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Adverse Effects of Antimicrobials
Transcript of Adverse Effects of Antimicrobials
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CASE STUDIES ON "ADVERSE
EFFECTS OF ANTIMICROBIAL
CHEMOTHERAPY"
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Case 1- A therapeutic regimen was planned for
a female patient diagnosed as having chronic
hepatitis C virus infection. The age of thepatient 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.
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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-Telbivudined-Tenofovir
A drug that must be included in the therapeutic
regimen of this patient is:
a- Interferon alpha
b-Lamivudine
c-Adefovir
d-Entecavir
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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.
Adding the drug chosen i to the therapeutic regimen
increases the risk of the following side effect:
a-Hepatotoxicity.
b-Anaemiac-Neurotoxicity
d-Thyroid dysfunction
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A 20-year-old woman with leukemia was undergoing
chemotherapy with intravenous antineoplastic drugs.
During treatment, she developed fever, cough. Her
throat was sore and white plaques appeared in her
pharynx. Blood neutrophilic count was 400/l. After
appropriate specimens were obtained for culture,empiric antibiotic therapy was started with
gentamicin, nafcillin, and ticarcillin intravenously.
The patientscondition did not improve . On day 4,
both the blood and urine culture grew out Candida
albicansand no bacterial growth.
Case Number 2
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Possible fungal infections: Persistent fever,
neutropenia, chest symptoms, or the presence of
pulmonary infiltrations on chest radiographs
Probable fungal infections: Persistent fever,
neutropenia, and infiltrates characteristic of fungal
pneumonia on a CT
Proved fungal infections: Typical infiltrates on a CTand detection of moulds in bronchoalveolar lavage or
bronchial secretions by culture during neutropenia
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The best course of action is to:
a. Continue current antibiotics and start
amphotericin B
b. Continue current antibiotics and start flucytocinec. Continue current antibiotics and start
ketoconazole
d. Stop current antibiotics and start amphotericin B
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Before administering amphotericin, the
patient is better to be premedicated with:
a. IV fluidsb. NSAID
c. Corticosteroid
d. All of the above
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The dose limiting toxicity of amphotericin B is
a. Hepatitis
b. Hypotensionc. Nephrotoxicity
d. Anaphylactic shock
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The opportunistic fungal infection in this
patient could have been prevented byadministration of:
a. Nystatin
b. Fluconazolec. Amphotericin B
d. None of the above
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A 52 year old man presents with abdominal pain,which has been worsening over the past week.
He is now having 8-10 watery stools a day and
mild cramping pain. About 10 days ago reveledthat he has completed a course of
amoxicillin/clavulanic acid for pneumonia. A
stool culture is negative but specific toxin assay
is positive. The condition was diagnosed as
Pseudomembranous colitis.
Case No 3
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1. What is the predisposing factor for
such a case?a. Low immunity.
b. Age of the patient
c. Amoxicillin/ Clavulenic acid.d. Dehydration
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2. Pseudomembranous colitis is afrequent complication of the following
antibiotic:
a. Penicillin G.B. Clindamycin.
C. Streptomycin.
D. Vancomycin
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Case No: 4
A 59-year-old man received one of the macrolidegroups of antibiotics for cough treatment after he has
been taking numerous over-the-counter cold
medications without relief. After three days therapy
the patient suffered from cardiac arrhythmia. What isthe possible explanation for this arrhythmia?
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Case No: 5
The patient received erythromycin which inhibitedhepatic metabolism of the antihistaminic present in
OTC cough therapy, resulting in increased serum
concentration of the antihistaminic and appearance of
one of antihistaminic side effects which is arrhythmia.
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3.An antibiotic that doesn't inhibit CYP-450enzymes:
a. Telithromycin.
b. Azithromycin
c. Clarithromycind. Any of the above
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Case Number6:
A child while receiving his second procainepenicillin injection ( for treatment of acute
tonsillitis) suddenly collapsed, with fainting,
cyanosis and severe pallor. A diagnosis ofanaphylactic shock was made.
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Case Number 7:
A woman presented her 5-years old son to thepediatric dental office with a certain heath
problem. The physician noticed yellowishdiscoloration which is nonbrush able. Shementioned that this color was found since years .The doctor asked the woman of previous exposure
of the child to drugs.
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5. 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.
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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 ?