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Biomedical subjects

J R Koup

Publications and source records attributed to J R Koup.

At least 55 records · Page 3Linked to original sources
PubMed1984

Pharmacokinetics of ceftriaxone in neonates and infants with meningitis.

The pharmacokinetics of ceftriaxone was studied in the plasma, urine, and cerebrospinal fluid of seven neonates and seven infants with meningitis. In addition, plasma and urine data were obtained in five neonates and one infant receiving ceftriaxone for other serious infections. All neonates younger than 14 days received daily doses of 50 mg/kg ceftriaxone; all other patients but two received 100 mg/kg. The average weight-corrected values for total body clearance (ClT), volume of distribution (Vdss), and biologic half-life (t 1/2) were 0.37 ml/min/kg, 0.45 L/kg, and 16.2 hours in neonates younger than 1 week; 0.77 ml/min/kg, 0.48 L/kg, and 9.2 hours in neonates older than 1 week; and 1.03 ml/min/kg, 0.39 L/kg, and 7.1 hours in older infants, respectively. There was a significant difference in ClT and t 1/2 between the neonates younger and both neonates older than 1 week, and infants. The Vdss was not significantly different among the three age groups. The average renal clearance in neonates younger than 1 week (0.28 ml/min/kg was 70%, in neonates older than 1 week (0.54 ml/min/kg) was 77%, and in older infants (0.49 ml/min/kg) was 47% of ClT, indicating that nonrenal elimination was less developed in neonates. The quantitation of CSF diffusion of ceftriaxone was assessed by comparison of the areas under the CSF and plasma concentration-time curve. The mean ceftriaxone penetration into the CSF in neonates and infants with bacterial meningitis was 17%. On the other hand, penetration in patients with aseptic meningitis amounted to only 4%. Mean ceftriaxone concentrations in the CSF in patients with bacterial meningitis were 2.8 mg/L after 24 hours, exceeding by many times the minimum inhibitory concentration of the common meningitis pathogens at this time.

Cefotaxime↗
PubMed1984

Disposition of tobramycin in patients with cystic fibrosis: a prospective controlled study.

The pharmacokinetics of tobramycin in adolescents or young adults with cystic fibrosis and in age-matched controls were prospectively compared. Patients with CF had a higher tobramycin total body clearance (121.2 +/- 14.2 ml/min/1.73 m2) than did controls (102.2 +/- 18.9 ml/min/1.73 m2, P less than 0.05). This was not associated with a higher glomerular filtration rate (iothalamate total body clearance 147.5 +/- 29.2 ml/min/1.73 m2 in patients vs 142.9 +/- 33.3 ml/min/1.73 m2 in controls) or a lower binding of gentamicin to serum proteins (14.3% +/- 2.6% in patients vs 17.4% +/- 3.8% in controls). Tobramycin renal clearance was not significantly different in the two groups (89.5 +/- 17.9 ml/min/1.73 m2 in patients vs 81.0 +/- 15.8 ml/min/1.73 m2 in controls). In the control group, tobramycin total body and renal clearances were highly correlated with iothalamate total body clearance (r = +0.95 and +0.88, P less than 0.01). In patients with cystic fibrosis, the correlation was not significant (r = +0.56, P greater than 0.05 for total body clearance, and r = 0.32, P greater than 0.1 for renal clearance). There was no significant difference in volume of distribution normalized to body surface area or in half-life of elimination. The higher tobramycin total body clearance without an increase in renal clearance, and the lower correlation with glomerular filtration rate indicate that an extrarenal clearance pathway might play a significant role in the elimination of tobramycin from the serum of patients with cystic fibrosis.

Adolescent↗
PubMed1984

Multiple-dose nonlinear regression analysis program for the microcomputer.

