ADVERSE REACTION DUE TO CLINDAMYCIN

ABSTRACTA 43-year-old patient was diagnosed of left sided empyema. He was started on injectable piperacillin-tazobactam combination and clindamycin.After 11 days, he developed itchy red lesions over different parts of the body. Both the drugs were immediately stopped in view of drug allergy.However, oral clindamycin with a lower dose was restarted, and patient tolerated the drug without any skin related episodes. Postdischarge he wasprescribed oral clindamycin for 2 more weeks. 2 days postdischarge he started developing rash. The patient continued the drug for next 10 daysand as a severity of rashes increased he reported to the hospital. He had itchy red lesions throughout the body. Clindamycin was stopped, and hewas prescribed clonate lotion and tablet cetirizine for 10 days. The lesions resolved. A patient was informed that he is allergic to beta-lactams andclindamycin.Keywords: Clindamycin, Skin rashes, Beta-lactams

Sertraline induced hyponatremia

A 53 year old female patient with a history of carcinoma of the breast in remission and dilated cardiomyopathy on treatment was newly diagnosed with depression. She was started on Sertraline 50mg once a day. 2 days later she developed severe hyponatremia (serum sodium 114mEq/l). Her condition further deteriorated and on the 6th day her medication was stopped and replaced with mirtazapine. Osmolality studies she was diagnosed with SIADH (Syndrome of Inappropriate Antidiuretic Hormone secretion). She was treated with IV sodium chloride for her hyponatremia. At discharge serum sodium levels improved (127mEq/l)  and subsequent follow up 4 weeks later showed normal sodium values (138mEq/L)Keywords: Sodium chloride, Syndrome of inappropriate antidiuretic hormone, Serum sodium, Serum osmolarity

A retrospective study of serious adverse drug reactions and associated risk factors in a tertiary care hospital

Background: Serious adverse drug reactions (ADRs) cause physical, psychological and economic harm to patients and society. This study was undertaken to understand serious ADRs in a tertiary care hospital and risk factors associated with it.Methods: The serious adverse reactions that occurred over a one-year period were assessed. The serious adverse drug reactions, action taken, outcome, predictability, suspect drug, causality, patient demographics and risk factors for the reaction was collected. Chi-square test was applied for observing relationships of predisposing factors for serious ADRs.Results: Out of a total of 984 reported adverse drug reactions, 94 (9.55%) were serious. Hematological disorders (41.05%) were the common serious ADRs followed by electrolyte disturbances (18.94%). Anticancer agents were the suspect drugs for majority of serious ADRs. Serious ADRs contributed to 39 (0.05%) admissions in the hospital. Recovery occurred in 97.87% of the patients. The causality was possible in 91.48% (n=86) and probable in 8.51% (n=8) of the serious adverse drug reactions. Males, patients even with a single concomitant disease and those with more than 2 concomitant medications were at increased risk (p<0.05) for developing serious ADRs.Conclusions: Serious ADRs are a significant problem in health care. Measures should be taken to detect and treat them at the earliest to reduce suffering of the patient

BRINZOLAMIDE-INDUCED EYE DISCHARGE: A RARE ENTITY

ABSTRACTA 62-year-old lady diagnosed to have normal tension glaucoma was receiving triple therapy of topical brinzolamide, timolol, and careprost. Postapplication of brinzolamide eye drops patient experienced mucoid eye discharge starting 10 minutes after application of eye drops and persistingfor ½ hr. Slit lamp examination findings did not reveal any signs of infection. She gave a history of mucoid discharge since the day she was started onbrinzolamide eye drops. There are only two case reports describing mucoid discharge following brinzolamide eye drops. Thus, we report a similarscenario in our patient. We report this case so as to avoid unnecessary suspicion of infection in such cases.Keywords: Glaucoma, mucoid, infection

PHARMACOTHERAPY OF HEART FAILURE

Abstract Heart failure is one of the major problems related to heart diseases in the modern era. Multiple comorbidities like coronary artery disease, hypertension, diabetes mellitus, anemia etc. have a great contribution in the development of heart failure.It is primarily two types systolic and diastolic heart failure. Insufficient or decreased pumping of the heart is Systolic heart failure whereas diastolic heart failure is because of lack of ability of the heart to relax or increased muscle inflexibility. The pathophysiology of heart failure is due to enhanced activity of sympathetic system, Renin Angiotensin system and structural changes in the wall of ventricle. The two definite targets of medical treatment in heart failure are: (1) Alleviation of obstructive (or) decreased output manifestations and replenishment of cardiac function. The drugs used are Frusemide, thiazides,ACE inhibitors/ARBs,Amrinone/Milrinone,Dopamine/ Dobutamine,Levosimendan,Digoxin, Hydralazine,Nitroprusside, Nitrate, Bisoprolol,Metoprolol, Nebivolol, Carvedilol (2) Prevention ofadvancementof heart failure and extension of patient survival - drugs used are β blockers,ACE inhibitors/ ARBs, Spironolactone andEplerenon

BILATERAL BLINDNESS DUE TO ANTI-TUBERCULAR TREATMENT: A RARE PRESENTATION

ABSTRACTEthambutol and isoniazid (INH) are antimicrobial agents used in the treatment of tuberculosis. Optic neuropathy is a well-recognized toxic effectof these drugs, usually manifesting as a decrease in visual acuity and deficits in color vision. This study presents the case of a 75-year-old malediagnosed of spinal tuberculosis, who developed irreversible bilateral optic neuropathy causing complete blindness induced by ethambutol and INH.Ophthalmologic examination revealed sluggish pupillary reactions and optic disc pallor in both eyes. Visual evoked potential and magnetic resonanceimaging brain complemented the confirmation of the diagnosis.Keywords: Ethambutol, Isoniazid, Optic neuritis, Tuberculosis