Therapeutics 3 Tutoring Exam 4 February 27 th, 2016 Lisa Hayes

Outline Antivirals Tuberculosis Fungal Infections

Things to Remember 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? 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? A – Mycamine B – Itraconazole C – Fluconazole D – Voriconazole

Itraconazole + which of the following drugs can increase the risk of prolonged QT? A – methadone B – lovastatin C – felodipine D - lurasidone

Voriconazole is the DOC for which of the following because it provide fungicidal activity? A – Blastomyces B – Aspergillosus C – Cryptococcus D- Candida

The IV formulation of Voriconazole is not reccomended beyond what CRCL? A – 25 B – 30 C – 45 D – 50

Which drug must be dose reduced for hepatic disease? A – Mycamine B – Caspofungin C – Fluconazole D - Itraconazole

Which two forms of Candida have intrinsic resistance to azoles? A – albicans, galbrata B – krusei, albicans C – krusei, galbrata D – lusitaniae, albicans

Antiviral Infections

Things to Remember 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? A – over 70 B – over 60 C – over 55 D – over 50

Acyclovir can cause which of the following side effects? 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? 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? 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 Acid fast bacilli DOT Hepatitis Failing Regimens

Which of the following RIPE drugs is the strongest inducer? 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? 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? 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? 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? 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

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