An adaptation of a previously published program for nonlinear regression analysis of serum drug concentrations which can utilize data obtained during multiple-dose administration is described. Specific programs have been developed for aminoglycosides, digoxin, and theophylline. The programs provide initial parameter estimates (for a one-compartment linear model) for each drug based on mean population parameters and refined estimates based on observed concentration data. Clinical examples which demonstrate the flexibility of these programs are provided. The programs may also be employed for fitting data for any drug that can be adequately described by a one-compartment linear model.

Adult↗
PubMed1982

Piperacillin pharmacokinetics in pediatric patients.

The pharmacokinetics of piperacillin were studied in 15 pediatric patients (age range, 3.3 to 14.3 years). Piperacillin was administered in a dosage of 1.5 +/- 0.4 g/m2 (mean +/- standard deviation) every 4 to 6 h. Peak serum concentrations ranged from 69 to 354 micrograms/ml. The mean elimination half-life was 37.0 +/- 13.3 min, which is shorter than that observed in most adults with normal renal function. The mean elimination half-life in three patients with renal impairment was 60.1 +/- 12.4 min, and the mean ratio of renal clearance to total clearance was 0.57. These results suggest a significant nonrenal elimination of piperacillin. Based on these data, a dosage of 1.5 g/m2 given as a 30-min infusion every 4 h is suggested for children with normal renal function. For patients with renal impairment, the daily dosage could be calculated as follows: corrected dose = normal dose x (0.35 + [0.65 x (ClCr/0.06)]), where ClCr is the creatinine clearance expressed as liters per minute per square meter.

Adolescent↗
PubMed1982

Single-point prediction methods: a critical review.

This article presents a critical review of a proposed method of dose prediction. Previously published experiences with this method are reviewed. New applications with drugs that have short elimination half-lives and drugs that demonstrate nonlinearity of clearance are discussed. Potential sources of error are demonstrated, using computer simulations.

Chloramphenicol↗
PubMed1982

Chloramphenicol succinate kinetics in infants and young children.

We sought to estimate the serum and urine pharmacokinetics of chloramphenicol succinate (CmS) and the effects of variation of these parameters on chloramphenicol (Cm) kinetics in 24 infants and young children ages two weeks to seven years. The mean T(1/2) of CmS was 0.40 hours; the mean body clearance was 0.72 liter/KG/hour; the mean apparent volume of distribution was 0.42 liter/kg. Variation in CmS T(1/2) did not correlate with significant variation in Cm T(1/2) (r2 = 0.002, P = 0.84). Urine collected during the dosing interval in nine patients contained 35% (mean) of the administered dose. Adjusting the infusion duration to 5 minutes or 120 minutes had no effect on the amount of CmS lost in the urine. The quantity of CmS lost in the urine affects the amount bioavailable, and secondarily the calculated volume of distribution and body clearance of Cm. We conclude that variation in urinary prodrug excretion affects the amount of Cm bioavailable to the patient, but variation in CmS T(1/2) has little effect on Cm T(1/2).

Area Under Curve↗
PubMed1982

Individualization of theophylline dosage using a single serum sample following a test dose.

Because formulas for theophylline requirement based on weight alone carry the risk of overdosing and toxicity, this study was designed to test a clearance nomogram for determining daily theophylline requirement after a known initial dose of theophylline. Twenty asthmatic children who had not taken theophylline for at least 36 hours fasted and were given one dose of anhydrous theophylline (5 mg/kg). Six hours later the serum level was measured and the appropriate dosage of sustained-release theophylline to achieve a serum level of 10 micrograms/ml was selected from the clearance nomogram. Three to seven days later a six-hour theophylline level was obtained. Of 20 patients, therapeutic levels of 10 to 30 micrograms/ml were achieved in 15, and the remaining five patients had levels close to this (range 6.2 to 16.0 micrograms/ml). The dosage requirement per 24 hours ranged from 10 to 32 mg/kg/24 hr. This method of determining theophylline requirements for children required measurement of the serum theophylline level only once for the determination of a safe and effective daily dose. It is especially valuable when follow-up is difficult and is a safe way to avoid serious overdosing while being certain of effective dosing.

