Background: Contemporary treatment for COVID-19 includes the use of SARS-2-CoV direct-acting antivirals (DAAs). An FDA assessment in the Medicare and Veterans Affairs population has suggested that individual agents in this class have significant differences in drug-drug interaction (DDI) potential based on their pharmacokinetic profiles; however, the clinical impact is not well established. We sought to [...]

Background: Warfarin is commonly used in long-term anticoagulation and has a narrow therapeutic index. Dosing is dependent on intrinsic patient variables including cytochrome P450 2C9 (CYP2C9) and VKORC1 polymorphisms. High protein binding and CYP-dependent clearance mechanisms of NSAIDs also affect warfarin serum levels. This study investigates the observed pharmacologic interaction of concurrent NSAID and warfarin [...]

Case Presentation: A 66 year old man presents with progressive weakness and diffuse myalgias. He has been on antibiotic treatment for an infected iliac artery stent which was removed on recent hospitalization. He was discharged in good condition on IV daptomycin and ceftriaxone. He presented one week after discharge and was found with an acutely [...]

Case Presentation: A 65-year-old woman with hepatitis C-induced liver cirrhosis status-post liver transplantation, coronary artery disease and gout, presents with one week of progressive fatigue, weakness, and severe pain in her right leg and left shoulder. She was on atorvastatin for cardiac disease and had recently started Ledipasvir/Sofosbuvir for hepatitis C two months prior. She [...]

Case Presentation: 52-year-old female with history of Stage IIIA triple negative right sided breast cancer, seizure disorder, and s/p lumpectomy presents with ataxia, confusion, and dyskinesia over the past 2 weeks. The patient is chronically on phenytoin, ondansetron, paroxetine, and potassium supplements. She has been on phenytoin since her last seizure three years ago. She [...]

Case Presentation: A 55 year old non obese African American male with the past medical history of HIV on tenofovir/emtricitabine/efavirenz and HCV genotype 1 infection who was being treated with ledipasvir/sofosbuvir came in with complaints of increased urinary frequency, nocturia, increased thirst and fatigue of 2 weeks duration. He denied any fever, chills, dysuria, abdominal [...]

Case Presentation: A 58-year-old man presented with two days of confusion, tremors and seizures. Past medical history included schizophrenia, epilepsy, HCV infection and right hemiparesis due to ischemic strokes. He initiated dasabuvir, ombitasvir, paritaprevir and ritonavir (Viekira Pak) three days earlier. His epilepsy had been well controlled on lamotrigine for years. Review of systems was [...]

Case Presentation: A 75-year-old white male presented to the Emergency Department with a 2-day history of gait disturbance, flailing bilateral upper extremity movements, and confusion. His wife stated that his symptoms had been occurring for the past 1 month and acutely worsened over the past several days. For the past year, he had been evaluated [...]

Case Presentation: A 69-year-old lady with a history of Psoriatic Arthritis on Methotrexate (MTX) and CKD stage III was admitted to the hospital with mucositis and leukopenia. Sixteen days prior to the admission she was prescribed Trimethoprim-Sulfamethoxazole (Bactrim) for UTI. A week after that she presented to ED and was discharged with impression of Hand, [...]