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I'll thoroughly explain the question afterwards......
Patient 44 years old and has chronic bronchitis due to smoking [15 year history]. at the local physician pt is prescribed a form of cocktail medications [ theophyilline + other vasodilators ] which she came back for 2 weeks later saying "doc this drug made my symptoms so much better but u notice on P/E pt has fever and a productive cough. on cbc analysis u notice decreased levels of theophyilline as well. associated with increased activity of CYP 450 which drug would treat this patients recurrent URTI and also enhance the activity of theophyilline?
A) quinolones
B) penicillin
C) rifampin
D) macrolides
E) cyclosporines
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C...p450.inducer
Induce P-450: GTQ CRABS Griseofulvin, Tetracycline, Quinidine, Carbamazepine, Rifampin, Alcohol, Barbiturates, Sulfa drugs (e.g. TMP-SMX etc.)
Inhibit P-450: IQ SMACKD Isoniazid (a.k.a. INH), Quinolones, Spironolactones, Macrolides, Amiodarone, Cimetidine, Ketoconazole, Dapsone
P-450 Dependent: WEPTD Warfarin, oEstrogen, Phenytoin, Theophylline, Digoxin
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maryam ur very close but it wouldn't b rifampin....
i see where u would think its rifampin but chronic bronchitis + productive cough = just a trick.....
the actual point in this question is to determine which drug would inhibit CYP450 enhancing theophyilline activity and also treating the "infection" so the correct choice would be D. macrolides.....
Macrolides inhibit CYP450 activity as u stated....
but the family cyp4501a2 gets enhancedddd by smoking** so since this patient is a smoker the cyp4501a2 is enhanced which metabolizes theophyilline.... so the patient still somewhat seems to get better but URTI are common with chronic bronchitis [ its def not TB ] primary tb is in the upper lobes but thats a rare case so common cold or w.e can cause a URTI can b treated with drugs like macrolides. and the function of macrolides is also to inhibit cyp4501a2** specific activity.... thus making theophyilline more available for better effectivity...
and also treatment of common urti assoc. with chronic bronchitis.... hope this helped!!!!
source : kaplan
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someone made a point..... thought id share:
if this patient was suffering from UTI** urinary tract infection instead of CHRONIC BRONCHITIS..... and this patient was on theophyilline for w.e vasodilation purpose u can than give Quinolones which would also inhibit CYP4501a2 activity enhancing theophyilline activity =D and treat patient for its UTI!
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oh sorry maryam... lol made the question of my head.... nxt time ill do a better job lol thanks for your input!! =]
