Clinical Case Based Questions in Pharmacology

Posted on
  1. 65/F
    • C/O-
      • Pain in both knees
      • More pain on left side
      • Worsened by walking or standing for some time
    • X-Ray-
      • Narrowing of joint space
      • Mild effusion
      • Osteophytic projections
    • H/O-
      • Heart attack 1year ago
      • Treated by angioplasty
      • Stent was placed.
    • Drug History-
      • 75mg Aspirin daily for myocardial infarction prophylaxis
    • Diagnosis-
      • Osteoarthritis of Knee
    • Questions-
      • Which analgesic/NSAID will be suitable for relieving her knee pain?
      • Which analgesic/NSAID should not be prescribed for her?
      • Whether any locally applied medication can be helpful in relieving her knee pain.
      • Explain MOA, adverse effects, uses of NSAID.
  2. 55/F-
    • C/O-
      • Visual difficulty for past few months
      • Later noticed “halos” around lights
      • Dull Chronic ache in forehead region
    • Tonometry-
      • Intraocular Pressure- 22mmhg & 24mmhg left and right eye respectively.
    • Question-
      • Suitable mydriatic for fundus examination and why?
      • Enumerate drugs for glaucoma
      • Explain MOA & Adverse effects of prostaglandin analogues
      • Management of Acute congestive narrow angle glaucoma.
  3. 30/M-
    • C/O-
      • Episodic breathlessness often following exertion
      • 1-3 episodes per day accompanied by wheezing
      • Every 2-3 days wakes up night with breathlessness
      • Alleviated by 2 puffs of inhaler(Salbutamol 100 micro g/puff)
    • Spirometry
      • FEV: 70% of preedicted value at baseline
      • 88% after 2 puffs of Salbutamol
    • Diagnosis-
      • Moderate bronchial asthma
    • Question-
      • Is the patient receiving adequate treatment for his conditon? or some othe drug/drugs need to be used? if so, what should be the first line treatment for this patient?
      • In case another drug is prescribed, should this patient continue to use salbutamol inhalations to releive episodes of breathlessness when they occur?
      • Which alternative drug can be used in this patient?
      • Briefly explain the mechanism of action, adverse effects and therapeutic uses of theophylline.
  4. A 60 year old male patient of moderately severe chronic obstructive pulmonary disease
    (COPD with FEVI, 45% of predicted, who has quit smoking for the last 5 years and is maintained on Ipratropium br. 20 pg/puffmetered dose inhaler, 2 puffs 3 times a day, and Theophylline 400 mg SR tab. twice a day, developed sore throat and fever. He was
    prescribed Tab Erythromycin 250 mg, one tab 4 times day for 5 days Tab Paracetamol 500mg 3 times a day till fever persists After 3 days he presented with pain in epigastrium, restlessness, irritability, inability to sleep, palpitation, tremor of fingers and hand and had vomited twice. His fever had subsided and throat was better.
    • a) What could be the reason for his recent illness?
    • b) Could this illness be prevented, if so, how?
    • c) Classify drugs used in bronchial asthma.
    • d) Describe the mechanism of action, adverse effects and therapeutic uses theophylline
  5. A known case of bronchial asthma patient did not respond to routine treatment. He developed severe breathlessness, tachycardia, and dehydration. What is this condition? How will you treat this patient?
  6. A 72-year-old man attends emergency department following a fall. He reports that while walking from one room to another at home, he tripped on the rug and fell forwards onto his knees. He has no significant medical history and does not take any regular medications. He lives alone. He is a smoker and an alcoholic. On examination he is alert, oriented and general and systemic examination is unremarkable. On neurological examination he had bilateral increased tone in the upper limb, with a pronounced resting tremor, with cogwheel rigidity. There is a slow, rhythmic pill
    rolling tremor in the left hand. The patient’s face appears expressionless and his speech monotonous. He walks with a shuffling gait. This patient is diagnosed to have an underlying Parkinson’s disease.
    • Classify drugs used for Parkinson’s disease treatment. Why is levodopa preferred rather than dopamine for this patient?
    • Enumerate the drugs and the rationale of combining various drugs with levodopa?
    • Explain the pharmacotherapy of drug induced Parkinsonism?
  7. A 65-year-old woman is diagnosed to have open angle glaucoma. She is inadvertently applying excessive pilocarpine drops to her eyes.
    • What is the mechanism of action of pilocarpine?
    • Enumerate the other classes of drugs used in the pharmacotherapy of open angle glaucoma and elaborate their mechanism of action.
  8. A 29-year-old female presents with symptoms suggestive of multi drug resistant pulmonary tuberculosis. Sputum positive for acid fast bacilli and resistant to isoniazid.
    • Enumerate the various classes of anti-tubercular drugs used in MDR- TB and briefly discuss the mechanism of action and adverse effects.
    • Categories of treatment regimens used in treatment of MDR-TB.
    • What are the interactions of the anti-tuberculous drugs and oral contraceptives. Brief on the management of such interactions.
  9. A pregnant lady with easy fatigability and pallor was diagnosed with iron deficiency anaemia. Enumerate oral and parenteral iron preparations. List out the adverse effects of oral iron. Explain the rationale of supplementing folic acid with iron.
