Case 12 by kannan

(a) Determine the most likely problem drug(s).

2014-12-18 01:48:56 UTC

Ciclosporin and fluconazole.

(b) Type of interaction, explanation of mechanism, and severity/clinical impact of the interaction or drug therapy problem.

2014-12-18 01:51:47 UTC

Fluconazole increases the level and effect of ciclosporin (pharmacodynamic interaction) by affecting hepatic or intestinal enzymes CYP3A4 metabolism (pharmacokinetic interaction), therefore leads to high risk of ciclosporin toxicity. This is a significant interaction.

(c) Course of action taken and suggestion of possible medication change to make.

2014-12-18 01:56:16 UTC

Replace Diflucan with intravaginal topical application of clotrimazole 2-3 times daily for 10-14 days, followed by one 500mg clotrimazole pessaries once every week at night for 6 months.

(d) Counseling points.

2014-12-18 02:00:58 UTC

- Avoid taking grapefruit juice, as it increase plasma concentration of ciclosporin by inhibit cytochrome enzymes on the metabolism of ciclosporin.

- Counsel the patient on the use of pessary.

Wash your hands.
Remove any foil or plastic wrapping from the pessary and applicator (if supplied).
If an applicator is supplied, push the pessary into the hole at the end of the applicator.
Sit or lie down with your knees bent and legs apart.
Gently insert the pessary into the vagina as far as is comfortably possible using either your fingers or the applicator.
If you are using an applicator, depress the plunger to release the pessary then remove the applicator from your vagina.
Wash your hands again.

Reference: http://www.netdoctor.co.uk/health_advice/facts/pessaries.htm#ixzz3MDAjg6bn