Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Drug design wikipedia , lookup
Drug discovery wikipedia , lookup
Polysubstance dependence wikipedia , lookup
Pharmaceutical industry wikipedia , lookup
Pharmacognosy wikipedia , lookup
Pharmacogenomics wikipedia , lookup
Prescription costs wikipedia , lookup
Pharmacokinetics wikipedia , lookup
Name of participant: Country: Module Drug interactions: Assignment In the following case study, you are asked to make choices for treatment of different disorders. Focus your choice on possible drug interactions and explain why you would choose the drug. Please always add the source of information as a reference. The assignment has to be sent back to the tutor, [email protected], latest until 6 July 2008! Good luck! 1. Prudence, a 35-year-old HIV-positive Tanzanian woman, has been on first-line treatment with NVP + d4T + 3TC for 6 months, and she is doing fine. However, she has high blood pressure, which is quite common among her family, and she needs treatment. You can choose between the calcium channel blocker nifedipine and the betablocker metoprolol. Which drug would you prefer to prescribe and why? 2. Some months later, during another follow-up visit, Prudence requests the contraceptive pill. She is using condoms but not regularly, and she does not want to get pregnant now because she just got a very interesting new job. How do you counsel her? What options are available? Do you prescribe the pill? 3. Prudence misses the next two follow-up visits, and you do not see her for 6 months. Finally, she returns to your clinic, and you find her in quite a bad condition. She complains again of chronic diarrhea, a symptom she had before starting ART. She reports that she is working very hard and that she has to travel a lot. She feels depressed. Based on her responses to some standardized questions, you find that she has missed more doses than in the beginning of her treatment because she sometimes forgets the ARV drugs when she is travelling. She also reports that she is taking some herbal pills for her depression. There are several reasons why treatment failure has to be suspected and you decide to put her on second-line treatment after an intensive counseling session on adherence. You switch her treatment to LPV/r + TDF + AZT. You would like to stop her herbal depression treatment, which contains St. John’s wort, which can cause drug interactions. What is the mechanism by which St. John’s wort can cause a drug interaction with NVP? Because depression is an important risk factor for non-adherence you decide to prescribe her amitriptyline. Are there drug interactions to be expected between LPV/rtv and amitriptyline? Further you have to consider that she is also taking pharmacotherapy for her high blood pressure. Can the drug you have chosen in the beginning (nifedipine or metoprolol) be combined with the new regimen? 4. Six months after the switch to second-line, Prudence is feeling better again and also her depression has improved a lot. Unfortunately, she has an accident and breaks her left hand, which is very painful in the first few days. You would like to give her morphine for the pains. Are there drug interactions to anticipate? 5. After two years on second-line treatment with LPV/r, Prudence exhibits increased cholesterol plasma levels. A first intervention with a special diet is not effective enough. Because she also suffers from high blood pressure, you are aware that she is at increased risk for cardiovascular disease, and you decide to prescribe her a statin. In the pharmacy, simvastatin, atorvastatin, and pravastatin are available. Which one of these three drugs do you prescribe?