EMQs in Clinical Medicine.pdf - Peshawar Medical College

236 Miscellaneous
91 Adverse drug reactions
Answers: A C I G L
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A 28-year-old man on anti-HIV therapy complains of circumoral
paraesthesia.
Adverse effects of the protease inhibitors also include fat redistribution
(e.g. buffalo hump) and metabolic disturbances, e.g. glucose intolerance
and hypertriglyceridaemia. Most protease inhibitors are cytochrome P450
inhibitors and therefore drug toxicity of other medications is possible.
A 55-year-old woman on treatment for ischaemic heart disease
complains of muscle pains.
The presence of muscle pain is not a contraindication to continuing therapy.
The presence of myositis, on the other hand, which is inflammation
of the muscle associated with markedly elevated CK levels, merits
immediate discontinuation of treatment.
There is an increased risk of myopathy if a patient is taking a statin plus a
fibrate drug, and so close monitoring of CK levels is particularly relevant
in this group of individuals. Liver function tests should be carried out
before starting treatment, a month/2 months after initiating treatment and
then repeated every 6 months. Serum transaminase levels of above around
three times the reference range are an indication to stop treatment.
A 65-year-old woman with asthma complains of wheezing and
shortness of breath after starting anti-hypertensive medication.
All blockers are contraindicated in patients with asthma, even those
that are 1 selective.
A 50-year-old woman on treatment for paroxysmal atrial fibrillation
presents with a photosensitive rash.
Patients should be advised to avoid exposure to direct sunlight because
of photosensitivity.
Corneal microdeposits occur in most patients and regress on termination
of the treatment. They rarely affect visual acuity, but some patients
may be dazzled by headlights at night.
Thyroid function tests should be carried out before treatment and
every 6 months after starting treatment because amiodarone can cause
hypo-/hyperthyroidism. This is usually reversible on withdrawal of
treatment.
A 55-year-old man on anti-hypertensive medication presents
with gout.
Thiazide diuretics reduce renal excretion of uric acid, thus increasing
plasma urate levels which may precipitate gout.