Practice Test 1

A 48-year-old male (86 kg, 182 cm) with HIV presents for counseling on a new prescription for fluticasone nasal spray 2 sprays per nostril daily for allergic rhinitis. Current medications: darunavir/cobicistat 800 mg/150 mg PO daily, emtricitabine/tenofovir alafenamide 200 mg/25 mg PO daily. Medical history: HIV (undetectable viral load), allergic rhinitis. Labs: AST 24 U/L (10–40), ALT 26 U/L (7–56), SCr 1.0 mg/dL (0.7–1.3). Allergies: NKDA. Which drug interaction poses the greatest risk to this patient?

A 62-year-old male (88 kg, 177 cm) with chronic hepatitis C cirrhosis (Child-Pugh B) is prescribed zolpidem 10 mg PO at bedtime for insomnia. Current medications: lactulose 20 g PO TID, furosemide 20 mg PO daily, spironolactone 50 mg PO daily. Medical history: cirrhosis with prior hepatic encephalopathy, ascites. Labs: albumin 2.8 g/dL (3.5–5.0), total bilirubin 2.6 mg/dL (0.2–1.2), INR 1.6 (0.8–1.2), AST 78 U/L (10–40), ALT 52 U/L (7–56). Allergies: NKDA. Which medication needs adjustment due to the patient's condition?