Levifloxacin Case Study

Adverse reactions to drugs are common and almost any drug can cause an adverse reaction.

Clinafloxacin is a broad-spectrum antibiotic of the quinolone carboxylic acid category that inhibits both DNA gyrase and topoisomerase IV dually in Streptococcus pneumonia. Clinafloxacin, a fluoroquinolone, is currently in development for oral and intravenous therapy of serious infections.

Last QDRR in 5/30/17 indicates that patient is free from poly-pharmacy but he is not free of potential drug interaction:

The use of strong cytochrome P450 3A4 inhibitors (e.g., ritonavir) with Symbicort may cause increased systemic corticosteroids. Formoterol, a component of Symbicort, can produce significant cardiovascular effects, such as flattening of the T-wave, prolongation of the QTc interval, and ST depression. In addition, because of the action of formoterol on the vascular system, taking with monoamine oxidase inhibitors and tricyclic antidepressants should be cautioned. Furthermore, beta-blockers, including eye drops may not only produce severe bronchospasm in patients with asthma, but may block the pulmonary effect of the beta-agonists, such as formoterol as well. Finally, caution is recommended when administered concomitantly with non-potassium-sparing

Zohydro offers a hydrocodone extended release formulation (12 hrs effect) without acetaminophen and its adverse effects as liver toxicity and possible ototoxicity. On the other hand, due to its high hydrocodone dose in just one pill could be very dangerous especially

Among SSRIs, paroxetine, fluvoxamine, and fluoxetine are mainly metabolized by CYP2D6. Sertraline, citalopram, and escitalopram are mainly metabolized by CYP2C19. There are CPIC guidelines for fluvoxamine and paroxetine regarding CYP2D6, also for citalopram, escitalopram, sertraline regarding CYP2C19. These guidelines suggest the reduction of the dose or alteration of medication if the patient has a poor metabolizer phenotype. Since this patient is a poor metabolizer for both CYP2D6 and CYP2C19, patients may experience side effects from relevant SSRIs due to higher plasma concentration, we may need to avoid using the above SSRIs. Additionally, she tried paroxetine, fluoxetine, and sertraline in the past which were all not successful, we would like to avoid those as well.

Some other common side effects include: decreased blood pressure (hypotension), fatigue, sensitivity to the sun (photosensitivity), hallucinations, headache, insomnia, mental depression, high blood potassium levels (hyperkalemia), low blood sodium levels (hypernatremia), diarrhea, inflammation of the mouth (stomatitis), inflammation of the liver (hepatitis), and inflammation of the pancreas (pancreatitis), low blood sugar (hypoglycemia), hemolytic anemia, leukopenia, megaloblastic anemia, and thrombocytopenia, and crystals in the urine. Kernicterus can also occur in

Make sure to take at same time every day. Can cause loss of appetite. Can cause thyroid problems, need to monitor thyroid levels. Can cause unexplained weight loss.

The health issues listed here are just a glance at what this drug can do to one’s health.

Warfarin is an anticoagulation that is metabolized in the liver and removed through the kidneys. The proper metabolism of his warfarin is being inhibited by the cimetidine. The effect of warfarin is increased due to the interaction between these two medications. According to Miller (2010), wafarin is a drug that needs to be carefully considered for a patient in terms of interactions. A second issue entails issues pertaining to his signs of bleeding and indication of slow clotting. The patient is having epistaxis, ecchymosis, and an increased international normalized ratio (INR). The normal INR range of warfarin is 2.0-3.0. According to Barta, Nutescu, and Johnson (2015), the patient needs to remain in the accepted range for as long as possible which indicates a stable level. The laboratory results indicated an elevated INR of 4.8. This indicates he is at risk for bleeding due to the rate that his blood is clotting. A third problem pertains to his abnormal digoxin level of 1.6 ng/ml. digoxin is an antiarrhythmic that is metabolized in the stomach and liver. The normal range for this medication is 0.5 to 0.8ng/ml. According to Niemeijer et al. (2015), digoxin can result in sudden death and must be carefully

According to Gould’s Pathophysiology for the Health Professions book, one of the common drug-nutrient an interaction with methotrexate is that happens with the prostaglandins (any of a group of cyclic fatty acid compounds includes the omega-3). There is a raise in incidence of heart attacks and strokes that associated with using these drugs together.

The results also showed that vancomycin trough level of 15 mcg/mL or greater was associated with increased risk of developing nephrotoxicity.5 Another retrospective study done by Kim et al demonstrated that among a total of 228 patients, the incidence of acute kidney injury (AKI) was lowest in the vancomycin group at 4.0% (p=0.003), 15.4% (p=0.047) in the piperacillin/tazobactam group, and 18.8% in the combination group.6 Also, Gomes et al conducted a cohort study with a total of 224 patients where two groups of patients received either piperacillin-tazobactam with vancomycin or cefepime with vancomycin. The results showed that the incidence of AKI was significantly higher in the piperacillin-tazobactam with vancomycin group compare to the cefepime with vancomycin group (34.8% and 12.5% respectively; p4 g/day), critically ill patients who are likely to experience rapid renal function changes, or receiving concurrent nephrotoxic agents.1,2 The authors mentioned that such toxicity may be confirmed if multiple (at least 2 or 3 consecutive) high serum creatinine concentrations (increase of 0.5 mg/dL or ≥50% increase from baseline) are noted after several days of vancomycin therapy in the absence of alternative explanations.1

Medications that can cause interactions include anticoagulants, probenecid, bisphosphonates, angiotensin-converting enzyme (ACE) inhibitors, anticoagulants (Warfarin), antiplatelet medicines (Clopidogrel), aspirin, corticosteroids (Prednisone), heparin, other NSAIDs (Ibuprofen), Rivaroxaban, or Selective Serotonin Reuptake Inhibitors (SSRIs) (Fluoxetine) due to the risk of stomach bleeding may be increased. Bisphosphonates (Alendronate), Cyclosporine, Hydantoins (Phenytoin), Lithium, Methotrexate, Quinolones (Ciprofloxacin), Sulfonamides (Sulfamethoxazole), and Sulfonylureas (Glipizide) side effects may be increased by Naproxen. The effectiveness of Angiotensin-converting enzyme (ACE) inhibitors (Enalapril), Beta-blockers (Propranolol), or diuretics (Furosemide, Hydrochlorothiazide) may be decreased by Naproxen (Lexi-Comp,

Adverse reactions to this medication are migraine, speech disorders, rhinitis, sinusitis, hyperglycemia, elevated liver function, elevated serum creatinine level, pancytopenia, bronchitis, dyspnea, toxic epidermal necrolysis, anaphylaxis, elevated creatine kinase, generalized pain, and infection. Nursing considerations with this medication is to have the patient swallow the whole tablet and not to chew. Watch for aspiration while watching the patient take the medication. Educate the patient about the medication and inform them to notify a physician if bleeding

Other side effects include cloudy urine, proteinuria, irregular heartbeats, and chest pain. Angioedema involving the extremities, face, lips, mucous membranes, tongue, glottis or larynx has been seen in patients treated with ACE inhibitors, including captopril (Capoten, 2014). If these effects happen nurses should be ready to administer epinephrine to reduce swelling. Other adverse effect according to Karch (2014) include, “CV: Tachycardia, angina pectoris, heart failure, MI, Raynouds syndrome, hypotension in salt-or volume depleted patients.”