Case Scenario 1
A 30-year-old sales manager was undergoing treatment for intestinal amoebiasis
with tablet Metronidazole. He attended a party and consumed alcohol. Shortly
after, he developed nausea, vomiting, giddiness, sweating, chest pain, headache,
and flushing. His ECG was normal and his blood pressure was 100/70 mm Hg.
1. Questions:
2. What is the reaction called?
3. What could have been the cause?
4. Name other drugs producing similar effects.
5. Name drugs used in aversion technique of chronic alcoholism.
1) What is the reaction called?
Disulfiram-like reaction (Antabuse reaction).
2) What could have been the cause?
The patient consumed alcohol while taking Metronidazole. Metronidazole inhibits
aldehyde dehydrogenase, leading to accumulation of acetaldehyde and causing
flushing, nausea, headache, and chest discomfort.
3) Name other drugs producing similar effects.
- Cefotetan
- Cefoperazone
- Cefamandole
- Chlorpropamide
- Procarbazine
- Griseofulvin
4) Name drugs used in aversion technique of chronic alcoholism.
- Benzodiazepines- Chlordiazepoxide, Diazepam
Naltrexone
Acamprosate
Disulfiram
Case Scenario 2
Mr. Rajesh, a 45-year-old male and known peptic ulcer patient, developed a severe
headache. He went to a medical shop and requested medicine to relieve his
headache. The pharmacist gave him a tablet, and although his headache resolved,
he subsequently developed severe epigastric pain and vomiting, which was blood-
stained.
Questions:
[Link] could be the reason for haematemesis?
[Link] is the role of prostaglandins in peptic ulcer?
[Link] the prostaglandin analogues used in peptic ulcer.
[Link] two other uses of prostaglandins.
1) What could be the reason for haematemesis?
The haematemesis is due to gastric mucosal erosion or bleeding ulcer caused by
NSAIDs. NSAIDs inhibit COX-1, reducing prostaglandins, mucosal protection,
and bicarbonate secretion.
2) What is the role of prostaglandins in peptic ulcer?
Prostaglandins protect the gastric mucosa by increasing mucus and bicarbonate
secretion, improving mucosal blood flow, and decreasing gastric acid secretion.
3) Name the PG analogues used in peptic ulcer.
- Misoprostol
- Enprostil
4) Write 2 other uses of prostaglandins.
- Induction of labour (Misoprostol, Dinoprostone)
- Medical termination of pregnancy (Misoprostol)
Case 3: Rajkumar a known diabetic was on treatment for diabetes mellitus
with [Link] , developed UTI and a nearby physician prescribed
[Link] took the drug and developed giddiness,behavioural
changes,confusion,fatigue,palpitation.
1) What were the symptoms due to?
The symptoms were due to hypoglycaemia caused by cotrimoxazole inhibiting the
metabolism of glibenclamide, leading to excessive insulin secretion.
2) What are the advantages of metformin?
- Does not cause hypoglycaemia
- Promotes weight loss
Prevent microvascular and macrovascular complications of diabetes
- Improves insulin sensitivity
- Reduces hepatic glucose production
- Prevents new onset type II DM in obese middle aged subject with impaired
glucose tolerance
3) Name 2 DPP-4 inhibitors.
- Sitagliptin
- Vildagliptin
4) What is Acarbose? How should it be taken?
Acarbose is an alpha-glucosidase inhibitor.
It is a complex oligosaccharide which reversibly inhibits alpha
glucosidases, final enzymes for the digestion of carbohydrates in the brush
border of small intestine mucosa.
It slows down and decrease digestion and absorption of polysaccharides
and sucrose.
In addition GLP 1 release is promoted which may contribute to the effect
It should be taken at the beginning of each major meal