TBL Pharmacology ,Semester III, Module of Infection and Immunity

CASE STUDIES ON "ADVERSE EFFECTS OF ANTIMICROBIAL CHEMOTHERAPY"

Case No 1:

52 years old man abdominal pain, which have been worsening over the past week. He is now having 8-10 watery stools a day and mild cramping pain.
NO illness, fever, ill contacts. history, about 10 days ago reveled that he has completed a course of amoxicillin/clavulanic acid for pneumonia.

. What is the name for this case?

a. Traveler diarrhea. b. Pseudomembraneous colitis. c. Cholera infection. d. Viral gastroenteritis

2. Which

is the predisposing condition for such a case? a. Pneumonia infection. b. Clavulanic acid. c. Amoxicillin. d. Dehydration

3. Mention the famous drug to produce this condition?

a. Penicillin G. B. Clindamycin. C. Streptomycin. D. Spectinomycin

Case No: 2
59-year-old man received one of the macrolide group of antibiotic for cough treatment after he has been taking numerous over-the-counter cold medications without relief has had to use his ipratropium inhaler more often than usual. after three day therapy the patient suffered from ventricular arrhythmia with prolongation of Q-T interval.

5.One macrolide that doesn't inhibit CYP-450

enzymes: a. Erythromycin. b. Azithromycin c. Ketolides d. Clarithromycin

Case Number 3:

A 20 -year-old female The patient condition was diagnosed as acute tonsillitis, and penicillin G injections have been prescribed to her. On the following month, while the nurse was giving the patient the injection, the patient was suddenly collapsed, with fainting, cyanosis and severe pallor. On examination, the radial pulse cannot be felt, and the systolic blood pressure was 40 mmHg while diastolic pressure cannot be traced. A diagnosis of anaphylactic shock was made.

6- 10 percent of cases allergic to penicillin, have cross sensitivity with cephalosporin, this is because:
a. Both are macrolide antibiotics. b. Both have beta lactam ring. c. They have idiosyncratic effect. d. All the members are destructed with penicillinase enzyme.

Case Number 4:

A woman presented her 5-years old son to the pediatric dental office with a certain heath problem. The physician noticed yellowish discoloration which is non brush able. She mentioned that this color was found since years .

7. What is the antibiotic responsible for this color: a. Co-trimoxazole. b. Tetracyclines c.Chloramohenicol d. Clindamycin.

8. The time of exposure that enhances this problem is : a.During fetal life. b. In nursing period c. In early child hood. d. Any of the above.

Case Number 5:
A premature baby treated with an antibiotic for severe infection, and then he begins to be cyanosed (Ash skin color), flaccid with poor reflexes, unable to suckle, vomiting, collapses and hypothermia.

Chloramphenicol

9.This occurs due to its effect on :

a. Immature glucoronidation. b. Immature excretion. c. Accumulation of the drug. d. All of above

10-This can be avoided by Proper:

a. Diagnosis early. b. Dose adjustment. c. Feeding. d. Warming the baby.

Case Number 6:

A 72-year-old female , fever and altered mental status. ,as an indwelling Foley catheter as a consequence of urinary incontinence.

A urinalysis ..... numerous count white blood cells and bacteria.

Blood and urine cultures also grow gram-positive cocci. She was treated with vancomycin and an aminoglycoside

11.Aminoglycoside toxicity Doesn't include the following: a. Nephrotoxicity. b. Neuromuscular blockade. c. Megaloblastic anemia. d. Hypersensitivity

- A therapeutic regimen was planned for a female patient diagnosed as having chronic hepatitis C virus infection. The age of the patient is 35 years, body weight of 57 kilograms. Biochemical tests revealed moderate elevation of the liver enzymes; AST and ALT without impairment of liver function.

Case Number 7

A drug that must be included in the therapeutic regimen of this patient is: a- Interferon alpha b-Lamivudine c-Adefovir d-Entecavir

One of the Lab tests that should be done to detect an important side effect of the selected drug is: a-Blood amylase level b-Complete blood picture c-Blood sodium level d-Blood lactic acid level

Sustained virological response can be increased by adding the following drug to the previously selected one: a-Interferon beta. b-Ribavirin c-Telbivudine d-Tenofovir

Adding the drug chosen in 1c to the therapeutic regimen increases the risk of the following side effect: a-Hepatotoxicity. b-Anaemia c-Neurotoxicity d-Thyroid dysfunction

Among the patient factors in this case that suggest good virological response to treatment are: a-Age of the patient. b-Intact liver function. c-Level of liver enzymes. d-All of above.

Case Number 8

leukemia was undergoing chemotherapy with intravenous antineoplastic drugs. During treatment, she
20-year-old woman with

developed a systemic infection from an opportunistic pathogen. There was no erythema or edema at the catheter insertion site. A white vaginal discharge was observed. After appropriate specimens were obtained for culture, empiric antibiotic therapy was started with gentamicin, nafacillin, and ticarcillin intravenously. The patients condition did not improve significantly. Her throat was sore and white plaques had appeared in her pharynx. On day 4, both the blood and urine culture grew out Candida albicans and no bacterial growth.

The best course of action is to:

a. Continue current antibiotics and start

amphotericin B b. Continue current antibiotics and start flucytocine c. Continue current antibiotics and start ketoconazole d. Stop current antibiotics and start amphotericin B

If amphotericin B administered, the patient should be premedicated with:

a. Diphenhydramine
b. Ibuprofen

c. Prednisone
d. Any or all of the above

14.The dose limiting toxicity of amphotericin B is

a. Hepatitis b. Hypotension c. Renal tubular acidosis d. Infusion related adverse effects

15.The opportunistic fungal infection in this patient could have been prevented by administration of
a. Nystatin b. Ketoconazole

c. Amphotericin B
d. None of the above

Remember

Penicillins Hypersensitivity Reactions GIT symptoms with oral penicillins

Aminoglycosides
Ototoxicity

Neurotoxicity

Nephrotoxicity

Chloramphenicol

Grey baby syndrome

Anemia

Types ?

Drug Interactions

Tetracycline

Fluoroquinolne

Bone , teeth effects

Tendon and cartilage effects

Photosensitivity

SULPHONAMIDES

Hypersensitivity

Haemolytic anemia ?

Kernictrus ?