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LR is a 72-year-old male that comes to your community pharmacy to pick up his prescription for clarithromycin. Before dispensing LR’s prescription, you check LR’s medication profile and find that he has been taking simvastatin for the past 10 years to manage his dyslipidemia.
Should LR still be taking clarithromycin? Why or why not?
Explanation
LR should not be taking clarithromycin. Clarithromycin is an inhibitor of CYP3A4. Simvastatin also happens to be metabolized by CYP3A4. If CYP3A4 is inhibited, then the serum concentrations of simvastatin will be higher than intended, which can lead to some undesirable side effects of statins, such as rhabdomyolysis.
FeedbackBK is a 76-year-old female with a 14 day history of persistent headache, fever, and lethargy. She is initiated on vancomycin, ceftriaxone, and ampicillin with minimal response. Lumbar Puncture reveals a CSF Cryptococcus Ag of 1:256. An HIV test is sent which comes back positive, CD4 count = 48.
Which antifungal regimen should be initiated?
Explanation
Amphotericin B + Flucytosine Based on patients’ symptoms she described, a positive lumbar puncture for Cryptococcus spp, and HIV+, patient can be diagnosed with invasive Cryptococcus meningitis. 1sst line treatment during induction phase includes combination therapy of Amphotericin B + Flucytosine. Patient can later be transitioned to Fluconazole monotherapy during maintenance phase. It is important to remember that Flucytosine should never be used alone due to the development of resistance.
Patient can later be transitioned to Fluconazole monotherapy during maintenance phase. It is important to remember that Flucytosine should never be used alone due to the development of resistance.
CV is a 39 year old male patient with malignancies undergoing chemotherapy. What major risk factor needs to be considered for this patient in preventing the development of infections?
What factors need to be considered when determining antibiotic regimens for this patient?
Explanation
Major risk factors for developing infection include severe neutropenia which is defined as having an ANC < 500 cells / mm3. Factors that need to be considered when determining antibiotic regimens include:
- Malignancy type
- Maternal cephalopelvic disproportion
- Anticipated duration of neutropenia
- Risk for particular infection
A patient who is very prone to motion sickness comes to your pharmacy with some questions. He tells you that he plans to fly down to Orlando for his Disney trip, but he is concerned that he will experience motion sickness while traveling.
Provide three counseling points for this patient to manage or prevent his motion sickness.
Explanation
- Motion sickness can be prevented by drinking plenty of water before and during travel.
- Avoid eating, reading, or looking down at a screen while the vehicle is in motion. This will reduce the risk of motion sickness.
- If motion sickness does occur, it can be relieved by taking meclizine, an H1 receptor antagonist known for its antiemetic properties.
AB is a 70 year old male with a history of infective endocarditis. During his routine dental check-up, his dentist recommends that he gets a root canal procedure for one of his back molars. Upon checking his medical records before the procedure, the dentist notices that he is allergic to penicillin and has a swallowing disorder. Does the dentist have to provide AB with any prophylaxis treatment regimen prior to the root canal?
If so, what would be the appropriate regimen?
Explanation
Since AB has a history of endocarditis, the dentist will have to provide the patient with a prophylaxis antibiotic treatment regimen prior to performing the root canal.
IE patients are at highest risk during dental procedures because bacteria from the mouth can congregate in the blood stream during the procedure and transport to the heart valve, blood vessel or myocardial lining of the heart.
Since AB is allergic to penicillin and unable to take oral medications, the recommended antibiotic prophylaxis regimen should be Ceftriaxone or Cefazolin 1 gram IV/IM or Clindamycin 600 mg IV/IM.
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Adducts and flexes thigh
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Cranial nerve nuclei of CN V, VI, VII, VIII
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Calcium oxalate
The most common renal stone?
The most common benign GI tumor?
Which cranial nerve nuclei are located in the pons?
What is the definition of: Stroma?
What is the treatment of choice for : Babesia?
What is the action of the following muscle: Pectineus?
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