Topik Kasus

Fenobarbital 1 GO is a 50-year-old, 75-kg (5 ft 10 in) male with tonic-

clonic seizures who requires therapy with oral
phenobarbital. He has normal liver and renal function.
Suggest an initial phenobarbital dosage regimen
designed to achieve a steady-state con- centration
equal to 20 g/mL.

Asumsi : interval 24 jam

2 GO is a 50-year-old, 75-kg (5 ft 10 in) male with tonic-

clonic seizures who requires therapy with intravenous
phenobarbital. He has normal liver and renal function.
Suggest an initial phenobarbital dosage regimen
designed to achieve a steady-state concentration equal
to 20 g/mL.

3 HI is a 42-year-old, 75-kg (5 ft 10 in) male with tonic-

clonic seizures who requires therapy with oral
phenobarbital. After dosage titration, the patient was
prescribed 120 mg daily of phenobarbital tablets for 1
month, and the steady-state phenobarbital
concentration equals 20 μg/mL. The patient is
assessed to be compliant with his dosage regimen.
Suggest a phenobarbital dosage regimen designed to
achieve a steadystate phenobarbital concentration of
30 μg/mL.

4 AS is a 9-year-old, 35-kg female (4 ft 6 in) with complex

partial seizures who requires therapy with oral
phenobarbital. She has normal liver and renal function.
Suggest an initial phenobarbital dosage regimen designed to
achieve a steady-state phenobarbital concentration equal to
20 μg/mL.
5 Patient AS (please see problem 3) was prescribed 30 mg twice
daily (60 mg/d) of phenobarbital elixir for 3 weeks, and the
steady-state phenobarbital concentration equals 8.3 μg/mL.
The patient is assessed to be compliant with her dosage
regimen. Suggest a phenobarbital dosage regimen designed to
achieve a steady-state phenobarbital concentration equal to
15 μg/mL.
Antibiotik 1 JM is a 50-year-old, 70-kg (5 ft 10 in) male with gram-negative
Aminoglikosida pneumonia. His current serum creatinine is 0.9 mg/dL, and it
has been stable over the last 5 days since admission. Compute
a gentamicin dose for this patient using conventional dosing.
2 JM is a 50-year-old, 70-kg (5 ft 10 in) male with gram-negative
pneumonia. His current serum creatinine is 0.9 mg/dL, and it
has been stable over the last 5 days since admission. Compute
 a gentamicin dose for this patient using conventional dosing.
(Same patient profile as in case 1), but serum creatinine is 3.5
mg/dL indicating renal impairment

3 ZW is a 35-year-old, 150-kg (5 ft 5 in) female with an

intraabdominal infection. Her current serum creatinine is 1.1
mg/dL and is stable. Compute a tobramycin dose for this
patient using conventional dosing.
Css max = 6 µg/ml
Css min = 0,5 µg/ml

4 JM is an 80-year-old, 80-kg (5 ft 8 in) male with

Streptococcus viridans endocarditis. His current serum
creatinine is 1.5 mg/dL, and it has been stable. Ampicillin and
gentamicin will be used to treat the infection. Compute a
gentamicin dose for this patient using conventional dosing.

5 JM is a 50-year-old, 70-kg (5 ft 10 in) male with gram-negative

pneumonia. His current serum creatinine is 0.9 mg/dL, and it
has been stable over the last 5 days since admission. A
gentamicin dose of 170 mg every 8 hours was prescribed and
expected to achieve steady-state peak and trough
concentrations equal to 9 μg/mL and 1 μg/mL, respectively.
After the third dose, steady-state peak and trough
concentrations were measured and were 12 μg/mL and 1.4
μg/mL, respectively. Calculate a new gentamicin dose that
would provide a steady-state peak of 9 μg/mL.

