Canadian Pharmacist Qualifying Exam Practice · Question
A 72-year-old female weighing 60 kg presents a prescription for 'gentamicin 120 mg IV Q24H'. Her current SCr is 150 µmol/L and she has a history of congestive heart failure. What is the most appropriate action for the pharmacist?
Gentamicin is primarily renally eliminated, and a dose of 120 mg daily may be too high for an elderly patient with impaired renal function, increasing the risk
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Question: A 72-year-old female weighing 60 kg presents a prescription for 'gentamicin 120 mg IV Q24H'. Her current SCr is 150 µmol/L and she has a history of congestive heart failure. What is the most appropriate action for the pharmacist?
Answer options: ✅ Calculate the patient's creatinine clearance and recommend a dose adjustment to the prescriber.
- Dispense the gentamicin 120 mg IV Q24H as prescribed, as this is a standard dose.
- Recommend to the prescriber to switch to a different antibiotic due to the patient's age and comorbidities.
- Advise the patient that she will need to be admitted to hospital for IV gentamicin administration.
Correct answer: Calculate the patient's creatinine clearance and recommend a dose adjustment to the prescriber.
Explanation: Gentamicin is primarily renally eliminated, and a dose of 120 mg daily may be too high for an elderly patient with impaired renal function, increasing the risk of nephrotoxicity and ototoxicity. The pharmacist should calculate the patient's creatinine clearance and suggest an appropriate dose and/or frequency adjustment.
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