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Comprehensive Sampling Manual: GSH Pharmacology Division of Pharmacology, GSH Old Main Building Please note that GSH Pharmacology is not affiliated with the NHLS, and remains a Within Groote Schuur Hospital: All specimens may be transported to the laboratory via the specimen depot. Transport times may vary and can be unreliable if the specimen is sent off after hours. Red Cross Children’s Hospital: Transport occurs three times a day via the NHLS sendaway laboratory. Specimens via NHLS Chemical Pathology arrive at the Pharmacology laboratory at 09h30, 12h00 and 15h00 on a daily basis. After hours service: All specimens arriving at the specimen depot after 19h00 will not be sent onto Pharmacology. The requesting doctor will be contacted to enquire whether the request is urgent. If urgent, private transport is requested by the doctor and arranged to drive the specimens over to Tygerberg Pharmacology. Non-urgent requests will be held over until the following day. Request form completion: No test will be carried out on a specimen without a written, signed request from a medical practitioner. All request forms MUST display the following information: o Patient Name o Test requested o Location o Requesting Doctor Exceptions to this may include Emergency Unit and Trauma Unit, where the patient’s name may be unknown. Specimen tube labeling: Requested tests will not be conducted if the name on the tube label does not match the name on the request form label. Request Form: GSH/UCT Pharmacology Request Form Availability: Samples are accepted by the specimen depot 24 hours per day, but the hours of the laboratory (K50.30) are from 08h30 – 19h00 (weekdays) and 09h00 – 13h30 (weekends and public holidays). Urgent specimens (by direct consultation with the requesting doctor only) are forwarded to Tygerberg Hospital for analysis. Comprehensive Sampling Manual: GSH Pharmacology Routine venipuncture; draw samples at least four hours after drug ingestion and again at 12 hours if indicated. Send immediately if you suspect a large dose and are not Storage Instructions: Whole blood may be stored at room temperature for short period of time. Centrifuge the specimen to separate serum from red cells within 4 hours of collection and Causes for Rejection: Wrong sampling tube. Turnaround Time: Routine: 24 hours; STAT: 1 hour from specimen receipt Reference Ranges: Therapeutic Range: 10-30 µg/mL. Critical Values: Potential Toxicity: >200 µg/mL at 4 hours, >100µg/ml at 8 hours and > 50 µg/mL at 12 hours post ingestion. Amikacin Peak: AMIP Amikacin Trough: AMIT Routine venipuncture. Draw trough levels immediately before dose; peak levels 0.5 to 1.0 hour after the end of a 30 to 60 minute infusion or one hour after IM dose. Storage Instructions: Serum and blood samples should be refrigerated as soon as possible. If analysis is delayed more than 8 hours, the serum or plasma must be stored frozen (-20°C). Turnaround Time: Routine: 24 hours; STAT: 1 hour from specimen receipt. Special Instructions: If sample is obtained through the infusion set, flush the line thoroughly with saline before taking the blood sample. Reference Ranges: Therapeutic Range: Peak >30 µg/mL; Trough Range, <10 µg/mL (8 hours); < 4 µg/ml (12 hours); < 1 µg/ml (24 hours) Potential Toxicity: Peak, >35 µg/mL; Trough, >10 µg/mL. Apparent accumulation after 24 hours (i.e. Trough > 1 Comprehensive Sampling Manual: GSH Pharmacology Routine venipuncture; draw trough levels immediately before Storage Instructions: Samples must be centrifuged within 4 hours of collection. Causes for Rejection: Improper collection, incorrect sample container, incomplete requisition or improperly labeled sample. Turnaround Time: Routine: 24 hours; STAT: 1 hour from specimen receipt. Specimen: Reference Ranges: Therapeutic Range: 15 - 45 nmol/L. Patients receiving carbamazepine together with other antiepileptic drugs may exhibit a therapeutic response between 7.5 - 15 nmol/L. Potential toxicity: 95 nmol/L. Toxicity for patients receiving carbamazepine concurrently with other antiepileptic drugs Routine venipuncture. Collect trough level 12-18 hours after oral dose for chronic usage, 12 hours after intravenous dose or immediately prior to next dose.C2 levels are collected 2 hours Store at room temperature, do not centrifuge. Causes for Rejection: Improper collection, incorrect sample container, clotted sample, incomplete requisition or improperly labeled sample Turnaround Time: Routine: 24 hours from specimen receipt. Specimen: Comprehensive