Download Therapeutics III

Therapeutics 3 Tutoring
Exam 4
February 27th, 2016
Lisa Hayes
[email protected]
Outline
• Antivirals
• Tuberculosis
• Fungal Infections
Fungal Infections
Things to Remember
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Drug interactions
Mechanism of action
Any indications listed that are focused on
Side Effects
Resistance Patterns
An immunosuppressed patient has presented to your hospital
with a systemic fungal infection. It has been decided that AmpB
is the most appropriate agent to treat her infection. Which of the
most appropriate actions is necessary as you administer her
therapy?
• A – Monitor potassium and sodium. Regular
checking of SCR.
• B – Monitor potassium and magnesium.
• C – Monitor potassium and sodium. Provide lipid
formulation. Provide hydration after
administration.
• D – Monitor potassium and magnesium. Provide
lipid formulation. Provide hydration before
administration.
Which two interactions are affected by
Fluconazole most?
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A – CYP2C19, CYP3A4
B – CYP2C9, CYP2C19
C – CYP3A4, CYP1A2
D – CYP3A4, CYP2C9
Which of the following drugs needs an
acidic environment for the oral form to
provide proper absorption?
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A – Mycamine
B – Itraconazole
C – Fluconazole
D – Voriconazole
Itraconazole + which of the following
drugs can increase the risk of
prolonged QT?
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A – methadone
B – lovastatin
C – felodipine
D - lurasidone
Voriconazole is the DOC for which of
the following because it provide
fungicidal activity?
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A – Blastomyces
B – Aspergillosus
C – Cryptococcus
D- Candida
The IV formulation of Voriconazole is
not reccomended beyond what CRCL?
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A – 25
B – 30
C – 45
D – 50
Which drug must be dose reduced for
hepatic disease?
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A – Mycamine
B – Caspofungin
C – Fluconazole
D - Itraconazole
Which two forms of Candida have
intrinsic resistance to azoles?
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A – albicans, galbrata
B – krusei, albicans
C – krusei, galbrata
D – lusitaniae, albicans
Antiviral Infections
Things to Remember
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Know which type of virus (DNA v RNA)
Side effects of medications
Dosing for Zoster, HSV
Neuraminidase inhibitors
– Drugs, contraindications, dosages
What age is the Zoster vaccine
recommended for?
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A – over 70
B – over 60
C – over 55
D – over 50
Acyclovir can cause which of the
following side effects?
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A – diarrhea
B – crystalline nephropathy
C – peripheral neuropathy
D – optic neuritis
Which of the following is the
appropriate treatment for HSV for an
initial episode?
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A – Acyclovir 500mg TID x 3-5 days
B – Valtrex 1gm BID x 3-5days
C – Valtrex 1gm BID x 7-10days
D – Famvir 500mg BID x 5-10day
Which drug is preferred for treatment
of Zoster?
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A – Valtrex
B – Acyclovir
C – Ganciclovir
D - Famvir
What drug is used for treatment of
CMV retinitis?
• A – Ganciclovir (5mg/kg IV q12hours)
• B – Acyclovir (7mg/kg IBW IV q12 hours)
• C – Famvir (10mg/kg IV q12 hours)
Which drug should be avoided in a
patient with a history of COPD?
• A – Tamiflu
• B – Zanamivir
• C – Peramivir
Tuberculosis
Things to Remember
• Drug therapy – RIPE
• Treatment for latent TB
• Drug side effects
– Any treatment available
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Acid fast bacilli
DOT
Hepatitis
Failing Regimens
Which of the following RIPE drugs is
the strongest inducer?
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A – Rifampin
B – Isonizaid
C – Pyrazanimide
D – Ethambutol
A repeat culture at 2mo is indicated when treating a patient for
TB. For patient BB, her repeat culture is positive. What should
you recommend for therapy at this time ?
• A – Continue therapy for additional 7 months
with all RIPE drugs.
• B – Continue therapy for additional 4 months
with all RIPE drugs.
• C – Continue therapy for additional 7 months
with R and I drugs.
• D – Continue therapy for additional 4 months
with R and I drugs.
A 65 year old patient on RIPE therapy presents with elevated
LFTS. His LFTs are 3x the upper limit of normal. He is
experiencing no side effects or adverse effects at this time. What
should you recommend?
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A – Discontinue all drugs.
B – Discontinue isoniazid.
C – Recheck LFTs.
D – LFTs – what?
A patient is on Rifampin for treatment of latent TB. She is also on
warfarin for treatment of her DVT. She is also using hormonal
birth control against the advice of her pharmacist. What would
you need to counsel her on?
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A – Increased efficacy of warfarin
B – Decreased efficacy of warfarin
C – Increased efficacy of OCP
D – decreased efficacy of OCP
When starting a patient on Isoniazid, what other agent
is recommended to reduce the risk of peripheral
neurotoxicity?
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A – Vit B12
B – Vit B1
C – Vit B6
D – Vit C
A patient is started on Rifampin for treatment of his
latent TB. He uses Verapamil for treatment of his high
BP. Should you recommend any changes?
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A – Increase dose of Verapamil
B – Decrease dose of Verapamil
C – Change Verapamil to another agent
D – No change necessary
Which agent is preferred in AIDS
patient due to the interaction profile?
• A – Rifabutin
• B – Rifampin
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Which drug in the RIPE regimen is
often neglected if sensitivity to the
other agents is known?
A – Rifampin
B – Isoniazid
C – Pyrazinamide
D - Ethambutol