Parenteral Medications Practice Test

A 67-year-old man (weight 82 kg) is admitted for fever, productive cough, and hypoxia and is diagnosed with community-acquired pneumonia requiring IV antibiotics. Past medical history includes chronic kidney disease stage 4 and hypertension; allergies: penicillin (anaphylaxis). Current medications: amlodipine 10 mg PO daily, furosemide 40 mg PO daily. Labs: serum creatinine 2.8 mg/dL, potassium 4.2 mEq/L, AST/ALT within normal limits; estimated creatinine clearance (Cockcroft-Gault) is 22 mL/min. The team orders levofloxacin 750 mg IV every 24 hours. What dose adjustment is needed for this patient's renal function?

A 45-year-old man (weight 90 kg, height 178 cm) with Crohn disease has been unable to tolerate enteral nutrition for 7 days due to high-output ileostomy and is started on total parenteral nutrition (TPN) via a double-lumen PICC. Past medical history includes malnutrition; allergies: none. Current medications: pantoprazole 40 mg IV daily, hydromorphone PCA. Labs: sodium 138 mEq/L, potassium 3.1 mEq/L (low), magnesium 1.4 mg/dL (low), phosphate 2.2 mg/dL (low), serum creatinine 0.9 mg/dL, AST/ALT within normal limits, glucose 168 mg/dL. The TPN order is being finalized. Which action should the pharmacist take to ensure safety?