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An elderly patient with a creatinine clearance of 40 mL/min is prescribed fluconazole. What dosage adjustment is required, considering the FDA-approved maximum dosage for geriatric patients?
An elderly patient with a creatinine clearance of 40 mL/min is prescribed fluconazole. What dosage adjustment is required, considering the FDA-approved maximum dosage for geriatric patients?
- Administer 800 mg/day, doubling the dose to compensate for reduced kidney function.
- Administer 200 mg/day, a 50% reduction from the FDA-approved maximum due to renal impairment. (correct)
- Administer 100 mg/day, a 75% reduction to account for both age and renal impairment.
- Administer 400 mg/day, no adjustment needed.
A patient taking phenytoin requires fluconazole. What potential drug interaction should be monitored?
A patient taking phenytoin requires fluconazole. What potential drug interaction should be monitored?
- Increased phenytoin levels due to fluconazole's CYP2C19 inhibition. (correct)
- Decreased phenytoin levels due to fluconazole.
- Increased fluconazole levels due to phenytoin.
- No significant interaction is expected.
Which of the following medications, if co-administered with fluconazole, would most significantly reduce fluconazole's effectiveness due to a drug interaction?
Which of the following medications, if co-administered with fluconazole, would most significantly reduce fluconazole's effectiveness due to a drug interaction?
- Warfarin
- Tacrolimus
- Rifampin (correct)
- Cyclosporine
A patient is prescribed fluconazole. What cardiac-related adverse effect should the healthcare provider monitor for during the course of treatment?
A patient is prescribed fluconazole. What cardiac-related adverse effect should the healthcare provider monitor for during the course of treatment?
A patient with normal renal function is started on fluconazole 400mg daily. After 5 days, lab results show elevated liver function tests (LFTs). Which action is most appropriate?
A patient with normal renal function is started on fluconazole 400mg daily. After 5 days, lab results show elevated liver function tests (LFTs). Which action is most appropriate?
A patient with a creatinine clearance of 30 mL/min requires fluconazole. By what percentage should the typical dose be reduced?
A patient with a creatinine clearance of 30 mL/min requires fluconazole. By what percentage should the typical dose be reduced?
Which medication, when administered concurrently with fluconazole may lead to a significant decrease in fluconazole's serum concentration?
Which medication, when administered concurrently with fluconazole may lead to a significant decrease in fluconazole's serum concentration?
What is the maximum FDA-approved daily dose of fluconazole for elderly patients?
What is the maximum FDA-approved daily dose of fluconazole for elderly patients?
A patient is prescribed both fluconazole and warfarin. What potential interaction should the healthcare provider monitor for?
A patient is prescribed both fluconazole and warfarin. What potential interaction should the healthcare provider monitor for?
What is a potential cardiovascular adverse effect associated with fluconazole administration?
What is a potential cardiovascular adverse effect associated with fluconazole administration?
Flashcards
Fluconazole forms
Fluconazole forms
Available as tablets, PO solution, and IV.
Max dose for geriatrics
Max dose for geriatrics
FDA-approved maximum dose is 400 mg/day PO/IV for elderly patients.
Off-label dosing
Off-label dosing
Loading doses up to 800 mg and maintenance up to 1,200 mg used off-label.
Renal adjustment
Renal adjustment
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Drug interactions
Drug interactions
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Fluconazole and food
Fluconazole and food
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QT prolongation risk
QT prolongation risk
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Effects of Rifampin
Effects of Rifampin
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Monitoring liver function
Monitoring liver function
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Strong CYP2C19 inhibitor
Strong CYP2C19 inhibitor
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Study Notes
Fluconazole (Diflucan)
- Available as tablets, oral solution, and intravenous (IV) formulations.
- Maximum FDA-approved dose for elderly patients is 400 mg daily, orally or intravenously.
- Higher doses (up to 800 mg loading dose and 1,200 mg daily maintenance dose) are sometimes used off-label.
- Renal impairment adjustment: Reduce dose by 50% if creatinine clearance (CrCl) is less than 50 mL/min.
- Can be taken with or without food.
- Monitor for QT interval prolongation.
- Fluconazole is a strong CYP2C19 inhibitor.
- It may increase the blood levels of phenytoin, cyclosporine, tacrolimus, and warfarin.
- Rifampin can decrease fluconazole levels by half.
- Monitor liver function tests (LFTs) due to potential increases.
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