CPK Assignment dosage form PDF

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A firm estimates its long-run production function to be

Suppose the firm employs 15 units of capital....

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CPK ASSIGNMENT

2) a) Patient Details     

Name : PQR Age : 60 y/s Weight : 56 kg Serum albumin of 2.9 g/dL ( Normal : 3.4 to 5.4 g/dl ) Steady-state plasma phenytoin concentration is 4.2 mg/L.

According to the data that we have, we can conclude that Patient PGQ is a hypoalbuminemia. Hence in order to calculate the top up dose, for patients with hypoalbuminemia the corrected phenytoin concentration must be calculated in order to estimate the top-up dose (3) (5) Corrected Phenytoin Calculation : Corrected Phenytoin = Phenytoin Conc (mg/L) / [0.9 x (Serum Albumin (g/L)/44) +0.1] (1) = 4.2 / [ 0.9 ( 29/44) + 0.1] = 6.1 mg/L

Cp desired: Therapeutic range of phenytoin = 10-20 mg/L, Therefore, Cp desired of 15 mg/L is taken (1) Cp measured = 6.1 mg/L

Top-up Dose Calculation: Increment Dose = [(Cp desired- Cp measured) x Vd x BW] / (S X F) (1) = [(15-6.1) x 0.65 x 56] / 0.92 x 1 = 352 mg » 350 mg Suggest to give incremental loading dose of oral Phenytoin 350mg .By increasing the dose, the concentration of phenytoin will be reached at 15mg/l which is clinically effective serum level.

b) Because of its limited therapeutic value, the dose of phenytoin should be increased with caution only the unbound form of phenytoin is pharmacologically active because it is 90% plasma bound to plasma proteins .A higher proportion of unbound drug is present in patients with decreased protein binding capacity may exhibit toxicity symptoms despite having normal total phenytoin levels. The therapeutic index of phenytoin is narrow. (4)

3) a) The threshold for liver toxicity is max dose of 250mg/5ml. In this case, the patient is 30 kg, so for the strength of (250mg/5ml), the max dose will be 450mg (9ml). Above this dose will lead to hepatotoxicity (3)

b) The patient ingested 150mL of Paracetamol (1 and ½ bottle = 100mL + 50mL) Dose per 5mL = 250mg Dose per 150mL = 7500mg (convert to g) = 7.5g Therefore, the patient has ingested 7.5g of Paracetamol.

c) The patient is at risk of hepatotoxicity. This can be concluded from the ALT results of the

patient, which the ALT value is higher than the normal range, which indicated that liver is damaged due to overdose of Paracetamol. The patient also has ingested more dose than the maximum dose per day which is 4g/day. (1) (2)

d) Based on the Rumack-Matthey nomogram, NAC infusion is required for the patient. The paracetamol plasma concentration marked above the solid line. The concentration of paracetamol was 1 (189 mg/dL) and hours after ingestion was 5 hours. The NAC infusion should be

initiated immediately for the patient (4)

Question 2 referennces 1. [Internet]. Pharmacy.gov.my. 2021 [cited 16 June 2021]. Available from: https://www.pharmacy.gov.my/v2/sites/default/files/document-upload/clinicalpharmacokinetics-pharmacy-handbook-ccph-2nd-edition-rev-2.0.pdf 2. Wu M, Lim W. Phenytoin: A Guide to Therapeutic Drug Monitoring. Proceedings of Singapore Healthcare. 2013;22(3):198-202. 3. Albumin - blood (serum) test Information | Mount Sinai - New York [Internet]. Mount Sinai Health System. 2021 [cited 16 June 2021]. Available from: https://www.mountsinai.org/healthlibrary/tests/albumin-blood-serum-test 4. Iorga A, Horowitz B. Phenytoin Toxicity [Internet]. Ncbi.nlm.nih.gov. 2021 [cited 16 June 2021]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482444/

5. Phenytoin (Dilantin) Correction for Albumin / Renal Failure - MDCalc [Internet]. Mdcalc.com. 2021 [cited 16 June 2021]. Available from: https://www.mdcalc.com/phenytoindilantin-correction-albumin-renal-failure

Question 3 Reference 1. Tests M. ALT Blood Test: MedlinePlus Medical Test [Internet]. Medlineplus.gov. 2021 [cited 16 June 2021]. Available from: https://medlineplus.gov/lab-tests/alt-blood-test/ 2. Site designed and developed bka interactive ltd N. Paracetamol - children | Health Navigator NZ [Internet]. Health Navigator New Zealand. 2021 [cited 16 June 2021]. Available from: https://www.healthnavigator.org.nz/medicines/p/paracetamol-children/ 3. Paracetamol dosing for children in primary care - bpacnz [Internet]. Bpac.org.nz. 2021 [cited 16 June 2021]. Available from: https://bpac.org.nz/2018/paracetamol.aspx

4 .Rumack-Matthew Nomogram [Internet]. Emedsa.org.au. 2021 [cited 16 June 2021]. Available from: http://emedsa.org.au/EDHandbook/toxicology/Paracetamol/rumack_nomogram.htm...