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Module 7: Mali: ID > ID pharm cases > Flashcards

ID pharm cases Flashcards

1
Q

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 he is in for this HTN follow up and is lethargic, withdrawn and has missed several AA meetings.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?

A

-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

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2
Q

what is a SE of PEG-INTERFERON and ribavirin used together?

A

depression

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3
Q

PEG interferon SE?

A
  1. flu like symptoms including fever, chills, body aches, flu like symptoms are more common than depression
  2. depression
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4
Q

what is peg-interferon used for?

A

hep B and C

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5
Q

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.

A

-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

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6
Q

is rifampin used for sole therapy? why?

A

not used for sole therapy and is always used in conjunction with isoniazid because it builds resistance very quickly when used alone

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7
Q

why do you have to use a four drug combination to treat TB?

A

there is a lot of resistance in mexico and thats why we you have the four drug combination

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8
Q

what is a SE of isoniazid?

A

: hepatitis so make sure they also stop using alcohol

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9
Q

what can rifampin cause a side effect so you should warn your patients? what does special precaution need to be taken with?

A

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

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10
Q

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?!

A

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

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11
Q

what are 4 SE of amantidine?

A

anxiety, dizziness on standing, insomnia, aggitation

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12
Q

how is zamavir administered? who is it more difficult for?

A

administrated by inhalation so contraindciated in pts who have respiratory disease and elderly

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13
Q

zanamivir and oseltamivir are used to tx which two diseases?

A

influenza A and B

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14
Q

what are the two drugs that cover ONLY influenza A?

A

amantadine and rimantadine

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15
Q

what do you need to check before prescribing an antiviral?

A

eGFR

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16
Q

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?

A

Doxycylcine!

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17
Q

what do you need to keep in mind about the antibody test for lyme? what does this mean?

A

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

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18
Q

what do you do if they get bit by a tick without the erythema migrans and they have the engorged tick or are unsure?

A

GIVE ONE TIME DOSE OF 200 MG OF DOXY IF THEY GET BIT BY A TICK

–POINT OF THE ARTICLE

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19
Q

what is a SE of doxycycline? 2 things you shoudn’t take it with?

A

photosensitivity don’t take with anacids or milk

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20
Q

what percent of people have the erythema migrans?

A

20%

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21
Q

what is the flu shot that should be given to elderly?

A

new double strength flu shot that is trivalent and stronger

illicits a better immune response

22
Q

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?

A

acyclovir 800 mg 3x a day since

23
Q

does acyclovir or valcyclovir get a higher intracellular concentration?

A

valcyclovir

but as a practical matter most people just go with acyclovir

24
Q

what would you use to treat eye involvement with shingles?

A

valcyclovir IV

25
Q

can valcyclovir be used IV?

A

YES!!

26
Q

what is valcyclovir? this means it gets broken int?

A

valcyclovir is a PRODRUG that is broken down into acyclovir and must be renally adjusted!

27
Q

what is a SE of acyclovir/valcyclovir?

A

seizures so caution in use of these pts

28
Q

Case 6: you work in a nursing home where there has been an outbreak of influenza B. None of the residents have been vaccinated and you are worried that people from the community will bring it into the facility.

2 DOC? explaination

A

DOC1: prophylactically treat with tamiflu
DOC2: start vaccination protection since it takes 2 weeks to be effective

NOT IDEAL GIVING AT THE SAME TIME, BUT GIVE SHOT AND OSELTAMIVIR AT THE SAME TIME BECAUSE IT IS THE BEST OPTION WE HAVE

29
Q

what is the max number of days you can give oseltamivir for prophylaxsis?

A

10 days

30
Q

what is the goal time frame to start taking oseltamivir

A

48 hours

31
Q

Case 7: 45 y/o female plans to travel to a p. falciparum malaria endemic area in rural area of central malaria. She wants to know what she can do for prevention/prophylaxis.

DOC?

A

chloroquine sulfate

32
Q

Case 8: 3 y/o child presents with very itchy scalp. He was sent home from daycare today because several of his playmates had the same problem. Small nits present at base of hair shaft.

DOC?
DOC2 if that didn’t work?

A

-lice

DOC1: permethrin 1% OTC, wash the bedding and stuffed toys

if that didn’t work:

DOC2: permethrin 5% which is prescription

33
Q

when do you use permethrin 1% and 5%?

A

1%-LICE

5%-scabies!!

34
Q

Case 9: you 30 y/o pt who is 4 months pregnant and has frequent and painful urination. her only other UTI was 10 years earlier. PCN allergy. no CVA tenderness. tender to palpation over suprapubic area.

DOC? why can this be used?

A

nitrofurantoin

minimal systemic effects and metabolized quickly

35
Q

who is it safe to use nitrofuratoin in?

A

prengnacy becuase of short half life and poor systemic absorption

36
Q

what is the halflife for nitrofuratoin?

A

t1/2 is 20-60 minutes

37
Q

which drug is on the BEERs list for inappropriate use for elderly patients

A

nitrfuratoin

38
Q

what is a dangerous side effect seen in the use of nitrofuratoin with long term use?

A

pulmonary fibrosis!

39
Q

Case 10: 70 y/o female with 6 episodes of cystitis in the past year. no anatomic abnormalities. she would like to take something to prevent the UTIs from reoccurring. HTN. CKD stage 3. angina. amlodipine. eGFR: 40ml/min

DOC? (2 options) and why can’t you use a different drug?

A

TMP-SMX and estrogen vaginal cream since she is post menupausal

don’t use nitrfuratoin here since CrCl is low and also eldery

40
Q

Case 11: you 24 y/o patient presents with severe diarrhea after 2 week long camping trip in northern maine. he states he did drink water from a stream in the woods.

A

-giardia

DOC: metronidazole

41
Q

what are two SE you need to be aware with with metronidazole?

A

metallic taste and disulfiram-like reaction

42
Q

praziquantel is a ________

A

antihelminth

43
Q

giardia is much more common so you would want to treat with what drug? drug class?

A

metronidazole

antiameobocide thats a nitromidazole abx

44
Q

what is the side effect of metronidazole?

A

metalic test and disulfram like reaction when you start vomiting as soon as you get it

45
Q

Case 12: 35 y/o female hospital based clinical who’s PPD test has just converted to positive. CXR is negative for TB and PE reveals no signs of TB.

A

would undergo prophylactic treatment

DOC:: isoniazid for 9 months and would need B6 supplement while taking it

46
Q

what must you take when prescribing isoniazid?

A

vitamin B supplement!!!!

47
Q

how long does someone get prophylactically treated for TB?

A

9 months

48
Q

what is the drug class of iodoquinol?

A

antiamebacide

halogenated hydroxyquinolone

49
Q

what si the indication of iodoquinol?

A

acute and chronic intestinal amebiasis

50
Q

what is the MOA of iodoquinol?

A

unknown

Module 7: Mali: ID (4 decks)

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