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Thanks to all who write on this padlet, and those who read from it..
1- a lot of you recommend to change the phenytoin , since it was already started, you have to be aware of possible interaction, even if you want to withhold or discontinue it, you need to monitor for CSA concentration..Now how frequent?! You need to state this>> this is guided by the CSA concentration itself, meaning to say that once stabilized [the CSA conc. within the recommended range] you should stop the 3-5 days interval checking. Some of you does not recommend to withhold or discontinue Phenytoin, which is fine, but still need to monitor for CSA conc.

Don’t make your statement vague [e.g. monitor closely, monitor frequently..], make it precise and clear to the reader.. Monitor>>frequency>>recommend dose adjustment..

2- I noticed that some of you state that sampling time may not be accurate, since it was 2hours-5min.. However, its stated by the produce leaflet that sampling to be within 2hours±5min..

3- One mentioned that the elevated creatinine is may be due to graft rejection or toxicity, this is a liver graft?! Not a renal one..

4- One student state 4-7 days?

5- Be aware of the word COMPARE.. if it comes in the exam.. it means to list similarities and differences between both compared points..

My Regards

Abdul Rahman

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Thanks to all who write on this padlet, and those who read from it..
1- a lot of you recommend to change the phenytoin , since it was already started, you have to be aware of possible interaction, even if you want to withhold or discontinue it, you need to monitor for CSA concentration..Now how frequent?! this is guided by the CSA concentration it self, meaning to say that once stabilized [the CSA conc. within the recommended range] you should stop the 3-5 days interval checking, You need to state this

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Tutorial CSA (Nurul Nasyitah & Nur Shahira)

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Tutorial CSA (Nurul Nasyitah & Nur Shahira)

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Polaris Office is a cloud-based office solution that enables you to seamlessly edit your documents anywhere, anytime.

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Siti Nurnabiha md alias, Anisah taha, Nur syazwanie ahmad hassan basri

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Azirah Ramlan 1311200

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MUHAMMAD AIMAN BIN MOHD FOZI (1312135)

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Salam. Attached here is my answer. Thank you.

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Salam. Attached here is my answer. Thank you.

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-NUR AMEEZAH BINTI SAMUIL (1318312)

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\nur iffah binti mohamad razit (1315614)

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1.TDM result that serum creatinine of the patient is high. Serum creatinine value obtained is 206 umol/l is higher than the normal value which is 53-97 umol/l. This high serum creatinine may be indicated the nephrotoxicity adverse effect by cyclo in patient or graft rejection due to transplantation. However, due to limited information, the cause or high serum creatinine cannot be determinded. Besides, HPLC assay indicated that cyclo C2 obtained is 1149 ng/ml or 1.15 mcg/ml. This value is still in the therapeutic range as the therapeutic range for 0-3 months after liver transplantation is 0.8-1.2 mcg/ml. However, the time for sampling is not too accurate as the sampling time is taken 5 minutes earlier. This may effect the result of TDM lab test.
2. The main concern is interaction between cyclo and phenytoin. There is serious interaction between these two drugs. Phenytoin will decrease the level of cyclo by increasing the metabolism. This will decrease the effect of cyclo. Thus an alternative drugs should be used for treating the patient's seizures.
3. Fever, lethargy, graft tenderness, high white blood cell, change in bile color or amount, hyperbilirubinemia, increase liver function test
4. Monoclonal assay is more specific than polyclonal assay as moniclonal assay can differentiate the Cyclo form and metabolite and polyclonal can not differentiate. Monoclonal assay also more precision as it does not detect metabolite unlike polyclonal assay. However, polyclonal assay is more cheaper than monoclonal assay

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Assalamualaikum.
FARAH ATHIRAH BINTI WAHAIRI & SUMAIYAH ABD AZIZ

Thank you!

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Assalamualaikum.

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Nur Liyana Malek

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Ros Shakinah Hashim

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Siti Afiqah Shikh Shatir

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-Siti Nurhanis binti Hali Rahman-

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assalamualaikum, attached here is the  answers.

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assalamualaikum, attached here is the  answers.

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(syakirah)

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Salam. These are my answers. Thank you.

-Nursazreen Amalina bt Mohamad Yusoff

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Dear all,
this is to share knowledge and discuss the case related to cyclosporine
CPK lecture, I'll expect all of you to participate, I'll post the tutorial, you need to interact and answer the questions related..
First, please note that I want you to ignore the reference ranges contained in the lecture, and just consider the attached file here, these are the only reference ranges that I want you to adopt.
Best Luck..

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Mrs. F.H, a 36-year-old, 71 kg male patient, had a liver transplant before 2 months ago

He is presently on:

Oral cyclosporine 75 mg bid

Current dose started 5/11/2015 at 8.30 pm

Last dose taken: 11/11/2015 at 8.30 am

Sampling time: 11/11/2015 at 10.25 am

Other medications: Oral Metoprolol 50 mg bid

F.H was admitted to the hospital due to newly onset of seizures, the physician ordered for him:

PO Phenytoin 100 mg E.R, tid (started at 11.30 am)

Lab results:

Serum creatinine: 206 mmol/L

Using HPLC, Cyclosporine C2 level obtained: 1149 ng/ml

Answer the following:

1. Interpret TDM lab results

2. Recommend proper therapeutic management

3. List clinical monitoring parameters in hepatic transplantation

4. Compare between HPLC, MC and PC assay method? and state why there is differences?

note: every one who answer must write his/ her name