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1. 06 01 2003 Yd 18 669 L 0 25 L kg F 100 00 CL 3 941 Lfhr kd 0 211 hr CF 100 0 t1 2 3 283 hr Dosage Recommendation Bayes Parameters Dose 200 0 mg every 12 0 hours Infused Over 1 0 hr Levels mg L Average 0 0 Post 1 0 hr 8 5 Peak 10 5 Trough 1 0 at Steady State A Natl Report Printing Options ase Note lv Print Graphics V Print Population Parameters Previous Print Figure 15 Individualized Report Screen The Individualized Report Screen Figure 15 displays the Patient demographic data Bayesian or Least Squares pharmacokinetic parameters and the last dosage regimen that you evaluated on the previous screen The Case Note box allows you to enter optional free text that you would like printed on the written report This free text can later be saved in the database in the Case record In the Report Printing Options box you can uncheck the Print Graphics and Print Population Parameters options to simplify the report that is printed Previous takes you back to the Bayesian Least Squares or Detailed Serum Level Analysis Screen depending on where you came from where you can change the data you entered Print takes you to the Windows print utility where you can designate the printer of your choice to print a written report 22 Work on the Same Patient and Same Drug Work on the Same Patient Work on a New Patient Save this Case in Database Previous Figure 16 Mode Sc2. MIC Figure 7 Population Serum Level Forecast Screen The Serum Level Forecast Screen Figure 7 allows you to predict the serum drug concentrations achieved by dosage regimen that you enter Results are calculated using population based pharmacokinetic values from the literature If you wish to change the population values you can change those values in the white boxes If this case was downloaded from the database the parameters stored in the database are displayed in the boxes below the Parameters Saved On heading You can select the route and specific drug product from the drop down box in the middle of the screen For intermittent administration enter the dosage regimen that you desire and the steady state serum levels predicted to be produced by this regimen are displayed For administration by continuous infusion simply enter the desired serum and T D M S will calculate the infusion rate needed to achieve this concentration For antimicrobial agents enter the minimum inhibitory concentration MIC of the organism to calculate pharmacodynamic values Post MIC Time Above MIC and AUIC at steady state which are displayed at the bottom of the second column See Appendix B for an explanation of these values Previous takes you to the Factors screen where you can change the factors you entered Report takes you to the Population Report Screen Figure 8 Done takes you to the Mode screen which provides several further opti
3. neanaeR g 3 A dL Birthday 08 24 1956 Crs 0 9 mg Sex Male Female CLer mLimin Updated Albumin gidL Updated Patient Note ree ee Previous Save Next Figure 4 Patient Demographics Screen This screen is used to gather information about the patient and drug of interest In the first three fields of the left Patient column you may enter the patient Last and First names and any Hospital Identification number These fields are not required but are used to store and later identify the patient in the database You may jump between fields with a mouse click enter key or tab key Birthday is entered as m d yyyy or mm dd yyyy Sex is entered by clicking on the appropriate radio button Male or Female Patient Note will be stored with the Patient record in the database Information in this field will be retrieved whenever the Patient or any of the patient Case records are retrieved In the right Case column you enter data about the particular course of drug therapy that you are studying Drug is selected from the drop down menu You may also type in the name of the drug and the drug name matching what you type will appear as soon as a match occurs Weight and Height are entered as numbers and the correct units are selected using the buttons to the right of each box The patient s creatinine clearance CLcr can be calculated from serum creatinine Crs or it can be entered directly if you have a measured value Selec
