Micromedex
RB, a 67-year-old man, found a white oval tablet marked “PD 158” and “80” in his pill organizer and wants help identifying it.
RB’s current medications include:
Amlodipine 10 mg (Norvasc) – for hypertension
Metformin 500 mg (Glucophage) – for diabetes
Atorvastatin 40 mg (Lipitor) – for cholesterol
Atorvastatin 40 mg (Lipitor)
During an appointment with you, a patient states they are having symptoms of a cold, including nasal congestion and increased sinus pressure. You ask them if they are currently taking any medication or supplements, and they say no. When you ask about lifestyle, they tell you that they drink a cup of Green Tea every morning. The patient is wondering if they can use Sudafed to treat the sinus congestion symptoms of their cold. Would this be an appropriate recommendation for them given the information above?
Advise the patient to consider other options and recommend a non-ephedrine based decongestant, or advise the patient to stop drinking green tea during the duration of treatment with Sudafed.
RB is a patient of yours that reports taking the following medications:
- Lisinopril 10 mg
- Atorvastatin 20 mg
- Hydrochlorothiazide 25 mg
- Red Yeast Rice
Are there drug interactions present? If so, which are you the MOST concerned about?
Red Yeast Rice & Atorvastatin is MOST concerning
- HCTZ & lisinopril require monitoring
You and your preceptor are finishing up a pediatric appointment. It has been determined that the 3 year old child has uncomplicated acute otitis media and will need to be treated with antibiotics. This patient has no known penicillin allergies, so your preceptor would like to use amoxicillin.
What is the high-dose regimen for amoxicillin in children with this condition?
80 to 90 mg/kg/day in two divided doses
Your preceptor approaches you with a question on a parenteral medication administration. She asks you if you thought that ceftriaxone sodium and potassium chloride are safe to be given intravenously.
Using Micromedex, what should you tell your preceptor?
Yes, there are four studies indicating compatible IV use.
TD, a 42-year-old man with chronic kidney disease and anxiety, asks if kava is a safe and effective alternative to his prescribed alprazolam.
Using the Natural Medicines Database, what should you tell him?
Kava may reduce anxiety with 150–400 mg daily for at least five weeks, offering effects similar to low-dose benzodiazepines. However, due to the risk of severe liver toxicity—even with short-term use—it’s not recommended, especially for patients with CKD.
Patient with new-onset atrial fibrillation (AF), is discharged from the hospital with a prescription for warfarin BID. He also takes metoprolol tartrate 50 mg BID for heart rate control. He calls the hospital and he asks: “Are there any foods that I should avoid while taking this?”
Ethanol: Binge drinking increases PT/INR; daily use decreases it. Limit alcohol and monitor INR.
Food: Keep your diet consistent. Vitamin K-rich foods decrease the warfarin effect; vitamin E and cranberry juice increase it.
You are working in the clinic and have an appointment with a pregnant patient. She is about 28 weeks pregnant and is wanting to know if she can use an NSAID (like ibuprofen) to treat some of the mild back pain she is experiencing.
What answer do you provide this patient?
No. NSAID use should not be used in pregnant women past 20 weeks due to the risk of low amniotic fluid and fetal harm.
AR is a 46-year-old. She is currently taking Metformin 1 g PO BID for her Type 2 Diabetes. She is also currently taking Atorvastatin 20 mg PO every day and Amlodipine 5 mg PO every day. Over the past couple of years her kidney function has declined and after her visit today you have concluded that her kidney prognosis has worsened, and she is now classified in Stage 3 Kidney failure with eGFR of 45 mL/min. Upon reviewing her current medications, which needs to be adjusted based on her new diagnosis?
Atorvastatin and Amlodipine do not have renal dose adjustments, but Metformin does. For a patient with an eGFR of 30 to 45 mL/min, the provider should weigh risks vs benefits of continuing the use of this medication.
KM, a 45-year-old female, visits the clinic reporting that her prescription for sertraline (Zoloft) "hasn’t been working like it used to" and she's been feeling more anxious and having trouble sleeping. When asked if she’s started anything new recently, she mentions a family friend suggested St. John’s Wort supplement to help with stress, and she’s been taking it daily for the past three weeks.
Past Medical History:
-Generalized anxiety disorder
-Depression
-Insomnia
Current Medications:
-Sertraline 100 mg daily
-Melatonin 3 mg nightly PRN
-Occasional use of diphenhydramine for sleep
Interactions with Drugs: St John’s Wort does induce CYP3A4, which can reduce the efficacy of drugs like sertraline and other SSRIs. It can also increase risk for serotonin syndrome when taken with SSRIs.
Can cause insomnia, anxiety, phototoxicity and irritability
A patient is recently diagnosed with Type 2 Diabetes and is going to be prescribed metformin. This patient is experienced in medicinal chemistry, but can’t quite remember what he previously knew about metformin.
What transporter(s) is metformin a substrate for?
OCT1, OCT2
CR brings in his mother, AR, now 75, today because for the past couple of days she has been confused, experiencing drowsiness, and urinary incontinence. Upon testing she was diagnosed with a UTI. It's important to note that over the last 29 years her kidney failure has progressed and her new eGFR is 28 mL/min. Using the Beers List, which of the following medications would be the safest option to prescribe AR for this condition and are safe to use with her current medications:
Amlodipine, Atorvastastin, and Mounjaro.
Cipro: 250 mg BID for 3 days
Nitrofurantoin: 100 mg BID for 5 days
Amoxicillin: 500 mg BID for 4 days
Amoxicillin 500 mg BID for 4 days is safe to use with her current medications. Fluoroquinolones are on the Beers list for increased risk of tendon rupture and Nitrofurantoin is on the Beers list for increased risk of toxicity in patients with CrCl <30 mL/min.