Medication Safety>Adverse Event Response Practice Test

A 55-year-old man presents with severe bilateral thigh pain, dark cola-colored urine, and weakness for 24 hours. Medications: simvastatin 80 mg nightly, clarithromycin 500 mg twice daily (started 3 days ago for sinusitis), lisinopril 20 mg daily, and aspirin 81 mg daily. Vitals are stable. Labs: creatine kinase 18,500 U/L, serum creatinine 1.9 mg/dL (baseline 0.9), AST 140 U/L, ALT 98 U/L, potassium 5.2 mEq/L, urinalysis positive for myoglobin. He denies trauma or strenuous exercise. The prescriber has not been reached yet. The pharmacist suspects a drug interaction causing statin-induced rhabdomyolysis.

Mr. J is a 58-year-old Black man with hypertension and type 2 diabetes who presents to the community pharmacy with sudden swelling of his lips and tongue that began 30 minutes ago. He reports hoarseness, difficulty swallowing, and a tight sensation in his throat. He denies itching or hives. Vitals: BP 148/86, HR 102, RR 24, O2 sat 94% on room air. Current meds: lisinopril 20 mg daily, hydrochlorothiazide 25 mg daily, metformin 1000 mg twice daily, ibuprofen as needed. Labs from last week: SCr 0.9 mg/dL, K 4.1 mEq/L, A1C 7.6%. He took his morning lisinopril dose 2 hours ago. The pharmacist suspects angioedema secondary to an ACE inhibitor.