4. Desired Trough 9 5 mg L Infusion Time of Loading Dose 1 hr Infusion Time 1 hr Infusion Rate Since Level 0 0 mgfhr Desired Average Concentration mg L Exact Estimate Loading Dose 233 mg Exact Estimate Rate mg 24 hr 7 Serum Drug Previous Level Forecast Done l l l l l l 13 8 hr If Continuous IV l l l l l l Figure 6 Population Dosage Regimen Forecast Screen The population dosage regimen forecast screen Figure 6 allows you to predict the dosage regimen required to achieve the exact serum drug concentrations that you enter Results are calculated using population based pharmacokinetic values from the literature If you wish to change the population values you can change those values in the white boxes If this case was pulled from the database the parameters stored in the database are displayed in the boxes below the Parameters Saved On heading You can select the route and specific drug product from the drop down box in the middle of the screen After entering the desired serum concentrations and times the exact dosage regimen required to produce the serum drug concentrations you specify are displayed in the Exact Estimate column You may enter further information in the Loading Dose Forecast column If the patient has been on the drug and you have a serum concentration drawn at 11 a known time you can enter these T D M S will calculate the dose required to produce the Desired Post
5. 225 fhr t1 2 3 078 hr Route Product Intermittent IY Injection v Salt 1 00 F 100 Previous No Fitting Next Figure 9 Parameters Adjustment Screen Prior to analysis of a specific dosage regimen you may adjust the population parameters used as a starting point for the fitting routine You may also need to specify a route of administration and drug product from the dropdown menu for some drugs Previous takes you to the Factors screen where you can change the factors you entered No Fitting takes you to the Mode screen which provides several further options Next takes you to the History Spreadsheet Screen where you enter the dosage and serum level histories of the patient 15 EEE S555 SEREUE Ei Figure 10 History Spreadsheet Screen On this screen you enter the Dosage History and Serum Level History for the patient Up to 9 different dosage regimens may be entered In the final column you must specify if the doses were given on the inpatient I or outpatient O setting Up to ten serum levels may be entered As most fields are filled completely the cursor will jump to the next cell On subsequent lines the Year Date minutes and Route will be automatically filled with the same data as the line above if you hit the Enter or Tab key You may change these default data by typing in other values To navigate this screen without entering default data use the mouse or arrow keys The F2 key also jumps betw
6. 225 0 211 RF a t1 2 hr 3 078 3 283 H 3 054 H Steady State Level Predictions mg L Route Product Intermittent I Injection x Salt 1 00 Intermittent I Infusion Oral iM e aoe ontinuous I Infusion Dose 200 mg Time of Post 1 hr Dose mg Infusion Interval 12 hr Time 1 hr Interval hr Rate mgfhr Population Bayes 95 Cl Least Sq 95 CI Previous Peak 8 25 10 49 8 22 12 76 11 57 11 34 11 80 Bayes Report Trough 0 69 1 03 0 23 1 83 0 95 0 91 1 00 ond Post 6 58 aag 6 84 10 15 9 22 9 06 9 38 L S Report Average 5 Done Figure 14 Detailed Analysis Screen The Detailed Analysis Screen Figure 14 allows you to predict the serum drug concentrations achieved by dosage regimen that you enter Results are calculated using both Bayesian and Least Squares values and provide both mean serum concentration values and the 95 confidence intervals around each level Previous takes you to the Analysis Results Screen where you can change the data you entered Bayes Report and LS Report both take you to the Individualized Report Screen Figure 15 The parameters reported there depend on whether you select Bayes or L S Report on this screen Done takes you to the Mode screen which provides several further options 21 Your Institution THERAPEUTIC DRUG MONITORING SYSTEM 123456 4 Patient Test 47 Years Male 166 0 Ib 72 0 in Crs 1 0 mg dL Est CLcer 96 4 mL min Gentamicin Bayes Parameters
7. T D M S Version 6 0 For Windows THERAPEUTIC DRUG MONITORING SYSTEM USER MANUAL Copyright 1986 2003 Healthware Inc PO Box 33483 San Diego CA 92163 Phone FAX 858 452 0297 Designed by Jenn Ting Pharm D Written by Philip O Anderson Pharm D Jenn Ting Pharm D The programs and equations contained in T D M S were derived from the medical literature identified in the documentation provided with this program and are combined to provide a system that supplements the judgment of the clinician in dosing various drugs T D M S is not intended to replace the sound clinical judgment of the user in the care of patients Neither Healthware Inc nor any of its employees shall be liable for any damages resulting from any use of this software package By the use of this software package the user waives all warranties expressed or implied including any warranties to the accuracy quality or suitability of T D M S for any particular purpose either medical or nonmedical Healthware Inc provides a license to use T D M S under the following conditions 1 You may make a copy of the program to a working diskette or hard disk as a backup to use on any machine owned by the purchaser so long as only the number of copies allowed by the T D M S protection scheme is not exceeded 2 Copies of T D M S screens may be made for teaching or patient care purposes No copies of T D M S screens may be mad
