PHA 128 Spring 2000 Final Exam On my honor, I have neither given nor received unauthorized aid in doing this assignment. Name TYPED KEY Questions Points 1. /1 2. /1 3. /1 4. /1. /10 6. /10. /10 8. /10 Total /100 1
1. M.N., a 4-year-old, 60 kg female with a serum creatinine of 9 mg/dl is to be given tobramycin. (1 points) a) alculate a maintenance dose which will produce a peak concentration of 8 mg/l one hour after the infusion has been started, and a trough concentration at the end of the dosing interval of 1 mg/l. Assume that tobramycin will be administered as a one-half hour infusion. ( 140 4) 60 L cr 4. ml / min 4. L / h 8 9 V d 2 60 1L k 4. 1 3h 1 τ ln8 + 1. 9h 8h 3 8 max 9. 3µ 0. 3 0 e. 3 8 3 0 D. 3 3 1. 9 91 2 93 136 140mg 14 b) If M.N. was to be given tobramycin mg/kg QD, what would be the calculated steady-state peak concentration one hour after starting the half-hour infusion? Also predict subsequent steady-state plasma concentrations 12 hours after starting the infusion and at the trough. D 60 300 3 0 3 24 300 14 max 133. 3 18. 9µ 4. 99. * 3 max 18. 9 e 16. 3µ 311. h 18. 9 e 6µ 12 18. 9 e 02 3 23. 24 h µ 2
2. Z.., a kg, 34-year-old patient with a serum creatinine of 1.6 mg/dl has been receiving IV tobramycin, 100 mg over one half-hour Q 8 hr, for several days. A peak plasma concentration obtained one hour after the start of the infusion was 8 mg/l, and a trough concentration obtained just before the initiation of a dose was 3.0 mg/l. Estimate the apparent elimination rate constant, clearance and volume of distribution for tobramycin in Z.. Also, calculate a dosing regimen for Z.. that will achieve a peak concentration of mg/l and trough concentrations of approximately 1 mg/l. (1 points) 8 ln 3 1 k 14h V d 2 18.8 L L 14 18.8 2.6 L/h τ ln + 1 14. 9h 12h 14 max. 0. 14 e 1412 14 0 D. 14 18. 8. Better: 14 14 0 ( 8 3 100 d 18. 6L 14 V. 81 9. 9 11 120mg 0 3
3. A.K., a 64-year-old, 3 kg female, was admitted to the hospital for possible digoxin toxicity. Her serum creatinine was 3.4 mg/dl and her dosing regimen at home had been 2 mg of digoxin daily for many months. The digoxin plasma concentration on admission was reported to be 3. ng/ml. If no more doses are given how long will it take for the digoxin concentration to fall from 3. to 2.0 ng/ml? alculate the daily dose which will maintain A.K. s average digoxin plasma concentration at 1. ng/ml. (1 points) F D 2 L 2. 1L / h τ 3. 24 ( 140 64) 3 L cr 13. 9mL / min 84L / h 8 3. 4 estimated L 33 3 + 9 13.9 1. + 12. 30 ml/min 1.8 L/h (with HF) or V d 3.8 3 + 3.1 13.9 201.4 + 43.1 244. L k 2. 1 1 L 0086h V 24 d (003 h -1 ) 3. ln 2 t 6h ( h) 0086 D L 24 F 1. 2. 1 4. D 4. 24 108 µg 100 µg (93 µg) 4
4. R.S., a 6-year-old, 68-kg male (Ser 1.3 mg/dl) is to receive a course of methotrexate therapy. His regimen will consist of a 30 mg methotrexate loading dose to be administered over 10 minutes, followed by an IV infusion of 30 mg/hr for the next 36 hours. He will then receive a 20 mg dose of leucovorin every six hours intravenously for the first four doses followed by eight doses orally at sixhour intervals. The leucovorin regimen will begin immediately after the 36-hour methotrexate infusion has been discontinued and is scheduled to continue for the next 2 hours, ending 108 hours after initiation of the methotrexate therapy. Methotrexate levels are scheduled to be obtained 24 hours after the beginning of the 30 mg/hr infusion, at 48 hours (12 hours after the end of the 36-hour infusion), and at 60 hours (24 hours after the end of the methotrexate infusion). alculate the anticipated methotrexate concentrations at the scheduled sampling times. (1 points) ( 140 6) L 68 4. ml / min cr 2 1. 3 L MTX 1.6 4. 8.2 ml/min.2 L/h 30 24. 8mg / L 12. 8µ M. 2 23112 48 12. 8 e Time for µ M: 8µ M 12. 8 ln t 14h after end of infusion 0 231 60 e -0693 10 2 µm
. P.T., a 3-yea-old, 4 kg male, had been taking 300 mg/day of phenytoin; however, his dose was increased to 30 mg/day because his seizures were poorly controlled and because his plasma concentration was only mg/l. Now he complains of minor NS side effects and his reported plasma phenytoin concentration is 22 mg/l. Renal and hepatic function are normal. Assume that both of the reported plasma concentrations represent steady state levels and that P.T. has complied with the prescribed dosing regimens. alculate P.T. s apparent Vm and Km and a new daily dose of phenytoin that will result in a steady-state level of about 1 mg/l. (10 points) Km 300 Vm 300 Km 30 22 Vm 30 Vm 2100 Km 300 22Vm - 00 Km 30 300 Vm 1 039 Vm Vm 380 mg Km 1.9 µg/ml 22 Vm 22 30 D 380 1 mg 1. 9 + 1 33 6
6. A.R., a 62-year-old, 6 kg male, was admitted with a diagnosis of hepatic encephalopathy and cirrhosis. On the fourth hospital day, he developed ventricular arrhythmias and lidocaine was ordered. alculate a bolus dose (be specific) and a maintenance infusion rate that will achieve a steady-state lidocaine level of 3 mg/l. (10 points) Vc 6 6 39 L LD 3 39 134mg mg 8 140 additional LD of 0 mg after 20 and 40 min 3 36 6 MD 81mg / h 80mg / h 8. S.R., a 0 kg, 40-year-old male, has been receiving an IV aminophylline infusion at a rate of 3 mg aminophylline/hr. At the beginning of the therapy, an IV loading bolus dose of 0 mg has been administered. The reported plasma theophylline concentrations at 1 hr and 8 hr after the start of the infusion are 19 and 1 mg/l. alculate the expected steady-state theophylline concentration in this patient. Is a dosing adjustment needed? (10 points) L 2 3 8 2 + ( 19 + 1) 0 ( 19 1) ( 19 + 1) ( 8 1) 1. + 1.18 2.93 L/h 3 8 1 2µ 2. 93 To increase dose for 1 0 mg/h 8. Explain why digoxin has a much longer half-life than gentamicin. (10 points) Digoxin has a much larger volume of distribution (-8 L/kg vs 2 L/kg)