Sampling Manual: GSH Pharmacology Urine (Qual): Amphetamines , Cocaine, Opiates, Benzodiazepines, Cannabinoids, Barbiturates Storage Instructions: Refrigerate Turnaround Time: Routine: 24 hours; STAT: 1 hour from specimen receipt. Special Instructions: Indicate suspected drug(s) if possible. All screens will be rationalized by the consultant on call after consultation with the Reference Ranges: Negative or positive Critical Values: Urine levels are time and clearance dependent and are not directly related to toxic symptoms seen clinically. Cut off limits: AMPH > 300 ng/ml = Positive Routine venipuncture; blood samples must be drawn 6-8 hours Storage Instructions: Store blood at 4-8C. Centrifuge the specimen and remove the serum from the red cells within 4 hours of collection. Store Causes for Rejection: Improper collection, incorrect sample container, incomplete requisition or improperly labeled sample Turnaround Time: Routine: 24 hours; STAT: 1 hour from specimen receipt. Specimen: Reference Ranges: Therapeutic Range: 1 – 2.5 nmol/L Critical Values: Potential Toxicity: > 2.6 nmol/L. Potential for toxicity in the Comprehensive Sampling Manual: GSH Pharmacology Ethyl Alcohol, Blood Alcohol, ETOH, Alcohol Routine venipuncture. Cleaning of puncture site should be performed with a non-alcoholic solution. Arterial, venous, or capillary whole blood properly collected in a closed system is the Storage Instructions: Centrifuge the specimen to separate the serum from the red cells and refrigerate. Do not open the tube. Blood stored without NaF is stable at room temperature (25°C) for 48 hours or refrigerated (5°C) for about two weeks. Turnaround Time: Routine: 24 hours; STAT: 1 hour from specimen receipt. Specimen: Minimum Volume: 1 mL plasma or serum Container: Blood concentrations above 11 mmol/L (0.05 g%) are past the GENTAMICIN, serum Gentamicin Trough: GENT Gentamicin Peak: GENP Collection: Routine venipuncture. Peak Levels: Collect blood 0.5 to 1.0 hour after the end of a 30-minute infusion or one hour after IM dose; Trough Levels: Draw immediately before dosing. Storage Instructions: Refrigerated (2-8C) as soon as possible. Centrifuge the specimen, remove the serum from the red cells and refrigerate. Causes for Rejection: Improper collection, incorrect sample container, incomplete requisition or improperly labeled sample. Turnaround Time: Routine: 24 hours; STAT: 1 hour from specimen receipt. Special Instructions: If the sample is obtained through the infusion line, flush the line thoroughly with saline before taking the blood sample. Reference Ranges: Therapeutic: Peak > 8µg/mL; Trough < 5 µg/mL (8 hours), <2.5 µg/ml (12 hours) and < 1 µg/ml (24 hours). Potential Toxicity: Peak >10 µg/mL; Trough >5 µg/mL. Potential for accumulation after 24 hours (i.e. Trough > 1 µg.ml). Comprehensive Sampling Manual: GSH Pharmacology Routine venepuncture. For Trough level, collect the sample Storage Instructions: Store at room temperature. Centrifuge the specimen to separate serum from red cells within 4 hours of collection and refrigerate Causes for Rejection: Improper collection, incorrect sample container, incomplete requisition or improperly labeled sample. Turnaround Time: Routine: 24 hours; STAT: 1 hour from specimen receipt. Specimen: Reference Ranges: Therapeutic Range: 45 - 130 µmol/L. Critical Values: Routine venepuncture. For trough level, collect immediately Storage Instructions: Store at room temperature or 2-8°C. Centrifuge the specimen to separate the serum from red cells within 4 hours of collection; Causes for Rejection: Improper collection, incorrect sample container, incomplete requisition or improperly labeled sample. Turnaround Time: Routine: 24 hours; STAT: 1 hour from specimen receipt. Specimen: Reference Ranges: Therapeutic Range: 40-100 µmol/L Critical Values: Comprehensive Sampling Manual: GSH Pharmacology Acetylsalicylic Acid, ASA, Aspirin, Salicylic Acid Storage Instructions: Centrifuge the specimen to separate the serum from red cells; Causes for Rejection: Improper collection, incorrect sample container, incomplete requisition or improperly labeled sample. Turnaround Time: Routine: 24 hours; STAT: 1 hour from specimen receipt. Specimen: Reference Ranges: Therapeutic Range: 0.7 – 2.2 mmol/L Critical Values: > 2.2 mmol/L is associated with toxicity Routine venepuncture. Collect trough level 12-18 hours after oral dose for chronic usage, 12 hours after intravenous dose or Store at room temperature, do not centrifuge. If transport is delayed over 24 hours, please freeze specimen at -20°C for