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1.2.12: Develop and implement individualized treatment plans, taking into consideration pharmacokinetic data to determine equivalence among drug products

A patient presents to the hospital with symptoms concerning for a bowel obstruction. His past medical history is significant for a liver transplant 3 months ago and he is receiving Myfortic 720 mg po bid. The physician wants to convert the patient from oral Myfortic to IV due to po intolerance resulting from his bowel obstruction. Which of the following would result in comparable plasma concentrations of mycophenolic acid?

(A) Mycophenolate sodium 720 mg IV bid

(B) Mycophenolate sodium 1000 mg IV bid

(C) Mycophenolate mofetil 720 mg IV bid

(D) Mycophenolate mofetil 1000 mg IV bid

The correct answer is (D).

CellCept, or mycophenolate mofetil, is available in an oral and IV formulation. When converting a patient from po Myfortic (mycophenolate sodium) to IV therapy, IV mycophenolate mofetil (CellCept) can be used at a therapeutically equivalent dose. Myfortic 720 mg is equivalent to 1000 mg of CellCept.

Answers a and b are incorrect. Myfortic, or mycophenolate sodium, is an enteric-coated delayed-release oral formulation and it is not available intravenously.

Choice (C) is incorrect. The dosing conversion between mycophenolate sodium and mycophenolate mofetil (CellCept) is not 1:1, but rather 720 mg of mycophenolate sodium is equivalent to 1000 mg of mycophenolate mofetil.

Select the cephalosporin that may be used in the treatment of acute otitis media that has a bitter tasting suspension and has differing bioavailability rates depending upon the oral formulation used.

(A) Ceftin

(B) Vantin

(C) Zithromax

(D) Cleocin

The correct answer is (A).

Cefuroxime axetil (Ceftin) is available in tablets and suspension formulations. The tablet and suspensions are not interchangeable because of differing bioavailability rates. Cefuroxime suspension is gritty and bitter tasting. Cefuroxime is also available as an injection, but the parenteral formulation is seldom used.

Answer (B) is incorrect. Cefpodoxime (Vantin) has a bitter tasting suspension, but the tablets and suspension have similar bioavailability rates.

Answer (C) is incorrect. Azithromycin (Zithromax) is available as a suspension, tablet and injection; however, the formulations have similar bioavailability rates and the suspension is not bitter tasting.

Answer (D) is incorrect. Clindamycin (Cleocin) has a poor tasting oral liquid, but the capsules and liquid are interchangeable.

Select the cephalosporin that may be used in the treatment of acute otitis media that has a bitter tasting suspension and has differing bioavailability rates depending upon the ...

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