Create a pharm card for each medication listed in the case

Mr T is a 67 year old retired Navy veteran. He has been taking simvastatin for 2 years to treat elevated cholesterolemia. During a recent visit to a 24 hour acute care clinic in a local mall he was prescribed clarithromycin for an acute sinus infection.Two days later Mr T arrives in the emergency room complaining of generalized muscle pain, muscle weakness and dark colored urine. Tests revealed myoglobin in the urine and a serum creatinine of 186 micromol/l (usual baseline for this patient was 90 micromol/l). A diagnosis of rhabdomyolysis is made.

1. Create a pharm card for each medication listed in the case.

2. Include drug generic name, routes of administration, indication/uses, side effects, contraindications, drug interactions, food interactions, method of metabolism, method of excretion

3. Define and describe rhabdomyolysis

4. What is causing the rhabdomyolysis AND describe how /why it developed.

5. How can Mr T avoid this complication in the future? What adjustments can you make in his medications now? How can you advise him?

After six weeks Mr. T is back to normal. He has returned to taking his normal dose of simvastatin and his sinus infection is resolved. Mr. T wants to stop taking medications, exercise, lose weight and become a healthy individual. He decides to go on a grapefruit diet to lose 20 pounds. One week after starting the diet Mr T begins to suffer muscle aches and pains and a darkening of his urine. He demands to be taken off his medication because he feels it is causing these problems.

1. Why have Mr. T’s symptoms returned?

List 8 factors that can affect drug bioavailability.


Explain the term ‘first-pass effect’ and give examples of two drugs that undergo significant first-pass effect.


identify three routes of drug administration that avoid ‘first-pass’ hepatic effects.