside Interval Amikacin",{"$f":"IF((((LN(60/0.9))/C26)+0.5)<24,24,IF((((LN(60/0.9))/C26)+0.5)<36,36,IF((((LN(60/0.9))/C26)+0.5)<48,48,((((LN(30/3))/C26))+0.5))))","v":{"$error":"#DIV/0!"}},{"$f":"IF((((LN(60/0.9))/D26)+0.5)<24,24,IF((((LN(60/0.9))/D26)+0.5)<36,36,IF((((LN(60/0.9))/D26)+0.5)<48,48,((((LN(30/3))/D26))+0.5))))","v":{"$error":"#DIV/0!"}}]
[null,"Calculated Dosage Interval (Hours)",{"$f":"IF(LEN(D22)<>0,\"\",IF($C15=\"Vancomycin\",(((LN(30/15))/C26)+2),IF($C15=\"Amikacin\",C32,C31)))","v":{"$error":"#DIV/0!"}},{"$f":"IF($C15=\"Vancomycin\",(((LN(40/15))/D26)+2),IF($C15=\"Amikacin\",D32,D31))","v":{"$error":"#DIV/0!"}}]
[null,"Input Rounded Dosage Interval (Hours)",null,{"$f":"C34","v":0},{"$f":"IF(C34<>\"\",IF(D26<>C26,IF(D36*24/D34>1.5*(C36*24/C34),\"Total Daily Dose should not be increased by more than 50%.\",\"\"),\"\"),\"\")","v":""},null,{"$f":"IF(C34>168,\"Verify dosage Interval entered\",\"\")","v":""}]
[null,"Calculated Maintenance Dose (mg)",0,0,null,null,"Maintenance Dose"]
[null,"Input Rounded MaintenanceDose (mg)",null,{"$f":"C36","v":0},{"$f":"IF($C36<>\"\",IF($C15=\"Vancomycin\",IF(C36/$C21>20,\"The entered maintenance dose, C36, is too large: \"&ROUND(C36/$C21,1)&\" mg/kg\",\"\"),IF(AND($C15=\"Gentamicin/Tobramycin\",C26>LN(20/0.3)/47.5),IF(ABS(1-(C36/($C21*5)))>=0.1,\"The entered dose, C36, is >= 10% higher or lower than calculated maintenance dose. \",\"\"),IF(AND($C15=\"Amikacin\",C26>LN(20/0.3)/47.5),IF(ABS(1-(C36/($C21*15)))>=0.1,\"The entered dose, C36, is >=10% higher or lower than calculated maintenance dose. \",\"\"),\"\"))),\"\")","v":""},null,"Dose (mg/kg)",{"$f":"D36/C21","v":{"$error":"#DIV/0!"}},{"$f":"IF(ISERROR(H36),\"\",IF(H36>=18,\"A lower dose, 10-17.5 mg/kg, is recommeneded\",\"\"))","v":""}]
[null,"Calculated Peak (mcg/ml)",{"$f":"IF(LEN(D22)<>0,\"\",C36*(1-EXP(-C26*$C16))/($C22*C26*$C16*(1-EXP(-C26*C34))))","v":{"$error":"#DIV/0!"}},{"$f":"D36*(1-EXP(-D26*$C16))/($E26*D26*$C16*(1-EXP(-D26*D34)))","v":{"$error":"#DIV/0!"}},{"$f":"IF($C$36<>\"\",IF($C$15=\"Vancomycin\",IF($D$36/$C$21>20,\"The entered maintenance dose, D36, is too large: \"&ROUND($D$36/$C$21,1)&\" mg/kg\",\"\"),IF(AND($C$15=\"Gentamicin/Tobramycin\",$D$26>LN(20/0.3)/47.5),IF(ABS(1-($D$36/($C$21*5)))>=0.1,\"The entered dose, D36, is >= 10% higher or lower than calculated maintenance dose. \",\"\"),IF(AND($C$15=\"Amikacin\",$D$26>LN(20/0.3)/47.5),IF(ABS(1-($D$36/($C$21*15)))>=0.1,\"The entered dose, D36, is >=10% higher or lower than calculated maintenance dose. \",\"\"),\"\"))),\"\")","v":""},null,"Total Daily Dose",{"$f":"D36*24/D34","v":{"$error":"#DIV/0!"}}]
[null,"Calculated Trough (mcg/ml)",{"$f":"IF(LEN(D22)<>0,\"\",C37*EXP(-C26*(C34-$C16)))","v":{"$error":"#DIV/0!"}},{"$f":"D37*EXP(-D26*(D34-$C16))","v":{"$error":"#DIV/0!"}}]
[null,"AUC (mg/hour/liter per day)",{"$f":"IF(LEN(D22)<>0,\"\",IF(C37<>C38,(C37+C38)*(C16/2)*24/C34+(C37-C38)*24/(C26*C34),C36*24/(C26*C22*C34)))","v":{"$error":"#DIV/0!"}},{"$f":"(D37+D38)*C16/2*24/D34+(D37-D38)*24/(D26*D34)","v":{"$error":"#DIV/0!"}},{"$f":"IF(ISERROR(C39),\"\",IF(C39>600,\"AUC is too high\",\"\"))","v":""}]
