Case Studies (April 2018)

APRIL 23, 2018
Vangjelis Kristollari, PharmD Candidate; Erin R. Weeda, PharmD; and Craig I. Coleman, PharmD
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?

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?