Phenytoin questions

1. DF is a 23-year-old, 85-kg (6 ft 1 in) male with tonic-clonic seizures who requires therapy with
oral phenytoin. He has normal liver and renal function (bilirubin = 1.0 mg/dL, albumin = 4.9
g/dL, serum creatinine = 0.7 mg/dL). Suggest an initial extended phenytoin sodium capsule
dosage regimen designed to achieve a steady state phenytoin concentration equal to 10 μg/mL.
2. Patient DF (please see problem 1) was prescribed extended phenytoin sodium cap sules 500 mg/d
orally. The current steady-state phenytoin concentration equals 23.5 μg/mL. Compute a new oral
phenytoin dose that will provide a steady-state concentration of 15 μg/mL.
3. TR is a 56-year-old, 70-kg (5 ft 9 in) male with complex partial seizures who requires therapy
with oral phenytoin. He has normal liver and renal function (biliru bin = 0.8 mg/dL, albumin =
4.4 g/dL, serum creatinine = 0.9 mg/dL). Suggest an ini tial phenytoin suspension dosage regimen
designed to achieve a steady-state pheny toin concentration equal to 15 μg/mL.
4. Patient TR (please see problem 3) was prescribed phenytoin suspension 200 mg orally every 12
hours. The current steady-state phenytoin concentration equals 8 μg/mL. Compute a new oral
phenytoin dose that will provide a steady-state concentration of 15 μg/mL.
5. PL is a 64-year-old, 60-kg (5 ft 2 in) female with simple partial seizures who requires therapy
with intravenous fosphenytoin. She has normal liver and renal function (bilirubin = 0.8 mg/dL,
albumin = 3.6 g/dL, serum creatinine = 1.2 mg/dL). Suggest an initial intravenous fosphenytoin
regimen designed to achieve a steady-state phenytoin concentration equal to 12 μg/mL.
6. Patient PL (please see problem 5) was prescribed intravenous fosphenytoin injection 200 mg/d
PE. A phenytoin serum concentration was obtained just before the fourth dose of this regimen
and equaled 4.1 μg/mL. Assuming the phenytoin concentration was zero before the first dose,
compute a new intravenous fosphenytoin injection that will provide a steady-state concentration
of 12 μg/mL.
7. MN is a 24-year-old, 55-kg (5 ft 5 in) female with complex partial seizures who requires therapy
with intravenous phenytoin sodium. She has normal liver and renal function (bilirubin = 0.8
mg/dL, albumin = 3.6 g/dL, serum creatinine = 1.2 mg/dL). Suggest an initial intravenous
phenytoin sodium dosage regimen designed to achieve a steady-state phenytoin concentration
equal to 12 μg/mL.
8. Patient MN (please see problem 7) was prescribed intravenous phenytoin sodium injection 300
mg/d. A phenytoin serum concentration was obtained at steady state and equaled 6.4 μg/mL. The
dose was increased to intravenous phenytoin sodium injection 400 mg/d and the measured steady
state concentration equaled 10.7 μg/mL. Compute a new intravenous phenytoin sodium injection
dose that will provide a steady-state concentration of 15 μg/mL.
9. SA is a 62-year-old, 130-kg (5 ft 11 in) male with complex partial seizures who requires therapy
with oral phenytoin. He has normal liver and renal function (bilirubin = 0.6 mg/dL, albumin =
3.9 g/dL, serum creatinine = 1.0 mg/dL). Suggest an initial extended phenytoin sodium capsule
dosage regimen designed to achieve a steady-state concentration equal to 10 μg/mL.
10. Patient SA (please see problem 9) was prescribed extended phenytoin sodium cap sules 200 mg
orally every 12 hours. A phenytoin serum concentration was obtained at steady state equaled 6.2
μg/mL. The dose was increased to extended phenytoin sodium capsules 300 mg orally every 12
 hours, and the measured steady-state con centration equaled 25.7 μg/mL. Compute a new oral
phenytoin dose that will provide a steady-state concentration of 15 μg/mL.
11. VG is an epileptic patient being treated with phenytoin. He has hypoalbuminemia (albumin = 2.4
g/dL) and normal renal function (creatinine clearance = 90 mL/min). His total phenytoin
concentration is 8.9 μg/mL. Assuming that any unbound concen trations performed by the clinical
laboratory will be conducted at 25°C, compute an estimated normalized phenytoin concentration
for this patient.
12. DE is an epileptic patient being treated with phenytoin. He has hypoalbuminemia (albumin = 2.0
g/dL) and poor renal function (creatinine clearance = 10 mL/min). His total phenytoin
concentration is 8.1 μg/mL. Compute an estimated normalized phenytoin concentration for this
patient.
528 10 / PHENYTOIN

13. KL is an epileptic patient being treated with phenytoin and valproic acid. He has a normal albumin
concentration (albumin = 4.0 g/dL) and normal renal function (crea tinine clearance = 95 mL/min).
His steady-state total phenytoin and valproic acid concentrations are 6 μg/mL and 90 μg/mL,
respectively. Compute an estimated unbound phenytoin concentration for this patient.
14. YS is a 9-year-old, 35-kg female with complex partial seizures who requires therapy with oral
phenytoin. She has normal liver and renal function. Suggest an initial phenytoin dosage regimen
designed to achieve a steady-state phenytoin concentra tion equal to 12 μg/mL.
15. Patient YS (please see problem 14) was prescribed phenytoin suspension 150 mg orally every 12
hours. The current steady-state phenytoin concentration equals 23 μg/mL. Compute a new oral
phenytoin dose that will provide a steady-state concentration of 15 μg/mL.