[null,null,null,null,"Dose 1 after starting level",null," ","Dose 2 after starting level",null," ","Dose 3 after starting level",null," ","Dose 4 after starting level"," ",null,"Dose 5 after starting level"]
[null,null,null,"Dose (mg)",null,null,"Dose (mg)",null,null,"Dose (mg)",null,null,"Dose (mg)",null,null,"Dose (mg)"]
[null,null,null,"Dose Date &Time ",null,null,"Dose Date &Time ",null,null,"Dose Date &Time ",null,null,"Dose Date &Time ",null,null,"Dose Date &Time "]
[null,"Current Date","2019-08-10T07:27:20"]
[null,"Date Therapy Initiated (Month/Day/Year)"]
[null,null,null,null,null,null,null,null,null," ",null,null," ",null,null," "]
[null,null,"Starting Level Before Dose 1 ",null,"Serum Levels (mcg/ml)",null,null,"Serum Levels (mcg/ml)",null,null,"Serum Levels (mcg/ml)",null,null,"Serum Levels (mcg/ml)",null,null,"Serum Levels (mcg/ml)"]
[null,null,"Starting Level Date &Time",null,"Serum Level Date &Time",null,null,"Serum Level Date &Time",null,null,"Serum Level Date &Time",null,null,"Serum Level Date &Time",null,null,"Serum Level Date &Time"]
[]
[null,null,null,null,"Trough Before Dose 1",null,null,"Trough Before Dose 2",null,null,"Trough Before Dose 3",null,null,"Trough Before Dose 4",null,null,"Trough Before Dose 5"]
[null,null,null,"Expected Levels (mcg/ml)",{"$f":"D46*EXP(-$D26*(E42-$D47)*24)","v":{"$error":"#DIV/0!"}},{"$f":"$D46*EXP(-$D26*(F47-$D47)*24)+($E41*(1-EXP(-$D26*$C16))*(EXP(-$D26*(((F47-$E42)*24)-$C16)))/($E26*$C16*$D26))","v":{"$error":"#DIV/0!"}},{"$f":"$D46*EXP(-$D26*(G47-$D47)*24)+($E41*(1-EXP(-$D26*$C16))*(EXP(-$D26*(((G47-$E42)*24)-$C16)))/($E26*$C16*$D26))","v":{"$error":"#DIV/0!"}},{"$f":"$D46*EXP(-$D26*(H42-$D47)*24)+($E41*(1-EXP(-$D26*$C16))*(EXP(-$D26*(((H42-$E42)*24)-$C16)))/($E26*$C16*$D26))","v":{"$error":"#DIV/0!"}},{"$f":"$H50*EXP(-$D26*(I47-$H42)*24) + ($H41*(EXP(-$D26*(((I47-$H42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$H50*EXP(-$D26*(J47-$H42)*24) + ($H41*(EXP(-$D26*(((J47-$H42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$H50*EXP(-$D26*(K42-$H42)*24) + ($H41*(EXP(-$D26*(((K42-$H42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$K50*EXP(-$D26*(L47-$K42)*24) + ($K41*(EXP(-$D26*(((L47-$K42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$K50*EXP(-$D26*(M47-$K42)*24) + ($K41*(EXP(-$D26*(((M47-$K42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$K50*EXP(-$D26*(N42-$K42)*24) + ($K41*(EXP(-$D26*(((N42-$K42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$N50*EXP(-$D26*(O47-$N42)*24) + ($N41*(EXP(-$D26*(((O47-$N42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$N50*EXP(-$D26*(P47-$N42)*24) + ($N41*(EXP(-$D26*(((P47-$N42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$N50*EXP(-$D26*(Q42-$N42)*24) + ($N41*(EXP(-$D26*(((Q42-$N42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$Q50*EXP(-$D26*(R47-$Q42)*24) + ($Q41*(EXP(-$D26*(((R47-$Q42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}},{"$f":"$Q50*EXP(-$D26*(S47-$Q42)*24) + ($Q41*(EXP(-$D26*(((S47-$Q42)*24)-$C16)))*(1-EXP(-$D26*$C16))/($E26*$D26*$C16))","v":{"$error":"#DIV/0!"}}]
