Case 3 CPT Compiled - TB

7/25/2019 Case 3 CPT Compiled - TB

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CPT CASE 3 TUBERCULOSIS

PAGE 31

1 WHAT GROUPS IN THE POPULATION IS THE HIGHEST RISK

FOR DEVELOPING PTB?

In general, a!l"# $ %& 'ear# () age *a+e "*e *g*e#"n-en-e ra"e an .1/ 'ear# () age0

HOW DOES VACCINATION WITH BCG AFFECT TST2TUBERCULIN SKIN TEST AND IGRA 2INTERFERON GA44ARELEASE ASSA5 TEST RESULTS? BCG6 " 7r(+e# false positive reactions, 8e-a!#e BCG #

er+e )r(9 an a""en!a"e #"ran () 40 8(+#0 T*!#, TST9ea#r!e# "*e re#7(n#e "( an"gen- #"9!la"(n 8' T -ell#

"*a" re#e# n "*e #:n ra"*er "*an re#7(n#e ()re-r-!la"ng 9e9(r' T -ell0

IGRA 2)(r la"en" TB6 9ea#!re# T -ell relea#e () IFN;' nre#7(n#e "( #"9!la"(n


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I#(na@o 4OA6 n*8"# #'n"*e## () 9'-(l- a-#,

an e##en"al -(97(nen" () 9'-(8a-"eral-ell ;& 9g

P'ra@na9eo 4OA6 -(n+er"e "( "*e a-"+e 7'ra@n(-

a- !ner a-- -(n"(n# n9a-r(7*age l'#(#(9e#0 8a-"er(#"a"-

o A+er#e ee-"#6 *e7a"("(-"', na!#ea,+(9"ng, r!g )e+er, an *'7er!r-e9a0

E"*a98!"(lo 4OA6 n*8"# 9'-(8a-"eral ara8n(#'l

"ran#)era#e#


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*a# le## en@'9e n!-ng a-"+"', *a# 8een !#e n7la-e () R)a97n0

/ THE PATIENTJS LIVER FUNCTION TESTS ARE SLIGHTL50 WH5

IS THIS I4PORTANT AND DOES IT CHANGE THE4ANAGE4ENT OF HER TB INFECTION?; T*e 9(#" -(99(n a+er#e rea-"(n () #gn=-an-e #*e7a""#0;7a"en"# #*(!l 8e -are)!ll' e!-a"e a8(!" "*e #gn#an #'97"(9# () r!g;n!-e *e7a""#ar: !rne, l(##() a77e""ean #*(!l 8e n#"r!-"e "( #-(n"n!e "*e"rea"9en" 7r(97"l' an #ee: 9e-al *el70

& HOW IS THERAPEUTIC EFFICAC5 ASSESSED IN THETREAT4ENT OF TB?

Ba-"er(l(g- e+al!a"(n6 -a!#ng -!l"!re () #9ear9-r(#-(7' # e##en"al n 9(n"(rng "*e re#7(n#e "("rea"9en" )(r TB0

Pa"en"J# () 7a"en"


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Pr(9("er 9!"a"(n# re#!l"ng n (+ere7re##(n () (*7Ca 7!"a"+e +r!len-e gene n+(l+e n 7r("e-"(n () -ell)r(9 (a"+e #"re##5e#, n#"ea !#e RME 2R)a97n, P'ra@na9e,E"*a98!"(l "*r(!g*(!" 2%; 9(n"*#0

HOW WOULD THE CLOSE CONTACTS OF THIS PATIENT BETREATED?