8. atabase entry Listed below the name of each Patient are the specific Cases that have been saved for this Patient Each Case represents a record containing data saved on different drug or date You may choose information by Patient name or Case by double clickicking on the desired line Patient information selecting by patient name is only demographic information whereas Case information selecting by drug is the Patient complete demographic information all drug specific dosage and serum level history as well as previously entered notes and recommendations for that Case Options are as follows Previous takes you back to the Database Search Screen where you can reenter a database search Delete allows you to delete a specified Patient or Case Deleting a Patient also deletes all associated Cases Next takes you to the patient demographic screen If no match is found in the database that match your search criteria the following message will appear Warning No record match found Press Previous to seach again or Next to proceed Figure 3 No Match After clicking the OK button you may either press the Previous button to reformulate your search or the Next button to continue to the Patient Demographics screen Your Institution 06701 2003 THERAPEUTIC DRUG MONITORING SYSTEM Patient Case Gentamicin X Last Patient Drug gt First Test Weight 166 lb C kg Hosp ID 12345 A Height 72 in em
9. atient Test 47 Years Male 166 0 Ib 72 0 in Bayes Parameters Gentamicin Crs 1 0 mg dL Est CLer 96 4 mL min Parameters Saved On 06 01 2003 Vd 18 669 L 0 25 Lkg Vd L CL 3 941 Uhr xg 0 211 jhr CL Uhr Salt kd hr CF 100 000 9 tij2 3 283 hr CF F t hr Salt 1 00 F 100 000 Route Product Intermittent I Injection 4 Loading Dose Forecast Initial Conc 0 0 mg L Time Drawn hr ago 0 0 hr Steady State Dosage Regimen Forecast Desired Post 7 mgiL Exact Estimate Time of Post After Infusion hr Ease MEGA ang I l l l Frequency j i Desired Trough 1 mg L quency Infusion ine of L ading Dose hr naene 11 2 hr If Continuous IV ee eyes 1 hr Infusion Rate Since Level 0 0 mg hr l Desired Average Concentration aes mg L Exact Estimate Loading Dose SSS mg Exact Estimate Rate mgi24 hr A Serum Drug Exewious Level Forecast Done Figure 13 Individualized Serum Level Forecast Screens The Individualized Bayesian and Least Squares Serum Level Forecast Screen Figure 13 allows you to predict the serum drug concentrations achieved by dosage regimen that you enter Results are calculated using Bayesian or Least Squares pharmacokinetic values indicated just below the patient s ID number and name On this screen you may select the Route and Product and enter the dosage regimen that you desire The steady state serum levels predict to be produced by this r
10. e Appendix A T D M S Installation Procedures for more details You are required to press this button and designate a database location the fist time you run T D M S after it is installed Next allows you to proceed to the following screen Note that you can either click on this Next button or press the keyboard combination of Alt N to proceed Wherever you see a letter underlined on a button throughout the program you can use the Alt letter combination to activate the button Your Institution lt WARNING READ THIS IMPORTANT INFORMATION BEFORE PROCEEDING gt The programs and equations contained in T D M S were derived from the medical literature identified in the documentation provided with this program and are combined to provide a system supplements the judgment of the clinician in dosing various drugs T D M S is not intended to replace the sound clinical judgment of the user in the care of patients Neither Healthware Inc or any of its employees shall be liable for any damages resulting from any use of this software package By the use of this software package the user waives all warranties expressed or implied including any warranty to the accuracy quality or suitability of T D M S for any particular purpose either medical or nonmedical Information in T D M S is current as of April 1999 New may have appeared subsequently that supersede this information T D M S and the T D M S User s Manual are copyright Hea
11. e for any other purposes commercial or noncommercial without written permission of Healthware Inc 3 You may transfer the program and license to another party if the other party agrees to the terms and conditions of this agreement S 4 You may not modify copy or transfer T D M in any way except as provided for in this license Any other uses or copies of T D M S are not allowed under this license and use of this program indicates your acceptance of these terms and conditions The T D M S User Manual is copyright Healthware Inc 2003 No part of this manual may be reproduced in any form or by any means without permission in writing from Healthware Inc T D M S is a trademark of Healthware Inc and all references to T D M S in this manual refer to the trademark although they may not be designated as such ACKNOWLEDGEMENTS The authors would like to thank James Lane Jr Pharm D William Murray Pharm D and Edmund Capparelli Pharm D who have provided numerous pharmacokinetic insights that improved the program CHAPTER 1 SYSTEM OVERVIEW T D M S 2000 Configure Database Figure 1 Title Screen The Title Screen Figure 1 displays the program name version the name of your institution and today s date as it is set in your computer There are two choices on this screen Configure Database allows you to designate the location of the T D M S database where patient data are stored se
