Case Studies (April 2018)

APRIL 23, 2018
Vangjelis Kristollari, PharmD Candidate; Erin R. Weeda, PharmD; and Craig I. Coleman, PharmD
CASE 1
NK is a 34-year-old woman with a history of intravenous (IV) drug use who presents to the hospital with generalized weakness, chills, and fatigue, and is found to have a temperature of 102°F, a heart rate of 107 beats per minute, and a white blood cell count of 15,000/ mcL. Urine and blood cultures are obtained at admission. NK’s physician initiates empiric therapy with IV micafungin 100 mg daily. A few days later, NK’s blood cultures come back positive for Candida krusei. After 5 days of daily treatment with 100 mg of IV micafungin, NK reports feeling better and is found to be afebrile; repeat blood cultures are negative and she is deemed ready for discharge. The physician would like to switch NK to oral fluconazole for 2 weeks of outpatient treatment. NK has no other significant past medical history or drug allergies.

As the pharmacist rounding with the team, what would you recommend to the physician?

CASE 2
MK is a 45-year-old man who presents to your pharmacist- led vaccination clinic for his annual influenza vaccine. With a past medical history significant for HIV, MK is currently taking a once daily oral combination pill that includes 600 mg of efavirenz, 200 mg of emtricitabine, and 300 mg of tenofovir disoproxil fumarate. His latest CD4 count is >500 cells/mm3. Upon review of MK’s vaccination history, you discover that he is up-to-date on his pneumococcal, tetanus, diphtheria and pertussis; Hepatitis B; measles, mumps, and rubella; and varicella zoster vaccinations.

Besides the influenza vaccine, what other vaccination(s) would you recommend for MK?

SEE THE ANSWERS ON PAGE 2.



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