delivery. All samples will be frozen at -20 °C if not assayed on Causes for Rejection: Improper collection, incorrect sample container, clotted sample, incomplete requisition or improperly labeled sample Turnaround Time: Assays are performed twice a week, on Tuesday and Fridays. Results are available by the end of the day. Repeat requests are Special instructions: All specimens must be received by the testing lab before 10h00 on Tuesday and Friday, to be included in the run for that day. Specimens arriving later than 10h00 will be held over until the Reference Ranges: 4-12 ng/ml Critical Values: < Therapeutic range, risk of rejection Comprehensive Sampling Manual: GSH Pharmacology Routine venipuncture. Collect trough level 12-18 hours after oral dose for chronic usage, 12 hours after intravenous dose or Store at room temperature, do not centrifuge. Causes for Rejection: Improper collection, incorrect sample container, clotted sample, incomplete requisition or improperly labeled sample Turnaround Time: Routine: 24 hours. Specimen: < Therapeutic range, risk of rejection Routine venepuncture. The usual sampling times for intravenous dosing are: Trough - prior to intravenous infusion; Peak - 30 minutes after completion of leading dose; or at timed intervals to evaluate therapy. For oral dosing, the usual sampling times are: Peak - 2 hours after rapid release product or 4 hours after sustained release product; Trough - immediately before next Storage Instructions: Centrifuge the specimen to separate serum from cells within 2 hours of collection. Refrigerate at 2-8°C. Causes for Rejection: Improper collection, incorrect sample container, incomplete requisition or improperly labeled sample. Turnaround Time: Routine: 24 hours; STAT: 1 hour from specimen receipt. Specimen: Reference Ranges: Therapeutic: 55-110 µmol/L Critical Values: Comprehensive Sampling Manual: GSH Pharmacology Tobramycin Trough: TOBT Tobramycin Peak: TOBP Routine venipuncture. Peak: Collect 0.5-1.0 hours after the end of a 30-minute infusion or 1 hour after IM dose. Trough levels are Storage Instructions: Refrigerate at 2-8C. Centrifuge the specimen, remove the serum from the red cells; refrigerate the serum. Causes for Rejection: Improper collection, incorrect sample container, incomplete requisition or improperly labeled sample. Turnaround Time: Routine: 24 hours; STAT: 1 hour from specimen receipt. Special Instructions: If the sample is obtained through the infusion set, flush the line thoroughly with saline before taking the blood sample. Indicate additional antibiotic therapy on the request slip. Reference Ranges: Therapeutic Range: Peak range, 8-10 µg/mL; Trough range, 0.5- Potential Toxicity: Peak, levels > 10 µg/mL and trough, levels > 2 Storage Instructions: Centrifuge the specimen, remove the serum from red cells and Causes for Rejection: Improper collection, incorrect sample container, incomplete requisition or improperly labeled sample. Turnaround Time: Routine: 24 hours; STAT: 1 hour from specimen receipt. Specimen: Reference Ranges: 100 – 400 ng/ml Critical Values: Tricyclic Antidepressants >400 ng/mL may be toxic. Comprehensive Sampling Manual: GSH Pharmacology Routine venepuncture. Collect sample immediately prior to next Storage Instructions: Store at room temperature or at 2-8°C. Centrifuge the specimen to separate serum from the red cells within 4 hours. Causes for Rejection: Improper collection, incorrect sample container, incomplete requisition or improperly labeled sample. Turnaround Time: Routine: 24 hours; STAT: 1 hour from specimen receipt. Specimen: Reference Ranges: Therapeutic Range: 350 - 700 µmol/L Critical Values: Routine venipuncture. Draw trough levels immediately before Storage Instructions: Serum and blood samples should be refrigerated as soon as possible. If analysis is delayed more than 8 hours, centrifuge the specimen, remove the serum and freeze the serum (-20C). Turnaround Time: Routine: 24 hours; STAT: 1 hour from specimen receipt. Special Instructions: If sample is obtained through the infusion set, flush the line thoroughly with saline before taking the blood sample. Request form must contain date and time of collection and time of last Causes for Rejection: Improper collection, incorrect sample container, incomplete requisition or improperly labeled sample. Reference Ranges: Therapeutic Range: Trough >10 µg/mL. With renal failure, levels must be checked to decide when to dose next. Levels are used to decide when to dose next. The risk of toxicity

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