Secondary And Tertiary Resources Practice Test

A 77-year-old woman (weight 50 kg) is started on vancomycin for suspected methicillin-resistant Staphylococcus aureus pneumonia. Current medications: piperacillin-tazobactam 3.375 g IV every 6 hours, furosemide 20 mg PO daily, and sertraline 50 mg PO daily. Allergies: none. Labs: serum creatinine 1.9 mg/dL (high), estimated creatinine clearance 22 mL/min; albumin 2.8 g/dL (low; ref 3.5–5.0). Using tertiary pharmacokinetic dosing references and current consensus guidance for AUC-based monitoring, what initial vancomycin regimen is most appropriate to start before levels are available?

A 29-year-old woman (weight 64 kg) with epilepsy is 10 weeks pregnant and reports increasing seizure frequency after her obstetrician started folic acid 1 mg PO daily. Current medications: lamotrigine 200 mg PO twice daily, prenatal vitamin daily. Allergies: none. Labs: serum creatinine 0.7 mg/dL; AST/ALT normal; lamotrigine trough concentration last month 4 mcg/mL (previously stable at 8–10 mcg/mL). Which source provides the best evidence to guide dosing adjustment and monitoring of lamotrigine during pregnancy (pharmacokinetic changes and therapeutic drug monitoring targets)?