12. een the Dosage and Serum Level Histories To change entered data move to the cell of interest with the mouse or arrow keys and retype the entry To erase entire lines of data enter the number O or letter X in the year field This will erase the data on that and all subsequent lines in the Dosage History or Serum Level History Previous takes you to the Parameters Adjustment Screen where you can change the data you entered Next takes you to the Analysis Results Screen 16 06 01 2003 THERAPEUTIC DRUG MONITORING SYSTEM Acutal Pop Bayes LS Patient Test 47 Years Male 166 0 Ib 72 0 in 0 9 Crs 1 0 mg dL Est CLer 96 4 mL min 9 2 Gentamicin Least Squares Range 100 000 10 000 16 552 0 418 3 756 0 060 Population 100 000 ti 9 999 H 5 398 0 980 23 278 5 241 100 000 100 001 0 227 3 054 100 0 0 225 3 078 100 003 Least Squares vs Pop Bayes 45 LS m ny op 12 op a Max 10 0 Max 10 0 12 24 36 48 60 Hours Routine Bayes Analysis Routine LS Analysis Detailed Analysis Figure 11 Analysis Results Screen The Analysis Results screen Screen 11 displays the results of the curve fittings which are grouped in three parts of the screen Throughout this screen red denotes Population values calculated from patient demographic factors blue denotes the res
13. egimen are displayed For antimicrobial agents enter the minimum inhibitory concentration MIC of the organism to calculate pharmacodynamic values i e Post MIC Time Above MIC and AUIC at steady state which are displayed at the bottom of the second column see Appendix B for an explanation of these values For oral or intramuscular drugs you may enter an uneven daily dosage regimen of up to 4 doses per day Enter the dose and hour on each line then the time of day that you wish to know the serum level that is predicted Steady state peak trough and average levels will be calculated in addition to the serum level at the time you specified Previous takes you to the History Spreadsheet Screen where you can change the data Report takes you to the Individualized Report Screen Figure 15 The parameters reported there depend on whether you select Routine Bayes or Routine L S Analysis on the previous screen Done takes you to the Mode screen which provides several further options 20 Your Institution 06 01 2003 THERAPEUTIC DRUG MONITORING SYSTEM 123456 A Patient Test 47 Years Male 166 0 Ib 72 0 in Crs 1 0 mg dL Est CLcer 96 4 mL min Gentamicin Population Bayes Range Least Squares Range F pa 100 000 100 000 9 999 100 000 10 000 d L 23 278 18 669 5 385 16 552 0 397 CL Lfhr 5 241 3 941 0 985 3 756 l 0 072 CF 0 100 0 100 000 100 003 100 000 4 100 001 kd fh 0
14. imen Forecast screen that allows you to predict the dosage regimen required to achieve given serum drug concentrations that you enter Serum Level Forecast takes you to the Population Serum Level Forecast screen that allows you to predict the serum drug concentrations achieved by dosage regimen that you enter Serum Level Analysis takes you to the screens for analysis of specific dosage regimen and serum drug concentrations that the patient has received 10 Population Pharmacokinetics The population pharmacokientics portion of T D M S calculates initial starting dosage regimens for your patient based on their demographic data age height weight etc and any factors that are documented to affect the drugs s pharmacokientics drug interactions diseases etc Your Institution THERAPEUTIC DRUG MONITORING SYSTEM 123456 A Patient Test 47 Years Male 166 0 Ib 72 0 in Population Parameters Gentamicii Crs 1 0 mg dL Est CLer 96 4 mL min Parameters Saved On 06 01 2003 vd 23 278 L 0 31 L kg v L CL 5 241 Uhr yg 0 225 jhr c Uhr sat kd hr CF 100 0 9 t1 2 3 078 hr CF F ng hr Route Product intermittent I Injection Salt 1 00 E 100 Steady State Dosage Regimen Forecast Loading Dose Forecast Desired Post 8 mg L Exact Estimate Dose 222 mg Initial Conc 0 0 mg L Time Drawn hr ago 0 0 hr Time of Post After Infusion 0 5 hr Frequency
