Drug Shortages And Biosimilars Practice Test

A 62-year-old man (weight 84 kg) presents to the emergency department with fever, productive cough, and shortness of breath and is being admitted for community-acquired pneumonia requiring intravenous therapy. Medical history includes type 2 diabetes and chronic kidney disease stage 3 (serum creatinine 1.8 mg/dL; estimated creatinine clearance 45 mL/min). Current medications: metformin 1000 mg by mouth twice daily, lisinopril 20 mg by mouth daily, atorvastatin 40 mg by mouth nightly. The prescriber orders ceftriaxone 1 g intravenously every 24 hours plus azithromycin 500 mg intravenously daily, but ceftriaxone is on shortage at your hospital. Which therapeutic alternative is most appropriate for this patient during the drug shortage?

A 29-year-old woman (weight 70 kg) with Crohn disease is seen in clinic for maintenance therapy. She has been stable for 8 months on infliximab (Remicade) 5 mg/kg intravenously every 8 weeks; last infusion was 7 weeks ago. Current medications: infliximab as above, azathioprine 100 mg by mouth daily, multivitamin daily. Your health system has added infliximab-dyyb (Inflectra) as the preferred product and the prescriber asks you to switch her at the next infusion. What is the best approach to substituting a biosimilar for this patient's medication?