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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?