15. lthware Inc 1986 2003 Their use is subject to the terms and conditions set forth in the User s Manual T D M S is a trademark of Healthware Inc Patient s LastName Enter Patient ID Number Leave blank for new Patient Previous Next Figure 2 Database Search Screen This screen displays the legal disclaimer at the top and has two boxes that allow you to search for a patient in the database You only need to fill in one of the two boxes Patient s Last Name allows you to search for a patient by the last name Partial name searches are possible so entering the letter An will retrieve all patient whose last name starts with An Enter Patient ID Number allows you to search by the identification number you have stored in the database such as the patient medical record number Previous takes you back to the Title Screen Next allows you to proceed to the following screen If you entered information into one of the boxes above you will be taken to the Database Screen Figure 3 where search results are displayed If you entered nothing in either box you will be taken to the Patient Demographics screen Patient Test 123456 A Male 08 24 1955 06 01 2003 Gentamicin 166 Ib 72in 1 mg dL 06 01 2003 Figure 3 Database Screen The Database Screen displays all Patients in the T D M S database that meet your search criteria Several columns of information are listed to assist you in selecting the appropriate d
16. lysis takes you to the Individualized Routine Dosage Regimen Forecast Screen Screen 12 that allows you to predict the dosage regimen required to achieve given serum drug concentrations that you enter Results are calculated using Least Squares pharmacokinetic values Detailed Analysis takes you to the Detailed Analysis Screen that allows you to predict the serum drug concentrations achieved by dosage regimen that you enter using both Bayesian and Least Squares values 18 Your Institution THERAPEUTIC DRUG MONITORING SYSTEM 123456 A Patient Test 47 Years Male 166 0 Ib 72 0 in Bayes Parameters Gentanlah Crs 1 0 mg dL Est CLer 96 4 mL min Parameters Saved On 06 01 2003 vd 18 669 L 0 25 L kg Vd L CL 3 941 Lfhr xg 0 211 jhr CL L hr Salt kd hr CF 100 000 tij2 3 283 hr CF F n2 hr Route Product intermittent I Injection Salt 1 00 E 100 000 Steady State Dosage Regimen Forecast Loading Dose Forecast Desired Post 7 mg L Exact Estimate Initial Conc 0 0 mg L Time of Post After Infusion hr Dose 162 mg Time Drawn hr ago 0 0 hr Desired Trough a mg L Frequency Infusion Time of Loading Dose hr Infusion Rate Since Level 0 0 mgfhr Desired verage Concentration mg L Exact Estimate Loading Dose mg l l l l l i mir If Continuous IV Infusion Time a hr 11 2 hr E l Exact Estimate Rate mg 24 hr l A Serum Drug Previo
17. ons 13 We recommend a dosage of 200 mg every 12 hours M Pant Graphics lV Pant Population Parameters Previous Figure 8 Population Report Screen This screen displays the Patient demographic data population pharmacokinetic parameters and the last dosage regimen that you evaluated on the Population Serum Level screen The Case Note box allows you to enter optional free text that you would like printed on the written report This free text can later be saved in the database in the Case record There are two options Previous takes you back to the Serum Level Forecast Screen where you can change the data you entered Print takes you to the Windows print utility where you can designate the printer of your choice to print a written report After printing the program takes you to the Mode screen to work on the next patient 14 Serum Level Analysis Pharmacokinetics Once serum drug concentrations are available for your patient the part of T D M S uses standard pharmacokinetic equations to help you create an individualized dosage regimen for the patient These equations are listed in Appendix C 06 01 2003 THERAPEUTIC DRUG MONITORING SYSTEM 123456 A Patient Test 47 Years Male 166 0 Ib 72 0 in Crs 1 0 mg dL Est CLer 96 4 mL min Gentamicin Initial Pharmacokinetic Parameters Value Range F 100 000 5 000 Vd 23 278 6 983 L 0 309 L kg CL 5 241 h 2 620 Lfhr CF 100 0 50 000 kd 0
18. reen The Mode Screen gives you several options Work on the Same Patient and Same Drug saves all the Patient and Case data You can only work on the same drug that you have been analyzing Work on the Same Patient saves all the Patient data You can work on any drug with a new patient Work on a New Patient deletes all Patient and Case data Save this Case in Database saves all data you have entered in the database Previous takes you back to the last screen you were working on Exit ends T D M S 23
19. t either Crs or CLer with the radio button and enter the value in the corresponding units in the box to the right of your selection Serum Albumin is only required when you have selected the drug phenytoin Otherwise this entry is skipped The date that this particular Case was updated is displayed in the field Updated Case Note will be stored with the Case record in the database Information in this field will be retrieved whenever this Case record is retrieved Buttons at the bottom of this screen allow you to go back to the Previous screen Save the information on this screen in the database or proceed with analysis of this case by pressing the Next button O Is this a critically ill or ICU patient O Is this a burn patient O Is this a hematology oncology patient O Is this a spinal cord injury patient O Is this a cystic fibrosis patient Dosage Regimen Serum Level Serum Level Forecast Forecast Analysis Figure 5 Factors Screen The Factors Screen Figure 5 allows you to enter up to two factors known to affect the pharmacokinetics by at least 10 of the drug being used in this Case Click on the check box to the left of any factor s that are applicable Once the appropriate factors have been checked click one of the buttons at the bottom of the screen Previous takes you back to the Patient Demographics screen where you can change the data you entered Dosage Regimen Forecast takes you to the Population Dosage Reg