[]
[null,null,null,null,"Square of Errors",{"$f":"IF(ISNUMBER(F50),(F50-F46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(G50),(G50-G46)^2,\"\")","v":""},null,{"$f":"IF(ISNUMBER(I50),(I50-I46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(J50),(J50-J46)^2,\"\")","v":""},null,{"$f":"IF(ISNUMBER(L50),(L50-L46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(M50),(M50-M46)^2,\"\")","v":""},null,{"$f":"IF(ISNUMBER(O50),(O50-O46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(P50),(P50-P46)^2,\"\")","v":""},null,{"$f":"IF(ISNUMBER(R50),(R50-R46)^2,\"\")","v":""},{"$f":"IF(ISNUMBER(S50),(S50-S46)^2,\"\")","v":""}]
[null,null,null,null,"Sum of Square of Errors",{"$f":"SUM(F52:S52)","v":0}]
[]
[null,"Marshall Pierce PharmD"]
[null,"No Warranties Are Expressed or Implied."]
[]
[]
[null,"Instructions For Use"]
[null,"1. Enter the data required in the blue colored cells in column C, (C1-C16)."]
[null,"2. Select the patients treatment condition in cell E5."]
[null,"3. Select the values in cells E8 through G8, E11 through F11, and E14 if the patient has amputation(s), paralysis, or malnutrition."]
[null,"4. Press the \"Calculate Creatinine Clearnance or Dose\" button. This will calculate the patient's creatinine clearance and suggested dose and frequency."]
[null,"5. Enter a rounded dosage interval and rounded dose in cells C34 and C36 respectively."]
[null,"6. Population based parameters (elimination rate constant and volume of distribution) are used to calculate the peak and trough in C37 and C38 respectively."]
[null,"7. Change the values in C34 and C36 to obtain your desired predicted peak and trough in cells C37 and C38."]
[]
[null,"Population Based Equations Using Standard One Compartment Pharmacokinetic Equations"]
[null,"Vancomycin"]
[null,"Volume of Distribution (liters) = 0.65 l/kg of total body weight"]
[null," Elimination Rate Constant (1/hours) = 0.00107 * Creatinine ClearanceIBW * 1.73/BSA +  0.0052"]
[null,"Aminoglycosides"]
[null,"Volume of Distribution (liters) = 0.25 l/kg of adjusted body weight"]
[null,"Elimination Rate Constant (1/hours) = 0.026 * Creatinine ClearanceIBW  + 0.014"]
[null,"Ideal body weight (IBW(kg)) Adults"]
[null,"Males(kg) =   50(kg) + 2.3(kg) * (height in inches - 60)"]
[null,"Females(kg) = 45.5(kg) + 2.3(kg) * (height in inches - 60)"]
[null,"Lean Body Weight for Children  or height < 48 inches (Peck Formula)"]
[null,"Female < 18 years = -77.55796 + (6.93728 * height in inches) -(0.171703 * Height2) + (0.001726* Height3)"]
[null,"Male < 18 years = -59.6035 + (5.2878 * Height) - (0.123939 * Height2) + 0.00128936 * Height3)"]
[null,"If height < 22 inches, lean weight = total weight"]
[null,"Adjusted body weight, aminoglycosides only, if actual weight > IBW."]
