Pceut532_Exam4_2008 Blank

# Pceut532_Exam4_2008 Blank - PHARMACEUTICS 532 Winter 2008...

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Page 1 of 11 PHARMACEUTICS 532 Winter 2008 Midterm #4 March 19 th Name_______________________________________ Student #____________________________________

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Page 2 of 11 Questions Points Part I. 1 10 2 3 3 3 4 2 5 9 6 10 7 8 Part II. 50 Part III. 5 Total 100
Page 3 of 11 Part I (45 points total) 1. (10 pts) SL is a 25 year old Caucasian female, 85 kg, 5’4” recently diagnosed with bipolar disease. A decision is made to initiate lithium therapy. SL’s serum creatinine concentration is 1.0 mg/dl. Lithium is excreted unchanged by the kidneys and is 100% absorbed after oral dosing. Based on population data, we know the following relationship: Lithium Cl (ml/min) = 0.25 x CrCl (ml/min) Calculate a maintenance daily dose for SL to target a desired average lithium concentration of 0.8 mmol/L . Note: 8.12 mmol Lithium = 300 mg of lithium carbonate. 2. (3 pts) A patient arrives in the ICU with a diagnosis of new onset acute renal failure. In order to calculate the needed dose of vancomyin, you estimate his CrCl using his weight, age and serum creatinine using the Cockcroft-Gault equation. Would your estimate be correct, too high or too low? Explain why?

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Page 4 of 11 3. (3 pts) Morphine is an extensively metabolized high extraction ratio drug with a high first pass effect. Explain why you need to adjust the dose of morphine in a patient with renal disease. 4. (2 pts) The Cockcroft-Gault equation estimates creatinine clearance, while the MDRD equation estimates _______________________________. 5. (9 pts) Fill in the blanks with be increased ( ), decreased ( ), or the same (1 pt each) A. Compared to adult levels, albumin plasma concentrations are____________ in neonates and _________________in a 3 year old child. B. Compared to adult levels, the activity of CYP3A4 is ________________in a 3 year old child and __________________in the elderly. C. Compared to adult levels, the activity of CYP2C19 is ______________in neonates and ________________in children 3 years old. D. Compared to adult levels, the activity of UGT is ______________in neonates, ________________in children 3 years old and __________________in the elderly 6. (10 pts) For each of the drugs below indicate whether you would expect the intrinsic clearance (Cl int ) to be increased ( ), decreased( ), or not changed compared to healthy age and sex matched patient. CT is a 55 yo female with mild to moderate cirrhosis. LN is a 35 yo male with acute viral hepatitis. Drug Metabolic Pathway(s) CT: Mild/Moderate Cirrhosis LN: Acute Hepatitis Lorazepam UGT Omeprazole CYP2C19 Risperidone CYP2D6 Cyclosporine CYP3A4 S-warfarin CYP2C9
Page 5 of 11 7. (8 pts) Fill in the Blanks (1 pt each) A. _____________ is a metabolic enzyme with higher activity in males than females. B. _____________ is a metabolic enzyme with lower activity in males than females.

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Pceut532_Exam4_2008 Blank - PHARMACEUTICS 532 Winter 2008...

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