Adverse drug reactions and interactions — likely causative agent
For each clinical scenario below, select the SINGLE most likely causative drug from the option list above. Each option may be used once, more than once, or not at all.
- A. Sodium valproate
- B. Gentamicin
- C. Vincristine
- D. Ciclosporin
- E. Amiodarone
- F. Isoniazid
- G. Co-trimoxazole (trimethoprim-sulfamethoxazole)
- H. Methotrexate
1. A 6-year-old girl on this drug for epilepsy develops hepatotoxicity and hyperammonaemia; increased appetite and hair thinning are also noted.
2. A neonate treated with this antibiotic for sepsis develops ototoxicity and nephrotoxicity, requiring therapeutic drug monitoring of peak and trough levels.
3. A child receiving this chemotherapeutic agent develops peripheral neuropathy with jaw pain and severe constipation.
4. A transplant recipient on this immunosuppressant develops gingival hyperplasia, hypertension, tremor, and nephrotoxicity.
5. A child treated for a tachyarrhythmia with this drug develops thyroid dysfunction and pulmonary fibrosis on long-term therapy.
6. A teenager on this antituberculous drug develops peripheral neuropathy, which is preventable with pyridoxine (vitamin B6) co-administration.
7. A child treated with this antibiotic develops a severe blistering skin reaction (Stevens-Johnson syndrome) and bone marrow suppression.
8. A child on this drug for juvenile idiopathic arthritis requires folic acid supplementation to reduce the risk of mucositis and hepatotoxicity.
9. A 4-year-old on long-term therapy with this antiepileptic develops thrombocytopenia and pancreatitis, identified on routine blood monitoring.
10. An infant receiving this aminoglycoside for a Gram-negative infection requires drug level monitoring because of its narrow therapeutic index.
11. A child on this vinca alkaloid develops severe constipation requiring regular laxatives as part of routine supportive care.
12. This calcineurin inhibitor is associated with an increased risk of opportunistic infection due to its immunosuppressive effect, alongside nephrotoxicity.
13. A child treated with this class III antiarrhythmic requires baseline and periodic thyroid and liver function monitoring throughout treatment.
14. This drug, used for tuberculosis treatment and prophylaxis, can cause hepatotoxicity and is monitored with regular liver function tests.
15. This antibiotic combination should be used with caution in infants under 6 weeks old, given the risk of displacing bilirubin from albumin and precipitating kernicterus.
16. This folate antagonist requires reliable contraception and blood count monitoring, given the risks of teratogenicity and bone marrow suppression.