title: Evaluation of a Pharmacy-Managed Pharmacokinetic Dosing Program.
abstract: OBJECTIVE
  The objective of this study was to determine the impact of a pharmacy-managed pharmacokinetic dosing program on appropriate dosing of famotidine, enoxaparin, and ketorolac.
  
  
  METHODS
  A large community teaching hospital implemented a pharmacy-managed pharmacokinetic dosing program for famotidine, enoxaparin, and ketorolac. Subjects were included if they received famotidine and had a creatinine clearance (CrCl) of <50 mL/min; received therapeutic enoxaparin and had a CrCl of <30 mL/min; or received ketorolac and had a CrCl <30 mL/min, age > 65 years or weight <50 kg.
  
  
  RESULTS
  One hundred and forty-six patients were included in the preimplementation group (famotidine [n = 50], enoxaparin [n = 46], and ketorolac [n = 50]) and 143 patients were included in the postimplementation group (famotidine [n = 50], enoxaparin [n = 43], and ketorolac [n = 50]). In all, 66% of patients were dosed appropriately in the preimplementation group (famotidine 28%, enoxaparin 85%, and ketorolac 86%) compared to 94% in the postimplementation group (famotidine 92%, enoxaparin 95%, and ketorolac 94%), P < .001.
  
  
  CONCLUSIONS
  Implementation of a pharmacy-managed pharmacokinetic dosing program significantly improved appropriate dosing of famotidine, enoxaparin, and ketorolac. These findings could justify expansion of pharmacist autonomy through institution-approved, pharmacy-managed programs for other medications to improve appropriate dosing. Analyses specifically evaluating patient-oriented or financial outcomes may provide additional support for expansion.
authors.affiliation: Seton Medical Center Hays, Seton Healthcare Family, Department of Pharmacy Kyle, TX, USA lkmeyenburg@seton.org.
authors.forename: Lyndsi K
authors.initials: LK
authors.lastname: Meyenburg
authors.affiliation: St Louis College of Pharmacy, Department of Pharmacy Practice, Saint Louis, MO, USA Mercy Hospital St Louis, Department of Pharmacy Services, Saint Louis, MO, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Crannage
authors.affiliation: College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Department of Pharmacy Practice Toledo, OH, USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Murphy
authors.affiliation: Mercy Hospital St Louis, Department of Pharmacy Services, Saint Louis, MO, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Korobey
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000493:pharmacokinetics; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000493:pharmacokinetics; D000925:Anticoagulants / Q000008:administration & dosage / Q000493:pharmacokinetics; D003404:Creatinine / Q000652:urine; D004334:Drug Administration Schedule; D017984:Enoxaparin / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D015738:Famotidine / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D008297:Male; D010607:Pharmacy Service, Hospital; D012189:Retrospective Studies
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D000925:Anticoagulants; D017984:Enoxaparin; D015738:Famotidine; D003404:Creatinine; D020910:Ketorolac
keywords: enoxaparin; famotidine; ketorolac; pharmacokinetics; renal dosing