S!8e-" "*e 7er#(n "( TST "( -(n=r9 e7(#!re6 T!8er-!lnRea-"(n #@e6 $& 99

C(n"a-" n+e#"ga"(n # an 97(r"an" -(97(nen" ()e-en" TB -(n"r(l

4ea#!re# "( l9" #!-* "ran#9##(n n-l!e# re#7ra"(r'#(la"(n () 7er#(n 0&9 8' >0390 T*e 8a-"era!#!all' a""a-: "*e l!ng#, 8!" TB 8a-"era -an a""a-:an' 7ar" () "*e 8(' #!-* a# "*e :ne', #7ne, an8ran0 TB # #7rea "*r(!g* "*e ar )r(9 (ne 7er#(n "(an("*er0

TB # -la##=e a# 7!l9(nar', e"ra7!l9(nar', (r8("*0

P!l9(nar' "!8er-!l(## 2TB # a -(n"ag(!#8a-"eral n)e-"(n "*a" n+(l+e# "*e l!ng#0 I" 9a'#7rea "( ("*er (rgan#0

P!l9(nar' "!8er-!l(## 2TB # -a!#e 8' "*e 8a-"er!9 Mtuberculosis (M. tuberculosis)0 TB # -(n"ag(!#0 T*# 9ean# "ea#l' #7rea )r(9 an n)e-"e 7er#(n "( #(9e(ne el#e0 5(! 8rea"*ng n ar r(7le"# )r(9 a -(!g* (r #nee@e () an n)e-"ere#!l"ng l!ng n)e-"(n # -alle 7r9ar' TB0

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1 Ba## () "*e 7r(8le9CC6

C(!g* )(r "*e 7a#" 3


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Tea-* "*e 7a"en" a8(!" "*e n)e-"(!# na"!re() "!8er-!l(## an "*e nee "( 7re+en" "##7rea0

Pla-e "*e 7a"en" n a nega"+e 7re##!re r((9an n a 7r+a"e r((90

All n!r#e# an +#"(r# en"erng "*e 7a"en"Q#r((9 #*(!l


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BCG +a--ne # -(n#ere )(r *eal"* -are


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rela7#e, a#7ergll(9a, 8r(n-*e-"a##,8r(n-*(l"*a##, =8r("*(ra, an 7(##8l'-ar-n(9a0 A -(7' () "*e -*e#" ra(gra7* a""*e "9e () -(97le"(n () "*era7' #*(!l 8e7r(+e "( "*e 7a"en" "( )a-l"a"e "*e

agn(## () la"e -(97l-a"(n#0T*e rela7#e ra"e )(ll(9g:g, 9a %>>9g 1>9g:g, 9a %>>9gISONIAMID 2H &9g:g, 9a 3>>9g 1>9g:g, 9a >>9gP5RAMINA4IDE 2M &9g:g, 9a g 3&9g:g, 9a 3gETHA4BUTOL 2E 1&9g:g 3>9g:g

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http://emedicine.medscape.com/article/296052-overviewhttp://emedicine.medscape.com/article/296961-overviewhttp://emedicine.medscape.com/article/296052-overviewhttp://emedicine.medscape.com/article/296961-overview


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RIFA4PICIN ISONIAMID P5RAMINA4IDE

ETHA4BUTOL

E-a-' 2An

an"8("-;&>9-g9l0

2A

8a-"er(#"a"-an"9'-r(8alr!g7re#-r8e "("rea""!8er-!l(##0; I"


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re##"an-e ()40"!8er-!l(### +er' rare0

7er9ea8l"'() "*e -ell

2 2 2

Page 1>of 3


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& Ien")' "*e DOC 28a##I#(na@

R)a97-nP'ra@na9eE"*a98(l

9(n"*# )(r HRME6 INITIALBACTERICIDAL PHASE/ 9(n"* HR6 CONTINUATIONSTERILIMING 7*a#e

% D#-!## "*e 7*ar9a-(:ne"-# an7*ar9a-('na9-# () "*e -*(#en r!g0

ISONIAMID

P*ar9a-('na9-#I#(na@ 8a-"er-al "( ra7l';+ng 9'-(8a-"era, 8a-"er(#"a"- ) "*e 9'-(8a-"er!9 # #l(


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8l(( le+el# rea-*ng a8(!" 1 "( *(!r#0B(a+ala8l"' # re!-e


