1. For Clinical Pharmacist
Clinical Pharmacology
For Clinical Pharmacist

2. Abbreviation Spoiler Alert
PK = Pharmacokinetics
PD = Pharmacodynamics
PG = Pharmacogenomics
PO = Per Os
PM = Post Meridiem
PC = Personal Computer
BARRY = Clinical Pharmacology

3. Educational Objectives
By the end of this session you should be able to:
Feel less daunted by Barry
Understand how Barry complements evidence based practice
Provide rationale recommendations for aminoglycoside monitoring

4. OVERVIEW Who is Barry? What can Barry do for me?
What does Barry want from me?
How do I get the most out of Barry

5. BARRY = DISEASE PROGRESS + DRUG ACTION
Barry as an equation
BARRY = DISEASE PROGRESS + DRUG ACTION

6. Disease progression

7. Drug Action
Correlates of Variability

8. Concentration Time Profiles following administration of IV paracetamol to neonates
2011, Anderson and Holford et al.

9. OVERVIEW Who is Barry? What can Barry do for me?
What does Barry want from me?
How do I get the most out of Barry

10. What can Barry Do for me
Understanding Barry can make you a better clinical pharmacist through improving evidence based practice.
Allow understanding of variability

11. Clinical Pharmacy Sufficient Outcome for a patient =
(Drug Action/Blah)Concordance
Warning Blah may contain traces of actual evidence, dosage
regimen,legislation, pharmacoeconomics, local policy, personal
preference, sales representative influence, health beliefs of the patient,
nocebo/placebo effect, stock availability, etc)

12. OVERVIEW Who is Barry? What can Barry do for me?
What does Barry want from me?
How do I get the most out of Barry

13. Starting a relationship with BarryPK
First Order Kinetics
AUC
Clearance
Half Life

14. First Order Kinetics

16. MDR = CPave,ss X Cl

17. PD Chapter 8. Principles of Pharmacokinetics and Pharmacodynamics
C. Lindsay DeVane, Pharm.D.
DOI: /appi.books

18. OVERVIEW Who is Barry? What can Barry do for me?
What does Barry want from me?
How do I get the most out of Barry

19. TDM VS TCI

20. Once daily dosing – from AMH
“Methods for monitoring drug concentration include graphical, trough plasma
concentration and target AUC (area under the plasma concentration – time
curve) methods. Not all are valid for use in renal impairment.
Although no method is proven to be clinically superior, the current preferred,
but most complex, method is based on target AUC (can be used in renal
impairment). It requires 2 samples: collect the first about 30 minutes after
completing the infusion/injection and the second 6–14 hours later. The
estimated 24-hour AUC is generally calculated using a computer program, eg
the one available from TCIWorks at

21. What Does QHealth have to Say

22. AMINOGLYCOSIDE MONITORING
Trough Concentrations
6-14 Hour Nomogram
Target AUC
Bayesian Forecasting

24. Bayesian Forecasting
Disclamer regarding TCI works

26. You (as the junior doctor) are told by your consultant to write up gentamicin for Beryl. You haven’t met Beryl but you have seen that her sputum sample is positive for pseudomonas.
What would you do next.

27. Questions for Cases
Later that day you are ask to provide advice regarding monitoring for gentamicin in a woman about to have a caesarean birth.
What would you ask and recommend?

28. 5 days later Beryl from case 1 has a blood sample taken at 8:50pm, it is sent to the lab for assay. The next morning at 10:30 on the ward round the doctor reviews the result (1mg/L) and rings the pharmacist for advice.
What do you do?

29. A further 3 days pass and Beryl is looking better
A further 3 days pass and Beryl is looking better. The doctors want your fantastic and friendly pharmacist advice regarding monitoring.
What do you say?