6 ZW is a 35-year-old, 150-kg (5 ft 5 in) female with an

intraabdominal infection. Her current serum creatinine is 1.1
mg/dL and is stable. A tobramycin dose of 165 mg every 8
hours was prescribed and expected to achieve steady-state
peak and trough concentrations equal to 6 μg/mL and 0.5
μg/mL, respectively. After the fifth dose, steady-state peak
and trough concentrations were measured and were 4 μg/mL
and <0.5 μg/mL (e.g., below assay limits), respectively.
Calculate a new tobramycin dose that would provide a steady-
state peak of 6 μg/mL.

Digoksin 1 MJ is a 50-year-old, 70-kg (5 ft 10 in) male with atrial

fibrillation for less than 24 hours. His current serum
creatinine is 0.9 mg/dL, and it has been stable over the last 5
days since admission. Compute an intravenous digoxin dose
for this patient to control ventricular rate.

2 MJ is a 50-year-old, 70-kg (5 ft 10 in) male with atrial

fibrillation for less than 24 hours. His current serum
creatinine is 0.9 mg/dL, and it has been stable over the last 5
days since admission. Compute an intravenous digoxin dose
 for this patient to control ventricular rate. (Same patient
profile as in case 1), but serum creatinine is 3.5 mg/dL
indicating renal impairment

3 Same patient profile as in example 1, but serum creatinine is

3.5 mg/dL indicating renal impairment. Additionally, the
patient is being treated for NYHA class III moderate heart
failure, not atrial fibrillation. Compute an oral digoxin tablet
maintenance dose for this patient.

4 4. MJ is a 50-year-old, 70-kg (5 ft 10 in) male with moderate

heart failure. His current serum creatinine is 0.9 mg/dL, and it
has been stable over the last 6 months. A digoxin dose of 250
μg/d using oral tablets was prescribed and expected to
achieve steady-state concentrations equal to 0.8 ng/mL. After
a week of treatment, a steady-state digoxin concentration was
measured and equalled 0.6 ng/mL. Calculate a new digoxin
dose that would provide a steady-state concentration of 0.9
ng/mL.
Fenitoin 1 JM is an epileptic patient being treated with phenytoin. He has
hypoalbuminemia (albumin = 2.2 g/dL) and normal renal
function (creatinine clearance = 90 mL/min). His total
phenytoin concentration is 7.5 μg/mL. Assuming that any
unbound concentrations performed by the clinical laboratory
will be conducted at 25°C, compute an estimated normalized
phenytoin concentration for this patient.
2 LM is an epileptic patient being treated with phenytoin. He
has hypoalbuminemia (albumin = 2.2 g/dL) and poor renal
function (creatinine clearance = 10 mL/min). His total
phenytoin concentration is 7.5 μg/mL. Compute an estimated
normalized phenytoin concentration for this patient.
3 TD is a 50-year-old, 75-kg (5 ft 10 in) male with simple partial
seizures who requires therapy with oral phenytoin capsule.
He has normal liver and renal function. Suggest an initial
phenytoin dosage regimen designed to achieve a steady-state
phenytoin concentration equal to 12 μg/mL.
4 UO is a 10-year-old, 40-kg male with simple partial seizures
who requires therapy with oral phenytoin (suspension). He
has normal liver and renal function. Suggest an initial
phenytoin dosage regimen designed to achieve a steady-state
phenytoin concentration equal to 12 μg/mL.

5 TD is a 50-year-old, 75-kg (5 ft 10 in) male with simple partial

seizures who requires therapy with intravenous phenytoin
sodium. He has normal liver and renal function. Suggest an
initial phenytoin dosage regimen (LD and MD) designed to
achieve a steady-state phenytoin concentration equal to 12
µg/mL.
6 TD is a 50-year-old, 75-kg (5 ft 10 in) male with simple partial
seizures who requires therapy with oral phenytoin. He has
normal liver and renal function. The patient was prescribed
400 mg/d of extended phenytoin sodium capsules for 1
month, and the steady-state phenytoin total concentration
equals 6.2 μg/mL. The patient is assessed to be compliant
with his dosage regimen. Suggest an initial phenytoin dosage
regimen designed to achieve a steady-state phenytoin
concentration within the therapeutic range.