[null,"Adjusted Body Weight(kg) = LBW(kg) + 0.4 * (Actual Weight(kg) – IBW(kg))"]
[null,"Creatinine Clearance Equations"]
[null,"Adults Cockcroft Gault Equation "]
[null,"Males(ml/min) = (140-age) * ( Use Ideal Body Weight(kg) or actual weight if less than IBW(kg)) / (Serum Creatinine *72)"]
[null,"Females(ml/mn): above x 0.85"]
[null,"Pediatic Schartz Equation"]
[null,"ClCr(ml/min/1.73 m2) = Factor* HeightCentimeters / Serum Creatinine"]
[null,"Factor: 0.45 < 1 year, 0.55 1-12 years,  > 12 years 0.55 female, > 12 years males 0.7"]
[null,"Amputation and Paralysis Serum Creatiine Multiplication Factors"]
[null,"Entire Leg Amputation (1.2269), AKA (1.1764), BKA (1.0638), Entire Arm Amputation (1.0695), AEA (1.0526), BEA (1.0309), Functional Palegia (1.4), Paraplegia (1.4), Quadraplegia(1.6)"]
[null,"Minimal Serum Creatinine: 0.5 mg/dL in patients with functional, para or quadraplegia, or malnutrition; 0.7 in other adults."]
[null,"Data Fitting: The program employees non steady state one compartment equations and uses the method of superposition to determine the expected level(s) from the input dosing history, "]
[null,"starting serum level, and and estimated pharmacokinetic parameters."]
[null,"CpT = Cp0e(-K(T-to)) + [D1(1-e(-KT’))*e(-K(T-Td1-T’))/(VKT’)]  +  [D2(1-e(-KT’))*e(-K(T-Td2-T’))/(VKT’)]……."]
[null,"The expected levels, displayed in the data fitting section, are calculated using the population elimination rate constant (C26) and volume of distribtution (C22) initially. "]
[null,"Once the data (dosing and serum levels) is fit the patient specific values of elimination rate constant and volume of distribution, D26 and E26,  are used. "]
[]
[null,"Objective Function to Minimize"]
[null,"Sum of the Square of Errors = (Predicted Level1 – Actual Level1)2  + (Predicted Level2 – Actual Level2)2    for all input levels"]
[]
[null,"Analyzing steady state levels using a trough drawn after a know steady state dose (this is our usual practice)"]
[null,"8. Steps 1-7 must be completed, enter the current frequency  and dose in C34 and C36."]
[null,"9. Enter the date therapy was started in cell C44."]
[null,"10. Enter the steady state trough in cell G46 and the date and time of the trough in G47."]
[null,"11. Enter the date and time of the dose which was given before the trough in E42. "]
[null,"12. Press the \"Assume Steady State: Trough drawn after dose 1\". This will copy the entered trough to cell D46, place the calculated time of the predose trough in cell D47, and the dose to E41."]
[null,"This is for your convience, if you choose to you can enter the data manually without pressing the \"Assume Steady State\" button."]
[null,"By placing the same trough around a single dose you are creating steady state conditions. This is the definition of steady state, levels are unchange dose to dose.  "]
[null,"13. Press \"Fit Data (Elimination Rate Constant Optimization)\" button. The program will determine the elimination rate constant that miniminzes the difference between the actual and predicted level."]
[null,"14. The calculated patient specific elimination rate constant is displayed in cell D26 after data fitting."]
[null,"15. The predicted state state levels using the patient specific elimination rate constant are displayed in cells D37 and D38 respectively."]
[null,"16. You may adjust the dosage frequency and dose in D34 and D36 to obtain your desired levels."]
[]
[null,"Steady State Levels with the trough drawn post dose past the time the next dose was due as next dose was held, the dose was given late, or a random level was ordered."]
[null,"Trough at time of Dose1 displayed in E50 = Trough PredoseD46*Exp(-K*(Time of Dose1 E42- Time of Predose Trough D47)*24)"]
[null,"The trough in D46 will show a time in D47 that is after the time of the dose1 in E42, but the equation above back extrapolates the calculated trough displayed in E50 to the time of Dose 1."]
[null,"The programs calculations are correct though the displayed values in D46 and D47 look incorrect. The value in E50 is the value used in the further calculations. "]
[]
[null,"Analyzing steady state levels using a trough drawn before a known steady state dose. This will be rarely use, but is included for flexible. "]
[null,"8. Steps 1-7 must be completed, enter the current frequency  and dose in C34 and C36."]
