ID pharm cases Flashcards
(50 cards)
case 1: 55 y/o with hepatitis C4. he is in for this HTN follow up and is lethargic, withdrawn and has missed several AA meetings. He has gone back to drinking daily. Lisinopril 10 mg. PEG-intron 105, ribavarin 400 mg, and sofobuvir 400 mg daily. eGFR 90. alcohol level negative.
what should you do about this and why is it happening?
-SE PGE-interferon which is depression
you can’ take him off this medication because it is needed to treat the hep C, can’t stop it because his hepatitis C virus will relapse
tell him know this is self limiting side effect and encourage counseling, get back to AA meetings, alcohol also depressant
what is a SE of PEG-INTERFERON and ribavirin used together?
depression
PEG interferon SE?
- flu like symptoms including fever, chills, body aches, flu like symptoms are more common than depression
- depression
what is peg-interferon used for?
hep B and C
Case 2: referred 30 y/o pt with TB to the state for treatment and he was told that he had to come in to the clinic and have his TB drug ingestion monitored. He isn’t happy about this and wants to know why he needs to do this. He also abused IV drugs while living in Mexico. Isoniazid, rifampim, pyrazinamide, ethambuton 5 days a week.
-directly observed therapy (DOT) watch him take the meds to make sure that he is compliant, in hopes to cut down on the amount of resistance
really important for him to be compliant since he is a IV drug user and is high risk!!
Mexico also has a lot of drug resistant TB
is rifampin used for sole therapy? why?
not used for sole therapy and is always used in conjunction with isoniazid because it builds resistance very quickly when used alone
why do you have to use a four drug combination to treat TB?
there is a lot of resistance in mexico and thats why we you have the four drug combination
what is a SE of isoniazid?
: hepatitis so make sure they also stop using alcohol
what can rifampin cause a side effect so you should warn your patients? what does special precaution need to be taken with?
cause a yellow orange staining of sercretion and body fluids so warn patients…
be cautious when using soft contact lenses because it can stain them
Case 3: 60 y/o taking amantadine that he got from a friend for prophylaxis against an outbreak of influenza A in his community. He didn’t get the influenza vaccine. He has taken the drug for 3 days now and has anxiety agitation, dizziness and insomnia. He wants to know what he should do to prevent missing work. Amlodipine 5 mg, albuterol MDI (COPD), eGFR 90 ml/min
DOC? and then?
what should you keep in mind?!
DOC: take off amandine and put on OSTELTAMIVIR
10 days of prophylaxsis and give him influenza vaccine
keep in mind: OSELTAMIVIR CAN BE USED FOR PROPHYLAXIS AND TX, WHAT DON’T WANT TO HAVE HAPPEN IS FOR HIM TO BECOME A VECTOR IN THE NURSING HOME
what are 4 SE of amantidine?
anxiety, dizziness on standing, insomnia, aggitation
how is zamavir administered? who is it more difficult for?
administrated by inhalation so contraindciated in pts who have respiratory disease and elderly
zanamivir and oseltamivir are used to tx which two diseases?
influenza A and B
what are the two drugs that cover ONLY influenza A?
amantadine and rimantadine
what do you need to check before prescribing an antiviral?
eGFR
Case 4: 25 y/o patient presents in august with 1 week of flu-like symptoms that prevents him from working. on exam you find a single red lesion that is 7 cm and pale in the center. he took a tick off him 5 days ago. Penicillin allergy.
DOC?
Doxycylcine!
what do you need to keep in mind about the antibody test for lyme? what does this mean?
LYME TEST ONCE THEY TURN POSITIVE THEY WILL STAY POSITIVE SO A POS TEST TODAY MEANS THAT AT SOME POINT HE HAS HAD LYME BUT DON’T KNOW IF IT IS POSITIVE FROM THIS TIME OR TIME BEFORE IT
MORE CLINICAL DX THAN LAB TEST, SO IF YOU HAVE THE OBSERVED ERYTHEMA MIGRANS AND TICK BITE SO KEEP THEM ON THE MEDS EVEN IF THEY ARE NEGATIVE
what do you do if they get bit by a tick without the erythema migrans and they have the engorged tick or are unsure?
GIVE ONE TIME DOSE OF 200 MG OF DOXY IF THEY GET BIT BY A TICK
–POINT OF THE ARTICLE
what is a SE of doxycycline? 2 things you shoudn’t take it with?
photosensitivity don’t take with anacids or milk
what percent of people have the erythema migrans?
20%
what is the flu shot that should be given to elderly?
new double strength flu shot that is trivalent and stronger
illicits a better immune response
Case 5: 70 y/o female with uncomfortable rash on left throax for the past 24 hours. It has red vesicles appeared yesterday after 3 days of a strange feeling on her thorax for the last 3 days. her friend had the same thing and got valcyclovir and she would like the same drug. she has allergy to lisinopril cause it caused her a cough. HTN. CKD> COPD. Anemia. Angina. Medications amlodipine 5 mg, FeSO4 325 BID, NTG, albuterol. BP 160/100 with av nicking. eGFR 25ml/min.
DOC?
acyclovir 800 mg 3x a day since
does acyclovir or valcyclovir get a higher intracellular concentration?
valcyclovir
but as a practical matter most people just go with acyclovir
what would you use to treat eye involvement with shingles?
valcyclovir IV
