manual case

Question 1

25 y/o, 1wk productive cough, fever, chills,

Answer 1

Amoxicillin 1g TID after meals PO 5-7 days
penicillin: interferes w/ transpeptidation rxn of bacterial cell wall synthesis
excreted by kidneys
AE: hypersensitivity, interstitial nephritis, fever, seizure
I: decrease effect w/ tetracycline, chloramphenicol, macrolides, sulfonamides

Question 2

20 mos/o, vomiting, HG fever, loss appetite, irritability

Answer 2

Ampicillin-sulbactam 1.2mg IV over 10min q6h 7 days
penicillin: interferes w/ transpeptidation rxn of bacterial cell wall synthesis
excreted by kidneys
AE: hypersensitivity, interstitial nephritis, fever, seizure
I: decrease effect w/ tetracycline, chloramphenicol, macrolides, sulfonamides

Question 3

45 y/o, stage 2 htn

Answer 3

Amlodipine 5mg OD PO for 30 days
CBB: blocks vascular calcium channels
excreted by kidneys
AE: bipedal edema, hypotension, angina, somnolence
I: increase conc in blood with simvastatin (CYP3A4)

Question 4

50 y/o elevated TC and LDL

Answer 4

Atorvastatin 40mg OD PO for 30 days
statin: inhibits HMG-COA reductase
excreted by bile and kidney
AE: GI disturbance (diarrhea, constipation, flatulence, abd pain), myalgia, myopathy
I: inc risk for myopathy w/ CCB (CYP3A4 inh)

Question 5

60 y/o, polyuria, polydipsia, polyphagia

Answer 5

Metformin 500mg BID PO before meals for 3 months
biuanides: activate AMP-acitvated protein kinase, dec. hep glucose production
excreted by kidney
AE: GI disturbance, LA, dec. vit.B12 absp
I: LA w/ cimetidine

Question 6

66 y/o, chronic NSAID, PUD

Answer 6

Omeprazole 20mg OD PO 1hr before bfast for 4 wks
PPI: inhibits H+/K+ ATP pump suppressing basal and stimulated acid secretion
metab by liver
AE: headache, skin rash, abd pain, acute interstitial nephritis and chronic kidney disease, gastric gland atrophy (atrophic gastritis) and intestinal
metaplasia , dec Vit.B12 absp
I: may inhibit the metabolism of clopidogrel, warfarin, diazepam, and phenytoin

Question 7

50 y/o. hand OA

Answer 7

Naproxen 500mg OD PO after meals as needed
nonselectice NSAID: inh COX-1 & COX-2, inh prostaglandin synthesis
AE: GI bleeding, ulcer, asthma, htn, anemia, inc ALT/AST
I: diltiazem + naproxen can inc BP