20. that you specified after the first dose Because calculations often result in impractical doses or frequencies the results obtained on this screen should be considered approximate dosage regimens The best exact regimens should be determined by using the Population Serum Drug Level Forecast Screen Previous takes you back to the Factors screen where you can change the factors entered Serum Level Forecast takes you to the serum level forecast screen that allows you to predict the serum drug concentrations achieved by dosage regimen that you enter Done takes you to the Mode screen which provides several further options 12 Your Institution THERAPEUTIC DRUG MONITORING SYSTEM 123456 A Patient Test 47 Years Male 166 0 Ib 72 0 in Population Parameters Gentamicin Crs 1 0 mg dL Est CLer 96 4 mL min Parameters Saved On 06 01 2003 Vd 23 278 L 0 31 L kg Vd L CL 5 241 Uhr xg 0 225 fhr cu Uhr saf el h cF 100 t1 2 3 078 hr c x ET wy br Route Product Intermittent IV Injection Salt 1 00 F 100 Steady State Serum Level Forecast Intermittent I Infusion Steady State Levels Continuous I Infusion Dose 200 mg Peak 8 2 mg L Infusion Rate mg hr Interval 12 hr Trough 0 7 mg L Time of Post 0 5 hr Post 7 4 mg L mg L Infusion Time 1 hr Average 0 0 mg 05 Post MIC 14 7 Time Above MIC 74 0 hr AUIC 153 Previous Report Done Steady State Level Average Level mg L
21. ults obtained from Bayesian curve fitting and green denotes the results obtained from nonlinear Least Squares curve fitting In the upper left pharmacokinetic parameters are displayed Bayesian and Least Squares values also display the Range standard deviation of each value In the upper right the serum concentration value at each point in time when a serum level was entered is displayed The actual measured values are followed by the values calculated using the Population Bayesian and Least Squares pharmacokinetic values for that time point At the bottom of the screen graphical representations of the serum concentrations versus time plots are displayed with Bayesian and Least Squares plots compared to Population plots in each case These graphs provide a visual method of checking for correct entry of the dosage and serum level history on the previous screen If only one serum level was obtained only the Population and Bayesian values and plots are displayed because there is no valid mathematical meaning to a Least Squares fitting of one point Previous takes you to the History Spreadsheet Screen where you can change the data you entered 17 Routine Bayes Analysis takes you to the Individualized Routine Dosage Regimen Forecast Screen Screen 12 that allows you to predict the dosage regimen required to achieve given serum drug concentrations that you enter Results are calculated using Bayesian pharmacokinetic values Routine LS Ana
22. us Level Forecast Done Figure 12 Individualized Dosage Regimen Forecast Screens The Individualized Bayesian and Least Squares Dosage Regimen Forecast Screens allow you to predict the dosage regimen required to achieve the exact serum drug concentrations that you enter Results are calculated using either Bayesian or Least Squares pharmacokinetic values indicated just below the patient s ID number and name On this screen you may select the Route and specific drug product in the dropdown box in the middle of the screen The exact dosage regimen required to produce the serum drug concentrations you specify are displayed in the Exact Estimates column You may enter further information in the Loading Dose Forecast column to calculate the dose required to produce the Desired Post after the first dose Because calculations often result in impractical doses or frequencies the results obtained on this screen should be considered approximate dosage regimens and the best exact regimens should be determined by using the Serum Drug Level Forecast Screen Figure 13 Previous takes you to the History Spreadsheet Screen where you can change the data Serum Level Forecast takes you to the serum level forecast screen that allows you to predict the serum drug concentrations achieved by dosage regimen that you enter Done takes you to the Mode screen which provides several further options 19 Your Institution THERAPEUTIC DRUG MONITORING SYSTEM 123456 A P
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