[null,"9. Enter the date therapy was started in cell C44."]
[null,"10. Enter the steady state trough in cell D46 and the date and time of the trough in D47."]
[null,"11. Enter the date and time of the dose which was given in E42. "]
[null,"12. Press the \"Assume Steady State: Trough drawn before dose 1\". This will copy the entered trough to cell G46, place the calculated time of the post dose trough in cell G47, and the dose to E41."]
[null,"This is for your convience, if you choose to you can enter the data manually without pressing the \"Assume Steady State\" button."]
[null,"By placing the same trough around a single dose you are creating steady state conditions.  This is the definition of steady state, levels are unchanging dose to dose."]
[null,"13. Press \"Fit Data (Elimination Rate Constant Optimization)\" button. The program will determine the elimination rate constant that miniminzes the difference between the actual and predicted level."]
[null,"14.The calculated patient specific elimination rate constant is displayed in cell D26 after data fitting."]
[null,"15. The predicted state state levels using the patient specific elimination rate constant are displayed in cells D37 and D38 respectively."]
[null,"16. You may adjust the dosage frequency and dose in D34 and D36 to obtain your desired levels."]
[]
[null,"Analyzing steady state levels using a trough drawn before a known steady state dose and a peak after the same dose (Traditional Dosing for Aminoglycosides)"]
[null,"8. Steps 1-7 must be completed, enter the current frequency  and dose in C34 and C36."]
[null,"9. Enter the date therapy was started in cell C44."]
[null,"10. Enter the steady state trough in cell D46 and the date and time of the trough in D47."]
[null,"11. Enter the steady state peak in cell F46 and time of the peak in F47."]
[null,"12. Enter the date and time of the dose which was given in E42. "]
[null,"13. Press the \"Assume Steady State: Trough drawn before dose 1\". This will copy the entered trough to cell G46, place the calculated time of the post dose trough in cell G47, and the dose to E41."]
[null,"This is for your convience, if you choose to you can enter the data manually without pressing the \"Assume Steady State\" button."]
[null,"By placing the same trough around a single dose you are creating steady state conditions. This is the definition of steady state. "]
[null,"14. Press \"Fit Data (Elimination Rate Constant & Vd Optimization)\" button. The program will determine the elimination rate constant and volume of distribution that miniminzes the difference "]
[null,"between the actual and predicted levels."]
[null,"15. The calculated patient specific elimination rate constant is displayed in cell D26 and volume of distribution in cell E26 after data fitting."]
[null,"16. The predicted state state levels using the patient specific K and Vd are displayed in cells D37 and D38 respectively."]
[null,"17. You may adjust the dosage frequency and dose in D34 and D36 to obtain your desired levels."]
[]
[null,"Analyzing Non Steady State Levels"]
[null,"8. Steps 1-7 must be completed, enter the current frequency  and dose in C34 and C36."]
[null,"9. Enter the date therapy was started in cell C44."]
[null,"10. Enter a starting level and time of the level in cells D46 and D47 respectively. This level may be 0 if no drug is on board or any known level before the doses you wish to analyze."]
[null,"11. Enter all doses and the dates and times given from the time of the starting level through the last dose administered before the last level to be analyzed in chronological order, "]
[null,"oldest to most recent left to right. The doses are numbered 1-5, chronological after the starting level."]
[null,"12. Enter all levels and the times drawn to be analyzed in chronlogical order, oldest to most recent left to right."]
[null,"13. Press the appropriate data fitting button, \"Fit Data (Elimination Rate Constant Optimization)\" if only troughs have been drawn, and"]
[null,"\"Fit Data (Elimination Rate Constant & Vd Optimization) if a peak(s) and trough(s) have been drawn."]
[null,"14. The calculated patient specific elimination rate constant is displayed in cell D26 and volume of distribution in cell E26 after data fitting."]
[null,"15. The predicted state state levels using the patient specific K and Vd are displayed in cells D37 and D38 respectively."]
[null,"16. You may adjust the dosage frequency and dose in D34 and D36 to obtain your desired levels."]
[]
[]
[null,"When to assume levels are Non Steady State Levels"]
[null,"1. If you are ordering levels before 5 half lives of have passed from the start of therapy."]
