Renal Pharmacokinetics Problem

Questions provided by Teresa Lewis, Pharm.D.

LD is a 23 year-old Native American male with weight 171 lbs and height 74 in, who has a history of hypertension, diabetes and chronic kidney disease. The serum creatinine (Scr) is 3.36 mg/dL. LD is hospitalized with multidrug-resistant Pseudomonas aeruginosa bacteremia. The team wishes to treat this patient with an investigational antibiotic, Drug P. Drug P possesses concentration dependent bactericidal activity. Normal dosing for Drug P is 8 mg/kg/dose intravenously (IV) every 24 hours. Fractional excretion of Drug P is 0.68

1. Using the Cockcroft-Gault formula, calculate the creatinine clearance for LD (round your answer to the nearest whole number).

2. Calculate the dosage adjustment factor for LD's level of renal dysfunction.

3. Estimate an appropriate dosage regimen for LD? (Round the dosing interval to the nearest 12 hours and the dose to the nearest 10 mg)

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Some Equations:

IBW equation (male)
Equation 27.3.1 IBW for Male Patients

IBW equation (female)
Equation 27.3.2 IBW for Female Patients

Creatine Clearance C-G Equation
Equation 27.3.3 Creatinine Clearance (Cockcroft-Gault Equation)

MDRD eGRD Equation
Equation 27.3.4 eGFR (MDRD Eqaution)

Dose Adjustment Factor
Equation 27.3.5 Dose Adjustment Factor

Adjusted Dosing Interval
Equation 27.3.6 Adjusted Dosing Interval

Adjusted Dose
Equation 27.3.7 Adjusted Dose

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