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7re+(!# #(na@;a##(-a"e *e7a"- n!r' #e+ere area-"(n# "( #(na@ #!-* a# r!g )e+er, -*ll#, ar"an a-!"el+er #ea#e() an' e"(l(g', an "( 7regnan-'0

Dr!g In"era-"(n#

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$An"-(n+!l#an"#6 I#(na@ n*8"# *e7a"- 9e"a8(l#-ar8a9a@e7ne an 7*en'"(n, re#!l"ng n n-an"-(n+!l#an" -(n-en"ra"(n# an "(-"' n #(9e 7a"e#(na@ an -ar8a9a@e7ne (r 7*en'"(n are a9n-(n-!rren"l', #er!9 -(n-en"ra"(n# () "*e an"-(n+!l#an" 8e 9(n"(re, "*e 7a"en" (8#er+e )(r e+en-e () "(-"*e (#age () "*e an"-(n+!l#an" #*(!l 8e re!-e a--(r

$C'-l(#erne6 In -(98na"(n , *e7a""#


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)a"al *e7a""# # generall' -(n#ere an !n7re*'7er#en#"+"' rea

$He9a"(l(g-6 agran!l(-'"(##, *e9(l'"-, #er(8la#"a7la#"- ane9a "*r(98(-'"(7ena e(#n(

$H'7er#en#"+"'6 )e+er, #:n er!7"(n# 29(r8l9a-!l(7a7!lar, 7!r7!r-, (r e)(la"+e, l'97*aen(+a#-!l"#0 H'7er#en#"+"' rea-"(n# !#!all' (--!r n "*e =r


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# nge#"e > 9g (#e0 W"* re7ea"e a9n#"ra"(n, "*l)e e-rea#e# an rea-*e# a+erage +al!e# () a77r(9a"el'*(!r#0 T*e *al);l)e (e# n(" er n 7a"en"# > 9g al', an -(n#e!en"l', n( a!#"9en" # re!re0

A)"er a8#(r7"(n, r)a97-n # ra7l' el9na"e n "*e 8l

an en"er(*e7a"- -r-!la"(nen#!e#0 D!rng "*# 7rr)a97-n !nerg(e# 7r(gre##+e ea-e"'la"(n #( "*a" nea"*e r!g n "*e 8le # n "*# )(r9 n a8(!" % *(!r#9e"a8(l"e *a# an"8a-"erala-"+"'0 In"e#"nal rea8#(r7re!-e 8' ea-e"'la"(n, an el9na"(n # )a-l"a"e0

U7 "( 3> () a (#e # e-re"e n "*e !rne,


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C(n"ran-a"(n# R)a97-n # -(n"ran-a"e n :n(


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an -*lren


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an"*ne (a#e "( &;*'r('7'ra@n(- a-

Time to pea' serum concentration6 P'ra@na9e; 1 "( *(!P'ra@n(- a-;/ "( & *(!r#

&ea' serum concentration:

&yrainamide:A77r(9a"el' 1 9-g9L a)"er a #ngle (#e () 1/ 9g:gA77r(9a"el' 3 9-g9L a)"er a #ngle (#e () 9g:g&yrainoic acid:A77r(9a"el' 3 9-g9L a)"er a #ngle (#e () 1/ 9g:gA77r(9a"el' /0& 9-g9L a)"er a #ngle (#e () 9g:gHal) l)e ;1> *(!r# 2n(r9al -(n"(n#limination: Renal a77r(9a"el' 3 () !n-*ange 7'ra@na9e, 37'ra@n(- a-, an 3% () re9anng en"=a8le 9e"ae-re"e n !rne "( %>

