A QUICK GUIDE TO THE (SANFORD) GUIDE 2011 (41st Edition)

1. A QUICK GUIDE TO THE (SANFORD) GUIDE 2011 (41st Edition) Presented by Doug Black, Pharm.D.

2. THINGS I OFTEN HEAR ABOUT THE SANFORD GUIDE • I have a hard time finding what I want. • I can’t read it. • I hate all those abbreviations. • Do I need to get a new one every year? • What’s new in this year’s edition? • What about the web edition?

3. EXCLUDING ALASKA AND LOUISIANA, WHICH STATE HAS THE FEWEST COUNTIES (3) AND WHICH HAS THE MOST (254)? DELAWARE and TEXAS, respectively

4. I have a question about trimethoprim-sulfamethoxazole (Bactrim) and I don’t know where to look, so I’ll start with the index. That would be p.218. Note that p.100 is bold (does not always mean the same thing) Stephanie Troy’s table (before p.1) is handy Note also the abbreviations list on pp 2-3

5. (T/F) ACCORDING TO THE CONSTITUTION, THE NEXT-IN-LINE TO ASSUME POWER AFTER THE PRESIDENT, VICE PRESIDENT, AND SPEAKER OF THE HOUSE IS THE SECRETARY OF STATE. FALSE. The next in succession is the President Pro Tempore of the Senate. Who is that person right now?

6. I need to estimate the CrCl of my 190-kg patient. See p 188 (the beginning of table 17A)

7. HIS FIRST NAME MEANS HAPPY, BUT THREE OF HIS FIVE SYMPHONIES ARE WRITTEN IN MINOR KEY. WHO IS HE? FELIX MENDELSSOHN

8. What’s the correct empiric therapy for a 35-yo male with presumed bacterial meningitis? Easy enough: table 1A (p. 7). Note that the vancomycin dose has been fixed from previous editions. Dosing in this table (there is no table 1B, by the way) trumps other tables in the Guide.

9. K2 (MT GODWIN-AUSTEN, 28,251’) IS THE SECOND-HIGHEST MOUNTAIN IN THE WORLD. IS THERE A K1? YES. It is Masherbrum (25,659’), also in Pakistan and the 22nd-highest mountain in the world.

10. I’ll choose meropenemfor my patient with meningitis because of allergy history. The patient has a CrCl of 30. What’s the correct dose? Again, seems easy enough (table 17A, p. 189)

11. (T/F) IN 1971, CAROLINE DAVIDSON, A PORTLAND STATE UNIVERSITY ADVERTISING STUDENT, DESIGNED AND THEN SOLD THE “SWOOSH” TO PHIL KNIGHT (FOUNDER OF NIKE) FOR $60. FALSE. She actually sold it for $35. Davidson met Knight while he was teaching accounting classes and began doing freelance work for his company.

12. How would I treat Burkholderiacepacia? I need a starting point. Table 2 (pp 63-65) is helpful for such questions. But look at table 4, p. 68 I would make these points: 1) Sanford sometimes conflicts with itself; 2) even the normally trustworthy table 2 can falter, and 3) I remain squeamish about table 4

13. (T/F) THE ONLY ACTOR EVER TO WIN THE “BEST ACTOR” OSCAR TWO YEARS IN A ROW IS TOM HANKS FOR PHILADELPHIA AND FORREST GUMP (1993-1994). FALSE. Spencer Tracy also did it in 1937 and 1938 for Captains Courageous and Boys Town. Nobody has won more than two best actor awards; some say this is because of the Academy’s fondness for Tracy.

14. Someone suggested I treat a kid with Altabax BID for impetigo. How many days does he need? First, what is Altabax? See table 23, p 209 Next, the duration: table 3 (p. 66) might seem logical When in doubt, table 1A (p 52) Note there is generally no duration in table 10C (p 100)

15. WHAT MARGATE CITY, NJ HOUSING AREA HAS BEEN MISSPELLED ON THE MONOPOLY GAME BOARD FOR ALMOST 80 YEARS? Marvin Gardens (should be Marven Gardens). Parker Brothers acknowledged the error in 1995 and formally apologized to the residents of Marven Gardens.

