Problem solving exercise
2023
CVS
A 45 year old patient with angina was stabilized on
isosorbide mononitrate and atenolol. After few days, he
developed erectile dysfunction. A quack advised him to
take sildenafil. He took it and within half an hour he got
sudden chest pain for which he was hospitalized.
a. What could be the reason for his condition?
b.What are the adverse effects that can occur with
nitrate therapy?
c. What is the role of nitrates in cyanide poisoning
d. Isosorbide mononitrate and Atenolol. Comment on this
prescription.
e. Mention four organic nitrate preparations available.
A 65 year old female a known case of athersclerotic angina was
prescribed a statin along with other antianginal drugs for
her increased lipid levels. 2 weeks later she had symptoms
suggestive of URI and was started on Tab. Erythromycin
following which she complaints of muscle tenderness. On
examination her CPK levels were raised.
a. What is the probable diagnosis?
b. What is the reason for the above condition?
c. What are the measures that can be taken to prevent this
complication?
d. Mention the adverse effects of Erythromycin.
e. Mention any four hypolipidemic agents along with their MOA.
CNS
A 45 year old male was brought to the casualty with severe
agitation and aggressive behaviour. He was started on
haloperidol and became responsive & co operative. After 2
weeks of treatment he developed high grade fever muscle
rigidity and abnormal behaviour.
a. What is the most probable diagnosis?
b. Outline the management for this condition.
c. Explain the rationale of drugs used here.
d. Mention the adverse effects of typical antipsychotics
e. Mention any two differences between typical and
atypical antipsychotics.
A 30 year old female, a known epileptic on long term treatment
with an antiepileptic drug presented with complaints of
tiredness and arthralgia. On examination she was found to
have gum hypertrophy, anaemia and hirsutism. Lab
investigation revealed megaloblastic anaemia and
hyperglycemia. a. Which antiepileptic is known to cause the
about effects?
b. What are the features of acute toxicity?
c. Mention two drugs for absence seizures.
d. Name four newer antiepileptic drugs.
e. Enumerate the drugs used in status epilepticus
A patient with major depressive illness was put on fluoxetine.
After 2 months as there was no improvement in the
symptoms, Phenelzine was added following which the patient
developed agitation, restlessness, rigidity, hyperthermia,
sweating, twitching followed by convulsions.
a. What is the cause for the patient’s condition. Explain
b. Mention a few drugs that can precipitate a similar condition
in patients taking fluoxetine,
c. Howa can you prevent the above symptoms when fluoxetine
and Phenelzine are to be given for the same patient?
d. What are the other uses of fluoxetine?
e. Name 4 SSRIs other than fluoxetine.
CHEMOTHERAPY
Miss.Violet, a 30 year old obese patient underwent a surgery.
Postoperatively she developed deep vein thrombosis for which she was
treated with heparin initially then switched over to warfarin after one
week. She was prescribed some antibiotic following which she developed
bleeding complications.
a. What are the antibiotics that potentiate warfarin toxicity?
b. What is the mechanism by which antibiotics enhance warfarin toxicity?
c. Mention the other drugs which enhance the anticoagulant action of
warfarin.
d. What is the antidote for Warfarin?
e. How will you adjust the dose of oral anticoagulants?
44 year old male diagnosed to have tuberculosis was prescribed
newly diagnosed drug sensitive TB regimen for the past 4 months.
He developed paraesthesia and tingling sensation of toes and
fingers.
a. What is cause for paraesthesia and how will u prevent it?
b. Mention the first line anti TB drugs along with their MOA
c. . Mention any two adverse effects for all the first line drugs.
d. What is multidrug resistant TB & extensive drug resistant TB ?
e. What are the indications of chemoprophylaxis of tuberculosis?
A 40 year old male PLHA patient who was on Zidovudine, Lamivudine
and Nevirapine for past 3 years comes to the ART centre for review.
Lab investigations revealed Hb – 6.4 gm% and the patient was
diagnosed to have anemia. CD4 count – 320 cells/cumm.
a. Which of the above drugs is responsible for the patient’s condition? Explain
b. What is the alternate regimen preferred in this patient?
c. Mention any four newer antiretroviral drugs along with their MOA.
d. Mention the primary prophylaxis regimen for pneumocystis jiroveci
pneumonia for a HIV patient with CD4 count < 350 cells/cumm.
e. What is substitution and switch of in ART regimen.
A fifteen day old preterm new born was diagnosed to have LRI and was
prescribed syrup cotrimoxazole following which the baby developed
encephalopathy.
a. What is cotrimaxazole?
b. What is the cause for development of encephalopathy in this baby?
c. What are the other adverse drug reactions of Cotrimoxazole?
d. What is the rationale behind this fixed dose combination?
e. Mention any two combinations of sulfonamides available in the market along
with their indications
A 56 year old man was administered Penicillin IV, within 5 minutes he
developed urticaria, swelling of lips, hypotension and bronchospasm.
a. What is the diagnosis?
b. How will you treat this patient?
c. What precaution will you take before administering penicillin?
d. Mention the antimicrobial agents inhibiting cell wall synthesis
e. What is Jarisch Herxheimer reaction?
Mr.Moorthy, a sales manager was taking treatment for intestinal
amoebiasis. On the 3rd day of treatment, he attended a cocktail party, but
left it early as he felt uneasy & restless. He also developed intense
flushing, severe nausea, giddiness, headache, sweating and chest pain. BP
was 100/70mmHg.
a. Explain the cause for the patient’s symptoms
b. Name four drugs that cause similar reaction in a patient who consumes alcohol.
c. Mention the drugs available for extraintestinal amoebiasis.
d. What is paramomycin?
e. How will you manage a case of amoebic liver abscess.
NSAIDs
Mr. Suresh, 60 yr old male, a known peptic ulcer patient had severe knee
joint pain. He went to a medical shop and asked for medicine to relieve his
pain. The pharmacist gave him a tablet and his problem resolved, but he
developed severe epigastric pain & vomiting which was blood stained.
1. What could be the reason for haematemesis?
2. What could be the alternative NSAID analgesics suitable for this patient? Justify
3. What is the role of Prostaglandins in peptic ulcer?
4. Name the PG analogue used in peptic ulcer.
5. Write 2 other uses of prostaglandins.
