Case Study- Hot Flushes

Menopause- hot flushes, night sweats, sleep disturbance, vaginal dryness and discomfort.

Monitoring of Hypothyroidism

Symptomatic improvement occurs in 2-3 weeks with the use of levothyroxine, but it takes around 6 weeks to bring TSH levels to normal. TSH monitoring is done every six weekly with the change of levothyroxine dose. Once TSH comes within range, thyroid profile test is conducted once yearly. The use of hormone replacement therapy and oral contraceptives raises the total T4 levels, so free T4 is also measured if the patient is taking any of these medicines. The usual dose of levothyroxine is 100-200 micrograms daily.

Hypothyroidism

Primary hypothyroidism is due to autoimmune disease (Hashimoto’s disease) in which the body produces antibodies against the thyroid gland. Possible causes are:

• Congenital- poor production of thyroid gland.
• Enzymes defect in thyroid gland.
• Dietary iodine deficieny
• Surgical removal of thyroid gland.
• Over treatment with antithyroid medicine.
• Radioactive iodine therapy.
• Lithium and amiodarone.

Secondary hypothyroidism results from an underproduction of thyroid hormones characterized by deficient thyroid stimulating hormone (TSH) stimulation by pituitary gland.

Case Study on weight gain

Hypothyroidism- low metabolic rate leading to weight gain, even on a calorie controlled diet, hair thinning and feeling cold.

Case Study- Pyridostigmine Use in Myasthenia Gravis

Pyridostimine is less powerful and slower in action than neostigmine but it has longer duration of action. It has mild gastrointestinal side effects, but antimuscarinic drug is still required for stomach cramps. The total daily dose of 450 mg should not be exceeded as it leads to acetylcholine receptor downregulation. Immunosuppressant therapy is required at a daily dose of 360 mg. it is only available as a tablet, unlike neostigmine which is available as a tablet and an injection.

case study- Myasthenia Gravis

 

• The presence of acetylcholine receptor antibodies.
• Edrophonium test: in which edrophonium chloride is injected intravenously to prevent acetylcholine degradation, hence the level of acetylcholine increases at the neuromuscular junction.
• Nerve conduction study: conducted for fatigue, in which repetitive neuronal stimulation is done. It results in decrements of muscle action potential due to impaired nerve to muscle conduction.

Case Study: Muscle Weakness

ANS: MYASTHENIA GRAVIS

It is an autoimmune disease which is characterized by muscle weakness that starts with exercise and resolves at rest.Ptosis (drooping of eyelids) is common characterized by blurred vision due to affected eye muscles that control the eye movements. Antibodies target the acetylcholine receptors by altering or destroying them at the neuromuscular junction, hence contraction of the muscles does not take place, and there are fewer acetylcholine receptors available so the muscles receive fewer nerve signals.

acetylcholine 

Pharma BCQ- Sirolimus

ANSWER: C

DESCRIPTION
Sirolimus is calcineurin inhibitor which acts as immunosuppressant. It is used in prophylaxis of organ rejection in kidney allograft recipients. It can be given with ciclosporin initially, as ciclosporin is severely nephrotoxic, renal function is needed to be monitored when treatment is carried out with ciclosporin.

Pharma BCQ- Seborrhoeic dermatitis

ANSWER: A

DESCRIPTION

Dandruff is a form of seborrhoeic dermatitis. The use of shampoo containing coal tar can be used, but it is not the first choice. Betnovate lotion contains betamethasone, which is useful in severe dandruff.

Pharma BCQ- Phenylephrine

ANSWER: A

DESCRIPTION

Phenylephrine which is a sympathomimetic causes increase in heart rate and blood pressure; it should not be used systemically in glaucoma, hypertension, hyperthyroidism, ischemic heart disease and diabetes mellitus. However, topically it can be used in the above mentioned conditions as nasal decongestant. Both topical and systemic preparation is contraindicated in patients taking monoamine oxidase inhibitors, as it may aggravate the hypertensive crisis.

Pharma BCQ- Contact Lens Wear

ANSWER: A

DESCRIPTION

Phenergen contains anti-histamine promethazine and Valium contains benzodiazepine that is diazepam, both of which reduces blinking of the eye and causes dry eyes. Cilest contains combined oral contraceptive which causes corneal and eyelid edema.

Pharma BCQ- ISD

ANSWER:B

DESCRIPTION

Infantile seborrhoeic dermatitis or cradle cap is a type of eczema which is common in infants. It occurs in first three months of life and resolves spontaneously within a year. The use of almond oil, clove oil, baby oil or olive oil into the scalp leaving overnight and washing the following day can help treat cradle cap.

Pharma BCQ-Stemetil

ANSWER: D

DESCRIPTION

Stemetil is proprietary preparation of prochlorperazine, which is used in vertigo and labyrinthine disorders. There is no contraindication for the use of prochlorperazine with paracetamol.  Stemetil is available in the form of tablets, syrup and injection.