حاله سريرية
الطبيبة العجيبة - الأحد, 2009-06-21 18:57 | الأدوية | المحتوى الطبي
حالة سريرية
حالة سريرية
الوصف الكامل Background
A 17-year-old sexually active girl comes to your office complaining of acne that is unresponsive to the usual treatment regimen. Physical examination reveals severe nodulocystic acne of her face and upper chest and back. You consider prescribing isotretinoin (Accutane), but you are concerned about side effects. Reviewing the literature, you find which of the following to be true about isotretinoin?
a. Its efficacy can be profound and permanent
b. It is not known to be a teratogen
c. Most patients experience excessive tearing and salivation
d. Severe arthritis necessitating cessation of the drug occurs in about 15% of patients
فتاة عمرها 17 سنة أصيبت بحب شباب معند( عقيدي كيسي ) لم يستجيب للمعالجة العادية ،لذلك قرر الطبيب إعطاءها دواء فعال هو isotretinoin لكنه كان مترددا نظرا للأعراض الجانبية لهذا الدواء
اختر الإجابة الصحيحة فيما يتعلق بهذا الدواء
الجواب الصحيح هو a
Isotretinoin (13-cis-retinoic acid; Accutane) has proved to be very effective in the treatment of refractory nodulocystic acne.
The effects of treatment appear to be long-lasting.
Precautions regarding its use, however, are essential. Because of its teratogenic effects (isotretinoin syndrome), the drug is contraindicated
during pregnancy
and within 1 month of becoming pregnant.
Dry skin, eyes, and mucous membranes are the most frequent complications of therapy.
Other associated problems include musculoskeletal pain and hyperostosis, inflammatory bowel disease, pseudotumor cerebri, and corneal opacities.
Patients on isotretinoin therapy can often develop abnormal liver function tests, elevated triglyceride and cholesterol levels, and lowered levels of high-density
lipoproteins. Some have suggested that an increased risk of suicide is related to its use, although this link is less well established
isotretinoin علاج فعال جدا لحب الشباب العقيدي الكيسي المعند
كما أ تأثيره العلاجي يدوم طويلا
إلا أنه مضاد إستطباب في الحالات التالية
-أثناء الحمل
- قبل الحمل بشهر
أهم الأعراض الجانبية له
-جفاف الجلد والعين والأغشية المخاطية
-ألم عضلي هيكلي
-فرط في نمو العظم hyperostosis
-الداء المعوي الإلتهابي
-عتمة القرنية
-ورم كاذب في الدماغ ؟؟؟
أما مخبريا
-اضطراب وظائف كبد
-ارتفاع قيم الكولستول والشحوم الثلاثية
-انخفاض قيم HDL
يصاب المريض بالإكتئاب وقد ينتحر إذا كان عقلو صغير
مشكووورة كتير
على المعلومات القيمة
thank you very much
"ورم كاذب في الدماغ ؟؟؟"
هوارتفاع الضغط داخل القحف بدون وجود أفة شاغلة للحيز ,من أسبابه :vitamin A, tetracycline, minocycline, naladixic acid, corticosteroids
هوارتفاع الضغط داخل القحف بدون وجود أفة شاغلة للحيز ,من أسبابه :vitamin A, tetracycline, minocycline, naladixic acid, corticosteroids
جزاكِ الله خيرا دكتورة
Quick Question:
This patient comes to next week saying that she was afraid of the Accutane you prescribed and went to another doctor who told her to take some other "better" pill (she does not know the name). After 4 days she developed sever dysphagia and odynophagia and came back to you to help her?
What do you think happened with her?
The better pill I think it is Doxycyclin and it caused pill induced esophagitis
it seems that the doctor did not advise the patient to drink plenty of wanter and not to lay down immediately after taking the pill.
IM with doctor hot sause
its docycyclin or tetracyclin
Exactly ...
This is very typical for pill esophagitis
Remember it : I still see patient coming to my clinic with this presentation.
thank you doctoR ABIM
Alendronate
FeSO4
KCL
NSAIDs
teratogenic effects
even u shud advise the pregnant lady not to eat lots of liver during her pregnancy -even avoid -as it contains good deal of vitamin A which is a known treatogenic agent esp that isotretinoin is a systemic retinoid
thx for the case
thx for the case
معلومة كتير ظريفة ... شكرا كتير فدا
طيب وإذا كانت المريضة معها فقر دم بعوز الحديد ... وما بدها تاخد أدوية ... هل أمنعها أيضا من أكل الكبد