16. I have a patient with C. glabratafungemia, MIC 8 mcg/ml. I know fluconazole is the cheapest way to treat fungemia. Can I use it? Check the pharmacology table (9A, p. 82)

17. A patient receiving ciprofloxacin 400 mg IV q8h is transferred to my care and I want to switch to an equivalent oral dose. What would it be? This is a nice application of % absorption (9A, p. 81). The dosage table (10C, p. 97) is not very helpful for this.

18. What parenteral cephalosporin achieves the best concentrations in the CSF? Cefuroxime? See table 9A, p 80. Notice it is characterized as “marginal.” An actual CSF concentration column would be quite useful. So would a biliary concentration column, rather than the ratio. In fact, the Guide needs a tissue concentration TABLE.

19. WHAT ARE DIVIDED BY BOTT’S DOTS? Highway lanes. Caltrans worker Elbert Bottsinvented the raised highway markers. They first appeared in 1966 on I-80 near Fairfield and on Highway 99 near Fresno.

20. Is it safe to administer ciprofloxacin or levofloxacin to my UTI patient already on methadone? Seems like a simple application of the drug interaction table (22A, p.201: characterized as “of definite importance”). The problem is no way to check plausibility (methadone is a CYP2B6, 2C19, 2D6 substrate). Could it not simply be downregulation of CYP enzymes caused by proinflammatory cytokines associated with infection?

21. What is the longest name of a country consisting of alternating vowels and consonants? United Arab Emirates

22. I just prescribed a Z-pack (azithromycin) to a construction worker who is outdoors all day long. Does I need to worry about photosensitivity? Table 10B, p 91 says you do. But…

23. What is the only word in the Random House Unabridged Dictionary that contains the letters XYZ in consecutive order? hydroxyzine

24. My patient weighs 170 kg. What would be the appropriate dose of cefazolin for cellulitis? Kind of an odd place for obesity recommendations: table 17A, p 188. The Guide really needs a formal table to help with obesity dosing.

25. (T/F) JACK NICHOLSON ONCE REMARKED: "MY MOTHER NEVER SAW THE IRONY OF CALLING ME A SON OF A BITCH." TRUE

26. IN SUMMARY: Sanford does some things very well, other things not so well. Some recommendations are based on little to no data, and others may be conflicting. It could use a few new tables and some work on the existing ones. The web edition is worth a look.

27. My thanks to John and Paul for inviting me, and to each of you for listening. I wish you all the best in your fellowship experience. TEN THNGS TO REMEMBER • Be very careful with table 4

29. WHAT IS THE SMALLEST OCEAN? THE ARCTIC OCEAN

30. THE LAST MOTION PICTURE TO SWEEP ALL FIVE MAJOR OSCARS (BEST PICTURE, BEST DIRECTOR, BEST SCREENPLAY, BEST ACTOR, BEST ACTRESS) WAS TITANIC. FALSE. The last film to do that was Silence of the Lambs in 1991.

31. THE MOUNTAIN PICTURED IN THE PARAMOUNT PICTURES LOGO IS A HIMALAYAN PEAK, LIKE EVEREST OR K2 OR ANNAPURNA. FALSE. Paramount was founded by William Hodkinson, who grew up in Ogden, Utah. The mountain pictured in the logo is probably the distinctive Mt. Ben Lomond in the Wasatch Range (9,712 feet).

33. SPAM (THIS KIND) MEANS “SOMETHING POSING AS MEAT.” FALSE. It means Spicey Ham.

34. WHY IS UNIVERSITY WAY NE KNOWN AS “THE AVE?” Because it was originally known as Columbus Avenue, then 14th Avenue before finally becoming University Way in 1919.

35. (T/F) THE FIRST AMERICAN IN OUTER SPACE WAS JOHN GLENN. FALSE. The first American in space was Alan Shepard. He piloted “Freedom 7” for 15 minutes, 28 seconds on May 5, 1961.