  10. A 55-year-old man presented with complaints of tightness and discomfort over middle part of chest felt episodically, particularly after walking briskly or climbing stairs. This
    relieved with 5 — 10 minutes of rest. One or two episodes occur practically every day. He is a past smoker who quit smoking 5 years back. The pulse was 90/min and BP 124/82 mmHg. The resting ECG was normal, but the stress test was positive. A diagnosis of exertional angina was made.
    • Classify drugs used for the above clinical condition.
    • Describe the mechanism of action, uses and adverse effects of nitrates.
    • Add a note on drug therapy in myocardial infarction.
  11. A 40-year-old man on treatment for epilepsy is not adequately controlled. He needs newer antiepileptic agents.
    • Mention two newer antiepileptic agents.
    • Explain how these two drugs act.
    • Mention their adverse effects.
  12. During routine medical checkup, a 50-year male office executive with sedentary lifestyle was diagnosed to have developed type 2 diabetes mellitus. His fasting and post-meal blood glucose levels were 130 mg/dl and 190 mg/dl respectively, HbA1C was 7.8%, BP was 130/82 mmHg and body mass index was 27 kg/m2. He was advised suitable diet, exercise, and anti-diabetic drugs.
    • Classify anti diabetic drugs
    • Describe the mechanism of action, uses and adverse effects of Metformin.
    • Add a note on clinical benefits and adverse effects of sodium glucose cotransport-inhibitors (SGLT-2) in type two diabetes mellitus.
  13. A 20-year-old Ram was brought to the hospital with a continuous fever for the past 7 days. He also complains of abdominal pain, bloating, loose motions, loss of appetite,
    occasional vomiting, weakness, malaise, and cough. On examination, he looks ill, mildly dehydrated with a coated tongue. Pulse is 70 / min, abdomen is distended and tender
    on pressing, liver and spleen are palpable. The total leucocyte is 5000 /mm3. A provisional diagnosis of typhoid fever is made.
    • Enumerate the drugs used for the above clinical condition.
    • Explain the appropriate selection of antimicrobials
      for the treatment of multidrug resistant typhoid.
  14. A 60-year-old woman with deep vein thrombosis is given a bolus of heparin, and a heparin drip is also started. Thirty minutes later, she is bleeding profusely from the intravenous site. The heparin has stopped but the bleeding continues. The physician decided to administrate antidote to reverse the adverse effect of heparin.
    • What is the antidote for heparin and how does it act?
    • Write the mechanism of action of heparin and how you can monitor heparin dosage.
    • Low molecular weight heparin: advantages and mention its mechanism of action.
  15. A 75-year-old man has a fever of 1040F. He develops cough that produces blood-tinged sputum with gram positive cocci in clusters. A chest X-ray showed increased density in the right upper lobe.
    • Which penicillin group is indicated for the above patient?
    • What is the mechanism of action of penicillins?
    • Adverse effects and therapeutic uses of penicillins.
  16. A 45-year-old male came to the OPD with C/O recurrent headache, palpitations, and giddiness for the past one week. On examination, his BP was found to be 150/100 mm Hg.
    • Classify the drugs that are used in this condition.
    • Describe the mechanism of action, adverse effects, and contraindications of beta blockers.
    • Write briefly on the management of hypertensive emergencies.
  17. Mention the initial drug for a 45-year-old obese male, newly diagnosed case of type 2 diabetes mellitus. Explain the mode of action and the advantages of the chosen drug.
  18. A 43 years old male patient succumbed to head injury. Why is morphine contraindicated for him? What are the other contraindications of morphine?
  19. A 55-year-old man presented to the emergency department with acute attack of chest pain relived with rest. A drug that was given sublingually terminated this acute attack.
    • What is the probable diagnosis?
    • Name the drug.
    • Classify the group to which the drug belongs.
    • Discuss the mechanism of action of that drug with a diagram.
    • Enlist the adverse effects.
    • Enumerate two drug interactions.
  20. A 38 years old male come to the OPD with a BP of 200/100 mm Hg. He was asymptomatic.
    • What is the condition?
    • Name the drugs that can be used here.
  21. A 28 years old man presents with high grade intermittent fever with chills and burning micturition. Urine culture shows heavy growth of gram-negative bacilli.
    • What drugs can be used here for treatment?
    • Mention the drug’s mechanism of action.
  22. A 54-year-old male patient presents to the department with hyperventilation, dehydration 70/30 mmHg. He is a known case of type mellitus who is on irregular treatment.
    • What is your diagnosis?
    • Classify the insulin analogues.
    • What are the adverse effects of insulin therapy?
    • Outline the management for this patient.
    • Add a note on insulin resistance.
    • Route and site for insulin injection.
  23. A 20 years old man is suffering from allergy.
    • Which antihistaminic drug is better for him? Justify.
    • What adverse effects can they cause?
    • What other drug(s) are used for allergy?
  24. A cardiac surgeon consults you with the following problem: During a surgical procedure he got exposed to a 26-year-old female patient’s blood through a piercing injury on the finger. A needle had penetrated across his gloves and skin to a depth of 2-3 mm but was withdrawn immediately and the area washed under running water. On enquiry, the patient revealed that one year back she had tested HIV positive but was asymptomatic and not taking any anti-HIV medication.
    • Should the cardiac surgeon be advised to take post-exposure prophylactic medication for HIV or is no medication indicated under the circumstances?
    • If medication is advised, which drug/drugs and duration of use would be appropriate?
    • Explain the mechanism of action, adverse effects, and uses of non-nucleoside reverse transcriptase inhibitors.