Answers in TBL Infection

8/3/2019 Answers in TBL Infection

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CASE STUDIES ON "ADVERSEEFFECTS OF ANTIMICROBIAL

CHEMOTHERAPY"

TBL Pharmacology ,Semester III, Module of Infection and Immunity


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52 years old man

abdominal pain, which have beenworsening over the past week. He is nowhaving 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/clavulanicacid for pneumonia.

Case No 1:


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1. 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 forsuch a case?

a.Pneumonia infection.b. Clavulanic acid.c. Amoxicillin.

d. Dehydration


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3. Mention the famous drug toproduce this condition?

a. Penicillin G.

B. Clindamycin.C. Streptomycin.D. Spectinomycin


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Case No: 259-year-old man received one of the macrolide group ofantibiotic for cough treatment afterhe has been taking numerous over-the-counter coldmedications without relief

has had to use his ipratropium inhaler more often thanusual.

after three day therapy the patient suffered fromventricular arrhythmia with prolongation of Q-T

interval.


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

a. Erythromycin.b. Azithromycinc. Ketolidesd. Clarithromycin


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Case Number 3:

A 20 -year-old femaleThe patient condition was diagnosed as acutetonsillitis, and penicillin G injections have beenprescribed to her.

On the following month, while the nurse was giving thepatient the injection, the patient was suddenlycollapsed, with fainting, cyanosis and severe pallor.

On examination, the radial pulse cannot be felt, and thesystolic blood pressure was 40 mmHg while diastolicpressure cannot be traced. A diagnosis ofanaphylacticshock was made.


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6- 10 percent of cases allergic topenicillin, have cross sensitivity withcephalosporin, this is because:

a. Both are macrolide antibiotics.

b. Both have beta lactam ring.c. They have idiosyncratic effect.d. All the members are destructedwith penicillinase enzyme.


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Case Number 4:

A woman presented her 5-years oldson to the pediatric dental office witha certain heath problem. The physiciannoticed yellowish discoloration which

is non brush able. She mentioned thatthis color was found since years .


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7. What is the antibiotic responsible for this color:a. Co-trimoxazole.

b. Tetracyclinesc.Chloramohenicol

d. Clindamycin.

8. The time of exposure that enhances thisproblem is :

a.During fetal life.b. In nursing period

c. In early child hood.d. Any of the above.


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10-This can be avoided by Proper:

a. Diagnosis early.b. Dose adjustment.c. Feeding.

d. Warming the baby.


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Case Number 6:

A 72-year-old female , fever and altered mentalstatus. ,as an indwelling Foley catheter as a

consequence of urinary incontinence.

A urinalysis ..... numerous count white bloodcells and bacteria.

Blood and urine cultures also grow gram-positivecocci. She was treated with vancomycin and an

aminoglycoside


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11.Aminoglycoside toxicity Doesn'tinclude the following:

a. Nephrotoxicity.b. Neuromuscular blockade.c. Megaloblastic anemia.

d. Hypersensitivity


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- A therapeutic regimen was planned for afemale patient diagnosed as having chronic

hepatitis C virus infection. The age of thepatient is 35 years, body weight of 57kilograms. Biochemical tests revealedmoderate elevation of the liver enzymes; AST

and ALT without impairment of liver function.

Case Number 7


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One of the Lab tests that should be done todetect an important side effect of the

selected drug is:a-Blood amylase levelb-Complete blood picturec-Blood sodium leveld-Blood lactic acid level

Sustained virological response can beincreased by adding the following drug to thepreviously selected one:a-Interferon beta.b-Ribavirin

c-Telbivudined-Tenofovir

A drug that must be included in the therapeuticregimen of this patient is:a- Interferon alphab-Lamivudinec-Adefovir

d-Entecavir


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Among the patient factors in this case thatsuggest good virological response totreatment are:

a-Age of the patient.b-Intact liver function.c-Level of liver enzymes.d-All of above.

Adding the drug chosen in 1c to the therapeutic regimenincreases the risk of the following side effect:a-Hepatotoxicity.

b-Anaemiac-Neurotoxicityd-Thyroid dysfunction

C N b 8


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A 20-year-old woman with leukemia wasundergoing chemotherapy with intravenous

antineoplastic drugs. During treatment, shedeveloped a systemic infection from an opportunisticpathogen. There was no erythema or edema at thecatheter insertion site. A white vaginal discharge was

observed. After appropriate specimens wereobtained for culture, empiric antibiotic therapy wasstarted with gentamicin, nafacillin, and ticarcillinintravenously. The patients condition did not

improve significantly. Her throat was sore and whiteplaques had appeared in her pharynx. On day 4, boththe blood and urine culture grew out Candidaalbicans and no bacterial growth.

Case Number 8


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The best course of action is to:

a. Continue current antibiotics and startamphotericin B

b. Continue current antibiotics and startflucytocine

c. Continue current antibiotics and start

ketoconazoled. Stop current antibiotics and start

amphotericin B


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If amphotericin B administered,

the patient should be

premedicated with:

a. Diphenhydramineb. Ibuprofen

c. Prednisone

d. Any or all of the above


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14.The dose limiting toxicity

of amphotericin B is

a. Hepatitis

b. Hypotensionc. Renal tubular acidosis

d. Infusion related adverse effects


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15.The opportunistic fungal

infection in this patient could

have been prevented by

administration of

a. Nystatin

b. Ketoconazole

c. Amphotericin Bd. None of the above


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Remember

Penicillins

Hypersensitivity ReactionsGIT symptoms with oral

penicillins


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Aminoglycosides

Ototoxicity

NephrotoxicityNeurotoxicity


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Chloramphenicol

Grey baby syndrome

Anemia Types ?

Drug Interactions


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TetracyclineFluoroquinolne

Bone , teeth effectsTendon and cartilage

effects

Photosensitivity


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SULPHONAMIDES

Hypersensitivity

Haemolytic anemia ?

Kernictrus ?

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Answers in TBL Infection