Question

Case #2

TL is a 30-year-old female with a diagnosis of Apergillus spp. Pneumonia with typical ‘halo’ on the CT scan. The DOC and first-line treatment for Apergillus spp. pneumonia is voriconazole. Please evaluate what precautions should be taken into consideration regarding TL’s current medication regimen: Celecoxib 200 mg twice daily as needed Citalopram 20 mg daily at night Omeprazole 20 mg daily

Based on the cases study, answer these questions:

1.List each drug-drug interaction with existing regimen and pharmacology of interaction

2. List the medical risks due to each drug interaction

3. List any potential dose adjustments I.e. dose should be increased/decreased

4. List any required monitoring I.e. lab values, drug levels, side effects, etc.

you just need to answer the question below based on the case study.

Answer 1

1, Aspergillus spp is a type of fungus disease. people with weaken immune system when inhale aspergillus spores get lung disease and high risk health problem. it cause lung infection, alergic reaction and infection to other organ. voriconazole is a triazole antifungal medication that treat serous fungal infections. voriconazole is metabolized in human hepatic cytochrome p450 enzyme, cyp2c19,cyp2c9,cyp3A4. cyp2c19 significantly involve in metalosim of voriconazole.
Celecoxib is a selective cox2 inhibitor (NSAID). this drug interacts with ACE inhibitors, aliskiren, angiotensin II receptors blockers, water pills, lithium. this drug contraindication inpatient with NSAID hypersensitivity and if the patient history of asthma allergic-type reactions with other drugs.
citalopram treats depression. some drugs like antiplatelet drugs, NSAID, blood thinners interact with these drugs. MAO inhibitors with this drug cause serious drug interaction.
omeprazole treated stomach and esophagus problem like ulcer, acid reflux. this medicine has drug interaction with diazepam, ampicillin, anticoagulant, cilostazol, clopidogrel, atazanavir, and oral iron supplements and st.john wort.
2, voriconazole drug interaction with other drug cause medical risk like respiratory distress, inhibit metabolic activity, visual effect, QT prolongation, nephrotoxicity, increase PTT level, sedative effects, etc.
celecoxib and citalopram drug interaction with other drugs causes high bleeding risk.
omeprazole drug interaction causes high gastric PH and p-glycoprotein substrates.
3, no dose adjustment necessary for celecoxib it depends on renal function dose adjustment needed. 400mg once daily is the recommended dose.
Citalopram needs no drug adjustment. as an initial dose of 20mg daily recommended.
omeprazole 20mg once daily as a recommended dose is recommended before meals.
4, celecoxib monitoring for signs and symptoms of GI bleeding is important.
omeprazole monitoring for signs and symptoms of gastrointestinal reflux disease and peptic ulcer monitoring is important.
citalopram need monitoring with ECG, electrolyte disturbance with periodic followup is important.
voriconazole need monitoring with a liver function test to reduce the drug-related toxicity.