Asthma↗
PubMed1982

Altered theophylline clearance during an influenza B outbreak.

During the 1980 influenza B outbreak in King County, Washington, 11 children whose asthma had previously been controlled with a stable theophylline dose, developed theophylline toxicity on this same dose. Two had seizures, eight had nausea and vomiting, and three had headaches. All had clinical evidence of a febrile viral illness. The toxicity appeared to be related to decreased theophylline clearance, which gradually returned to preillness levels over a period of one to three months. Six of ten children had serologic evidence of influenza B, which is presumed to be the cause of the altered clearance. In children receiving chronic theophylline therapy, symptoms of vomiting, headaches, or seizures during a viral illness may be due to theophylline toxicity rather than the virus. Such patients should have an immediate serum theophylline determination, even if previous levels have been in the therapeutic range.

Asthma↗
PubMed1982

Integrated calculator programs for pharmacokinetic calculations.

A package of integrated programs for calculating pharmacokinetic variables and drug-dosing regimens using a hand-held programmable calculator is described. Twelve pharmacokinetic programs, which were based on previously published pharmacokinetic equations, were developed for use in a HP-41C hand-held calculator (Hewlett-Packard). The programs perform, pharmacokinetic calculations for many drugs, including digoxin, theophylline, phenytoin, nd the aminoglycosides. Also programs for ideal body weight, body surface area, and creatinine clearance calculations are included. Eleven of the 12 programs can be stored in the calculator at any time. Values generated in one program are stored in memory registers and can be recalled directly for use in other programs. The calculator has a continuous memory; therefore, all stored data, programs, and functions are maintained when the calculator is turned off. The integrated calculator programs provide a quick and reliable means of applying pharmacokinetic principles to everyday hospital pharmacy practice.

Computers↗
PubMed1981

Pharmacokinetic concepts - drug binding, apparent volume of distribution and clearance.

Blood flow rate-limited physiological pharmacokinetic models have been used to examine the relationship between apparent volume of distribution and clearance or, more specifically between drug binding in blood, eliminating regions or noneliminating regions and clearance. The influence of binding on drug elimination depends on the driving force concentration in the eliminating region. In most instances this is likely to be free drug concentration in the region. Under these conditions, the results indicate that apparent volume of distribution and drug clearance from the blood should be treated as independent pharmacokinetic variables. Volume of distribution per se has no effect on clearance or on average steady-state blood levels. Drug binding in nonvascular regions(i.e. tissue binding) seems to be of limited importance except as a determinant of half-life. Although changes in tissue binding will affect partition coefficient and apparent volume of distribution, such changes will have no effect on average steady-state blood levels of either total or free drug.

Computers↗
PubMed1981

Comparison of enzymatic and liquid chromatographic chloramphenicol assays.

A radioenzymatic assay and a "high-performance" liquid chromatographic assay for chloramphenicol were compared by using 52 patient specimens, 24 mock unknowns, and 13 quality control samples. Both methods were found to be rapid, precise, accurate, and sensitive, and either would be suitable for monitoring chloramphenicol concentrations in small volumes of serum. Linear regression analysis of serum chloramphenicol concentrations in patients receiving chloramphenicol succinate yielded a regression equation of Y = 1.04X + 0.274 (X = high-performance liquid chromatographic assay; Y = radioenzymatic assay), with a correlation coefficient of 0.971.

Acetyltransferases↗
PubMed1981

Acetaminophen pharmacokinetics after overdose.

Concentrations of acetaminophen in serum and urinary excretion rates of acetaminophen glucuronide and acetaminophen sulfate were determined in a 15-year-old female who had ingested an overdose which resulted in the absorption of an estimated 9.92 g of acetaminophen. The results obtained are in reasonably good agreement with predictions of acetaminophen disposition based upon a previously developed pharmacokinetic model of capacity-limited acetaminophen elimination, but additional studies are needed to refine that model.

Acetaminophen↗
PubMed1981

Single point estimation of phenytoin dosing requirement.