[null,"2. If you order levels after the 1st maintenance dose with or with out a loading dose."]
[null,"3. The patients doses or dosage intervals are not consistent."]
[]
[null,"Note: the predicted levels for input dosage regimens in column C (population) and D (patient specific) are independent from one another after data fitting."]
[]
[null,"Creatinine Clearance Calculation"]
[null,"How is creatinine clearance calculated when the serum creatinines is changing?"]
[null,"Most creatinine clearance equations assume stable renal function. "]
[null,"Creatinine clearance individualized (Clcr) Cockcroft Gault equation:"]
[null,"Males(ml/min) = (140-age) * ( Use Ideal Body Weight(kg) or actual weight if less than IBW(kg)) / (Serum Creatinine *72)"]
[null,"Females(ml/mn): above x 0.85"]
[null,"In the simplified form:   Creatinine Clearance = Creatinine rate of production / Serum Creatinine"]
[null,"Rate of production is constant for a patient and is determined by age, height, weight and sex. The rate of production is built "]
[null,"into the Cockcroft Gault equation and other creatinine clearanace equations. When renal function has changed the following  equation may be used to "]
[null,"calculate creatinine clearance before steady state serum creatinine levels are achieved. This is the most accurate method of "]
[null,"numerous published equations. An iterative method is used to determine clearnace as there is no direct solution to the equation."]
[null,"Serum Creatinine2 = Serum Creatinine1 * e(-KT) +  Rate of Production (1-e(-KT)) / Clearance of Creatinine"]
[null,"T is the time between serum two known creatinines (creatinine1 and creatinine2). "]
[null,"K is the elimination rate constant for creatinine."]
[null,"This equation accounts for the elimination of creatinine already present and the fraction of steady state achieved during the "]
[null,"time between the creatinines. "]
[null,"Assumptions of the non steady state equation:"]
[null,"All of the change in renal function has occurred at or before the time of the oldest creatinine (creatinine1)."]
[null,"The change in creatinines is due to renal function changes and is not due to tissue destruction or hydration changes."]
[null,"The serum creatinines are accurately determined and the time between them is known."]
[]
[null,"Data Storage"]
[null,"The program stores patient demographic information, current dose and frequency, along with calculated values including population and"]
[null," patient specfic elimination rate constant and volume of distribution  in a separate file. The file is password protected and the data is hidden."]
[null,"This allows analysis of predicted versus actual levels to optimize the parameters used in the program."]
[]
[null,"Program Requirements"]
[null,"Excel 2010"]
[null,"A shared drive with a copies of the program in separate folders if multiple users will be dosing patients at the same time or the program will have to be installed on multiple computers."]
[null,"A copy of the program should be placed in individual folders on the shared drive for each functional area of use along with the patient data file."]
[]
[null,"References"]
[null,"1. Chiou WL, Hsu FH. A new simple and rapid method to monitor the renal function  based on pharmacokinetic consideration of endogeneous creatinine. Res Commun Chem Pathol Pharmacol. 1975 Feb;10(2):315-30. PubMed PMID: 1153839."]
[null,"2. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41. PubMed PMID: 1244564."]
[null,"3. Devine BJ. Gentamicin therapy. Drug Intell Clin Pharm. 1974;8:650–655."]
[null,"4. Lau AH, Berk SI, Prosser T, Stonich T. Estimation of creatinine clearance in malnourished patients. Clin Pharm. 1988 Jan;7(1):62-5. PubMed PMID: 3126017."]
[null,"5. Gilbaldi M, Perrier D Pharmacokinetics Marcel Kekker, Inc New York 1975"]
[null,"6. Winter, Michael E. Basic Clinical Pharmacokintics 2nd Edition Applied Therapeutics Inc 1988"]
[null,"7. Murphy John E, Clinical Pharmacokinetics Third Edition American Society of Health Systems Pharmacists, Inc 2005"]
[null,"8. Schwartz GJ, Haycock GB, Edelmann CM, et al. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics. 1976;58:259-63"]
[null,"9. Schwartz GJ, Feld LG, Langford DJ. A simple estimate of glomerular fultration rate in full-term infants during the first year of life. Pediatrics 1984;104:849-54"]
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