Multi-Purpose Calculator

Not applicable to pediatric dialysis patients.

Initial Vancomycin Dosing

This protocol is to be used as a guideline, not a rule, and must be combined with clinical judgment.
For outliers or exceptions, consult with another pharmacist.
See Vancomycin Dosing Guidelines for full recommendations.

Indication

AKI?

PK Outlier?

Dosing Method/Target

Load

Maintenance

Use InsightRx to determine initial maintenance dose.

Maintenance

See NeoFax/Pediatrics for more detailed information as different disease states have different maximum daily doses.

Monitoring

Vancomycin Second Dose Timing

First Dose

Frequency

q6h q8h q12h q24h

Options to slide doses so third dose is on standard schedule:

First

Second

Third

(Load)

(1st Maint.)

(Standard)

Standard Times for Vancomycin

q6h

0500-1100-1700-2300

q8h

0500-1300-2100

q12h

0500-1700 or
0900-2100

q24h

0500, 0900, 1300,
1700, or 2100

Not applicable to dialysis patients

Initial Vancomycin PK Dosing

The "Initial Dosing" recommendations should be used for most patients (weight-based or InsightRx). This section is no longer routinely used. Historically, PK dosing was considered if there was a large discrepancy between the standard weight-based dosing and PK dosing, in patients with BMI < 30.

Est. Halflife

Suggested Dose

Suggested Frequency

Est. Trough

Choose Dose

Choose Frequency

Est. Trough

Not applicable to pediatric dialysis patients

Not applicable to PD patients

Not applicable to CRRT patients

Not applicable to SLED patients

Current Dose

Goal Trough

Current Dose

Trough

mcg/mL

Timing

Time Drawn

hrs before dose

Est. Half Life

Steady State Check

First Dose

Trough

Difference

Dose Adjustment for HD Patient

Single Level (Trough) Adjustment

Linear

New Dose

Change

Est. Trough

Suggested

Try Other Dose

New Dose

Change

Est. Trough

Suggested

Try Other Dose

Not applicable to dialysis patients

Vancomycin AUC Calculator

InsightRx or weight-based dosing should be used for all patients. This section is no longer routinely used, but is available for downtime and historical purposes.

Current Dose

Open Date/Time Calculator

Peak

hours after dose started

mcg/mL

Trough

hours after dose started

mcg/mL

AUC 24

Trough Goal

(for AUC:MIC of 400-600 mcg·hr/mL)

New Interval

Peak Level Timing

Calculate 1-2 hours after infusion is completed, based on start time and duration.

Dose not required - if entered, will be used to calculate infusion time

Current Dose

Infused over

minutes

Starting at

Not applicable to dialysis patients

Note: This tab does not apply to AUC dosing. Use the previous tab for AUC calculations.

Two-Level PK

First Level

mcg/mL

Second Level

mcg/mL

Est. Halflife

New Dose

Est. Trough

Aminoglycoside Extended Interval Dosing

Cystic Fibrosis?

Prepartum or Postpartum?

Dosing Weight

Drug

Goal Peak

mcg/mL

Goal Peak

Goal Trough

2 mcg/mL

Goal Trough

Dose Administered

Frequency

Last Dose

First Level

mcg/mL

Second Level

mcg/mL

Post-Antibiotic Effect

hours

Goal AUC

Recommended Dose

Redose Point

Predicted Trough

Predicted Peak

Calculated AUC

Halflife

First level drawn before presumed complete distribution.
Results may be inaccurate

Point Level Estimate (Informational Only)

Custom Date/Time

Estimated Level

Assumes a 1 hour infusion time for all doses and a 1.7 hour time to complete distribution.
All calculations are based on first-order kinetics for aminoglycosides and requires 2 levels drawn

IVIG Rate Calculator

Select Drug

Enter patient's actual weight

Dose

Rate

Dose is not required for calculation. If dose is specified, total infusion time will be calculated.

Corrected QT Interval

Heart Rate

bpm

QRS Interval

msec

QT Interval

msec

Corrected QT

Calculation method:

PCA Calculator

Drug and Therapy

PCA Dose

Lockout Interval

min

Before considering max dose...

Total Possible Dose

At most, new syringe every...

With max dose...

Ordered Maximum

mg/1 hr

At most, new syringe every...

Average bolus allowed

morphine (Standard) 30 mg/30 mL

Pump Limits	Hard Min	Soft Min	Soft Max	Hard Max
Loading Dose	n/a	0.1 mg	2 mg	4 mg
PCA Dose	n/a	0.1 mg	4 mg	5 mg
Continuous Rate	n/a	0.1 mg/hr	2 mg/hr	3 mg/hr
Lockout Interval	5 min	6 min	60 min	n/a
Max Accumulated Dose	n/a	0.1 mg/1 hr	7.5 mg/1 hr	15 mg/1 hr

KCentra Lot Number & Expiration

Scan one or multiple barcodes into the box below

Scan:

Total

Admin Inst.

Use this to determine the "starting dose" when continuing a heparin drip for a Discharge-Readmit patient.

Reverse Heparin Calculator

Dosing Weight

Open the heparin order set and select the drip only. Enter the patient's current dosing weight from the admin instructions of that order (not the original dosing weight).

Starting Rate

units/hr

Enter the rate that it's currently running at (the final rate before transfer from the previous location).

Test Rate

units/kg/hr

Round the above rate to confirm calculation/rounding. Enter this as the initial rate in the drip you got from the order set and discontinue the Discharge-Readmit order.
When documenting on the MAR, the nurse should answer "Yes" they are initiating the protocol.

Calculation Details

Time Between Doses and Levels

Calculation Details

Multipurpose Calculator

q6h

q8h

q12h

q24h