EMQs in Clinical Medicine.pdf - Peshawar Medical College

232 Miscellaneous
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Intravenous/liposomal amphotericin is the treatment of choice for
invasive aspergillosis.
As a result of the risk of anaphylaxis, a small test dose of amphotericin
should be given before the first infusion. Common adverse effects include
nausea, vomiting, diarrhoea and headache. More severe adverse effects
include hearing loss, diplopia, convulsions and peripheral neuropathy.
Amphotericin is associated with renal toxicity and so it is important to
monitor urea and electrolytes daily. Disturbances in renal function can
lead to hypokalaemia (causing arrhythmias) and hypomagnesaemia.
First-line treatment for a 23-year-old woman complaining of vaginal
itchiness and thick curd-like discharge.
This is a presentation of vulvovaginal candidiasis, commonly referred
to as thrush. Medical treatment can be topical with the use of azole
pessaries/creams. Alternatively, single dose oral treatment with a triazole,
e.g. fluconazole, can be used.
A 45-year-old woman requires treatment for fungal toenail infections.
She is on warfarin anticoagulation.
Oral terbinafine is the treatment of choice for the systemic treatment of
onychomycosis. The azoles are cytochrome P450 enzyme inhibitors and
so their use could result in enhanced toxicity of warfarin (which is
metabolized by cytochrome P450 enzymes).
Griseofulvin can also be used for the treatment of nail infections. It is a
cytochrome P450 enzyme inducer and therefore its use would reduce the
level of anticoagulation provided by the warfarin dose. The precipitation/
aggravation of systemic lupus erythematosus (SLE) is a rare but wellrecognized
adverse effect of griseofulvin treatment.
A 31-year-old HIV-positive man presents with pneumonia that began
with a dry cough. His chest radiograph shows bilateral perihilar
interstitial shadowing.
This is the presentation of Pneumocystis carinii pneumonia (PCP).
Co-trimoxazole is a combination of one part trimethoprim to five parts
sulfamethoxazole. The sulphonamide component is associated with several
adverse reactions, e.g. Stevens–Johnson syndrome and blood
dyscrasias. Therefore, such combination therapy is restricted to conditions
such as PCP where the synergistic activity merits its use.
The use of corticosteroids has been shown to be of some benefit in the
treatment of PCP when the patient is hypoxaemic (PaO 2 9.3 kPa).
88 Antiviral therapies
Answers: A J C L F
A 35-year-old man presents with a vesicular rash in a band over the
umbilical area.