clinical problem presentation pptppt.pptx

Presentations

1. Clinical problems-CNS

2. 1.Mr. X suffering from schizophrenia was given T. Chlorpromazine 100mg. After 10 days he developed muscle rigidity & tremor. The patient was assured & advised to take T. Levodopa 250 mg twice daily. What could it be? Is the treatment option (L DOPA) correct or not? Give reason for your answer. How will you manage? Why?

3. 2.Miss CK 20 years old patient has been on Tablet Lithium 1200mg/day of lithium for the past 1 year. She complains of tiredness, weight gain, intolerance to cold and slowing down. What is the most likely cause for this? How will you manage?

4. 3.A 35-year-old Patient whom is a known case of schizophrenia is brought with the history of fever, cough with expectoration. Drug history revealed that he is on clozapine. On examination - ulcers were found in mouth and throat. Small petechiae were found on the abdominal wall. What could be the possible reason and what investigation will you order to confirm or rule out this?

5. 4. Mr LM 55 years old male had been taking Tab carbidopa and levodopa 25/250 four times a day for the past 1 year. Initially for 6 months he was symptom free. Now he complains of some symptoms for the past 6 months. Nearly every day he has periods of immobility in which he cannot move followed by a sudden switch to a fluid like state often associated with dyskinetic activity. But he has been continuing the drug. But at times, 3 to 4 hours after taking the drug he feels like frozen particularly when he needs to move quickly. What could it be? Explain. How can you manage?

6. 5. A 27 years old woman who has been taking Tablet Phenytoin 400mg per day and sodium valproate 2000mg per day comes to the OPD with the history of amenorrhoea for 6 weeks and urine pregnancy test is found to be positive. While eliciting history it is known that despite taking oral contraceptive pills ( norgestrel 0.3mg with ethinyl estradiol 30mcg) regularly she has become pregnant. Explain the reason for contraceptive failure. What are the physiological changes in pregnancy that may affect the pharmacokinetics of AEDs?

7. 6.Mrs KV a 55-year-old lady with a history of complex partial seizures and a mechanical valve replacement comes to the OPD with the complaint of increase in seizure episodes. On eliciting drug history, it is known that she had been concomitantly treated with carbamazepine 600mg per day and warfarin 7.5 mg per day. Her INR ranged between 2 and 3 in the past 18 months. The doctor prescribed levetiracetam instead of carbamazepine thinking that levetiracetam will not have an adverse effect on bone density. Now the patient is on levetiracetam 500mg bd and warfarin7.5mg per day. After 2 weeks the patient comes to the OPD abdominal pain and nasal bleeding. Ecchymosis and petechiae were noted on her back and legs. Her INR is 9.5. Can you explain this increased INR and bleeding episode?

8. 7. A 29 years old man was on 1200mg per day of carbamazepine in 2 divided doses. In spite of that he continued to have seizures frequently. serum concentration of carbamazepine was 14mcg per ml. Thinking to replace carbamazepine with sodium valproate he added sodium valproate slowly and increased to 1000 mg twice daily. The patient is now on valproate 2000mg per day and carbamazepine 1200mg per day. At this dose the patient experiences symptoms of carbamazepine intoxication like double vision, unsteady gait and drowsiness. carbamazepine Serum concentration is 12mcg per ml and sodium valproate concentration is 40mcg per ml. Why does the patient experience CBZ intoxication even with the same plasma concentration which was previously well tolerated?

9. TOXICOLOGY-1 A 45-year-old man is brought with slurred speech, incoordination, nystagmus, memory loss and history of alcohol intake. His breath smells of alcohol and his blood alcohol concentration is found to be high. He is diagnosed with alcohol intoxication. • What is the line of management? • What is the role of glucose administration? • Name the drugs used in alcohol deaddiction programme with their mechanisms of action.

10. TOXICOLOGY-2 A 30-year-old female is brought with the history of poisoning. On examination she is stuporous. Pulse is weak and feeble. Blood pressure is 70/50mm of Hg. Respiration is shallow and effortless. Body temperature is below normal. The bystander of the patient shows some empty strips of tablets containing butobarbital. Probably she could have consumed this. What are the clinical features of poisoning? How will you manage this patient?

11. TOXICOLOGY-3 A 22-year-old male is brought with the history of poisoning with Diazepam tablets. The level of consciousness is reduced but he is arousable. His vital signs are normal. • What are the signs and symptoms of poisoning with the above drug? • What is the antidote? • How will you manage the patient?

12. TOXICOLOGY-4 A 47-year-old male is brought with the history blurred vision, photophobia after consuming alcohol. He is suspected to have consumed methyl alcohol. • What are the signs and symptoms of methyl alcohol poisoning? • What is the line of management? • Explain the mechanism of action of the drugs used to treat methyl alcohol poisoning?

13. TOXICOLOGY-5 A 25-year-old man with a history of drug abuse was unresponsive to treatment by paramedics at an inner-city nightclub. On arrival to the emergency department, the patient was hypo ventilating, cyanotic with small constricted pupils, and responding only to deep painful stimuli. The patient’s skin was cool and dry. Needle tracks were observed along the upper extremities. His pulse was 56 beats per minute; respiration rate, 6 per minute; blood pressure, 95/60 mm Hg, and temperature, 35.4°C (95.8°F). The patient’s abdomen was soft and had hypoactive bowel sounds. An electrocardiogram revealed a sinus bradycardia. What do you suspect? Explain the reasons for these signs in this poisoning. How will you manage the patient?