Patient is a 78 y/o male with a history of COPD & HTN. He smokes 1 – 2 packs/day & requires oxygen at home. He presents to the ER with increased SOA (shortness of air), fever, and worsened cough with...

Patient is a 78 y/o male with a history of COPD & HTN. He smokes 1 – 2 packs/day & requires oxygen at
home. He presents to the ER with increased SOA (shortness of air), fever, and worsened cough with
thick sputum production. The physician in the ER diagnosis him with pneumonia and starts him on
prednisone and clarithromycin, an antibiotic

Allergies
Penicillin (hives,
shortness of air,
swollen tongue and
throat)
Current Medications
Tiotropium (Spiriva®) inhaler I puff PO once daily
Theophylline (Theo-DUR) 300mg PO BID
Lisinopril 10 mg PO daily
Albuterol MDI (Proventil®) 2 puffs q 2-4 hours as needed for SOA
Prednisone 50 mg daily x 7 days
Clarithromycin (Biaxin) 500mg PO BID x 7 days
PMH COPD
HTN

1.using Clinical Pharmacology (Reports->Drug Interaction Reports) as a reference, discuss the drug
interaction between theophylline and clarithromycin.
2. What are the common side effects of theophylline?
3. What is the mechanism of action of tiotropium (Spiriva®)?
4. What are long-term complications / side effects of systemic steroid use?
5. The patient has been hospitalized now for 1 week. His pneumonia has resolved. The physician is
discussing sending him home soon. While giving the patient his morning medications, you notice that he
is very anxious and is twitching.. He tells you that his stomach has been upset and having diarrhea. You
take his pulse and it is 120 bpm. After you leave his room to call his physician, his family runs and tells
you that he is having a seizure. What are the possible reasons for the seizure?
6. List two medications that are used for status epilepticus?