Clinical Pharmacokinetics

Optimisation of drug dosage - e.g. Allopurinol & Febuxostat (gout), Metformin (antidiabetic), Anti-infectives e.g. Gentamicin & Vancomycin (antibiotics) and Ribavirin

Background:

• There is often a better correlation between patient responses to a drug and  measured drug plasma concentrations than the administered drug dose
• Many drugs have highly variable pharmacokinetics (plasma concentrations)
• Optimising drug dosage according to pharmacokinetics is the key to optimising drug effectiveness

Methods:

• Clinical: Patient recruitment, blood collections
• Analytical: Chromatography (HPLC), DNA extraction and genetic analysis (SNPs)
• Data analysis: Computerised PK modelling, simulations and optimising dosing, correlations with patient response 

Decision support: Can we help doctors make better prescribing decisions? 

Background:

• Medication management in Australian hospitals is shifting from paper to electronic formats, with many hospitals now using electronic prescribing systems 
• These systems often include computerised alerts, which trigger at the point of prescribing to warn doctors about potential errors in orders 
• Computerised alerts can help doctors make better prescribing decisions but getting this ‘decision support’ right is tricky 

Research: 

Qualitative methods (e.g. interviewing doctors) combined with quantitative methods (e.g. review of medication charts and alerts) to:

• Evaluate the current decision support at St Vincent’s Hospital – is it working?
• Understand what doctors want and need to be better prescribers – how can we help?
• Test new ways of helping doctors prescribe – what works and what doesn’t? 

Can outcomes for gout sufferers be improved with eHealth?

Background:

• Gout is the most common form of inflammatory arthritis. It is characterised by extreme pain and swelling and is caused by a build up of uric acid in the bloodstream.
• Gout can be successfully managed by drug therapy. However, the prevalence of gout is increasing.
• A novel IT intervention (a mobile phone app) to support gout management in the community could enhance outcomes for gout sufferers. 


Research:

Qualitative methods (e.g. interviewing doctors and gout patients) to:

• Understand usability of IT interventions – are patients happy to use an app to manage their condition? Would “gamification” improve user uptake?
• Designing effective educational materials for GPs on gout.
• Interviewing gout patients about their treatment satisfaction.
• Understanding how gout patients with comorbidities view gout in relation to their other conditions.

Effect of Paracetamol on myeloperoxidase 

Background:

• Paracetamol - major analgesic drug
• Myeloperoxidase - enzyme of neutrophils
• Myeloperoxidase produces HOCl - tissue oxidant
• Myeloperoxidase present in atherosclerotic lesions
• Paracetamol is substrate and inhibitor of myeloperoxidase
• Paracetamol may decrease atherosclerosis
• Interactions of paracetamol analogues with myeloperoxidase? 

Methods:

Analytical: Enzyme assay, Chromatography (HPLC), UV spectroscopy, Nuclear magnetic resonance spectroscopy

• Statistical analysis 

A critical look at drug development 

Background: 

•  Increasing prices for cancer medicines challenge our ability to pay for them.
•  Payers are being challenged to develop news ways for assessing the value of innovative cancer medicines.
•  There is little agreement about how much these drugs are really worth, and how governments should respond.  

Outline of Project: 

Summarising critical information about cancer medicines subsidised, or denied subsidisation, by the Pharmaceutical Benefits Scheme.

Focus: 

• Cancer.
• Access to medicines.
• Affordability/Reimbursement.
• Equity.
•  Influences on the R&D and drug development agenda.
•  Pharmaceutical policy.