Computer simulation demonstrated that a single serum sample obtained 24 hours after an intravenous loading dose of phenytoin (18 mg/Kg) can, with reasonable accuracy, predict the maintenance dose of phenytoin required to maintain a steady state serum concentration of 15 mg/L. A strong linear correlation (r = 0.959) was found between required phenytoin maintenance dose and the reciprocal of the 24 hour serum concentration.

Humans↗
PubMed1981

Chloramphenicol succinate pharmacokinetics in Macaca nemestrina: dose dependency study.

Chloramphenicol succinate ester in doses equivalent to 25, 100 and 250 mg/kg of chloramphenicol were administered by rapid i.v. infusion in a randomized crossover fashion to five adolescent ((18-36 month) male Macaca nemestrina monkeys. Thirteen serum samples and all voided urine were collected over a 5- to 6-hr period. Urinary excretion of unhydrolyzed ester was independent of dose and averaged 26.3 +/- 6.2% of the administered dose. Dose dependency was observed for the elimination rate constant, total body clearance and metabolic clearance of chloramphenicol succinate. Dose dependency was also observed for the apparent volume of distribution, total body clearance, metabolic clearance and time to peak concentration of chloramphenicol. Although significant dose dependency of various pharmacokinetic parameters ws demonstrated, the peak chloramphenicol concentration and the elimination rate constant of chloramphenicol after administration of chloramphenicol succinate showed no significant dose-dependent changes. Therefore, peak chloramphenicol concentrations would be expected to reflect changes in dose in a linear or proportional manner.

Animals↗
PubMed1981

Single point estimation of phenytoin dosing: a reappraisal.

A previously proposed method for estimation of phenytoin dosing requirement using a single serum sample obtained 24 hours after intravenous loading dose (18 mg/Kg) has been re-evaluated. Using more realistic values for the volume of distribution of phenytoin (0.4 to 1.2 L/Kg), simulations indicate that the proposed method will fail to consistently predict dosage requirements. Additional simulations indicate that two samples obtained during the 24 hour interval following the iv loading dose could be used to more reliably predict phenytoin dose requirement. Because of the nonlinear relationship which exists between phenytoin dose administration rate (RO) and the mean steady state serum concentration (CSS), small errors in prediction of the required RO result in much larger errors in CSS.

Humans↗
PubMed1980

Chloramphenicol sodium succinate kinetics in critically ill patients.

Chloramphenicol sodium succinate (SCAP) kinetics were studied in 10 critically ill patients. High-performance liquid chromatography was used to assay SCAP and chloramphenicol (CAP) in serum and urine. Total body (ClTB), metabolic (ClM), and renal (ClR) clearances of SCAP were variable. Correlations were found between creatinine clearance (Clcr) and ClTB, ClM, and ClR of SCAP (r = 0.92, p less than 0.001; r = 0.84, p less than 0.005; and r = 0.84, p less than 0.005). Recovery of SCAP in the urine also demonstrated large interpatient variability. Between 6.5% and 43.5% of the SCAP dose was recovered in the urine of 6 patients. This variability could not be explained by incomplete urine collection or by differences in renal function. Renal excretion of SCAP was shown to influence CAP serum levels. CAP ClTB was diminished, but no relationship was found between routine liver function studies and CAP ClTB. Therefore we caution the use of such relationships in using CAP in critically ill patients.

Acute Disease↗
PubMed1980

Numerical integration simulation programs for the microcomputer.

Programs for use with the Apple II Plus microcomputer that generate graphic simulations of various linear and Michaelis-Menten pharmacokinetic models are described. The programs numerically integrate sets of differential equations for appropriate pharmacokinetic models. Multiple oral (or intramuscular), intravenous bolus, or infusion doses (continuous or discontinuous) may be administered in any combination. Doses as well as pharmacokinetic parameters may be changed at the end of each simulated dosing interval. The programs can be easily modified by users familiar with the BASIC programming language and offer an economical approach to pharmacokinetic simulation.

Computers↗