T(- ee-"Se ee-"#6 n-l!e l+er n!r', ar"*ralga#, an(na!#ea an +(9"ng, '#!ra,9ala#e an )e+er, #er(ane9a, a+er#e ee-"# (n "*e 8l(( -l(""ng 9e-*an+a#-!lar n"egr"', an *'7er#en#"+"' rea-"(n# #!-* a# !r"7r!r"# an #:n ra#*e#0S7e-al Pre-a!"(n6Cr(##;#en#"+"' an(r rela"e 7r(8le9#

Pregnan-'Re7r(!-"(n; Ae!a"e an


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ETHA4BUTOLIn-a"(n6 a# an a!n-", n "*e "rea"9en" () 7!l9"!8er-!l(##0

P*ar9(-('na9-#6

E"*a98!"(l !#e# n"( a-"+el' gr(iotransformation6 U7 "( 1& () e"*a98!"(l # 9e"a8(lna-"+e 9e"a8(l"e#0Time to pea' serum concentration:E"*a98!"(l "( / *(!r#

*alf life $n patients +ith normal renal function, -

hours. $n patients +ith impaired renal function, uphours0

&ea' serum concentration6 "( & 9-g9L a)"er a #ngle (#e9g:glimination6 Renal 8' gl(9er!lar =l"ra"(n an "!8!lar #e-!7 "( > e-re"e


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e"*a98!"(l # (7"- ne!r(7a"*',8l!rre +#(nna8l"' "( #ee "*e -(l(r# re an green#!en -*ange# n +#(n#:n ra#*

"-*ng

S7e-al 7re-a!"(nH#"(r' () allerg' "( e"*a98!"(l (r "( an' r!g#"ell '(!r (-"(r ) '(! *a+e (r *a+e e+er *a :ne' #ea#e(r e'e #(rer# #!-* a# -a"ara-"#0"ell '(!r (-"(r ) '(! are 7regnan", 7lan "( 8e-(9e 7regnaare 8rea#";)eeng0 I) '(! 8e-(9e 7regnan" of 3


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C NON;PHAR4ACOLOGIC 4ANAGE4ENT

1 De"ar' #al" re!-"(n ; .%g NaCl DASH e"ar' 7lan De" r-* n )r!"#, +ege#"a8le# an

l(< )a" ar' 7r(!-"#


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0e N"r(gl'-ern 2S!8lng!al

F DISCUSS THE PHAR4ACOKINETICS ANDPHAR4ACOD5NA4ICS OF THE CHOSESN DRUG

E9ergen-' r!g6 SODIU4 NITROPRUSSIDE

S(!9 N"r(7r!##e # n-a"e )(r "*e 99ea"ere!-"(n () 8l(( 7re##!re () 7a"en"# n*'7er"en#+e -r##0 C(n-(9"an" l(nger;a-"ngan"*'7er"en#+e 9e-a"(n #*(!l 8e a9n#"ere#( "*a" "*e !ra"(n () "rea"9en"


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o E-re"(n6 4anl' n !rne, e-re"e en"rel' a#9e"a8(l"e#, 7rn-7all' "*(-'ana"e

A+er#e ee-"#6o 4(re -(99(n6 H'7("en#(n0 Bra'arr*'"*9a,

Pal7"a"(n#, D@@ne##, Heaa-*e, C(n)!#(n,4e"*e9(gl(8ne9a

o Le## -(99(n6 4l #:n ra#*, rr"a"(n (n "*ene-"(n #"e

C(n"ran-a"(n#6o I" # -(n"ran-a"e n 7a"en"#


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- Bl(-:# 8nng () ang("en#n II "( "'7e 1ang("en#n II re-e7"(r# 8l(-:# "*e+a#(-(n#"r-"(r an al(#"er(ne #e-re"ngee-"# () ang("en#n II

- Bel(ng# "( a gr(!7 () r!g# -alle

ang("en#n II re-e7"(r an"ag(n#"#- I" :ee7# 8l(( +e##el# )r(9 narr(> 9go T*e a-"+e 9e"a8(l"e () l(#ar"an *a# a *al) l)e

() 3;/ *(!r#o A8#(r7"(n6 L(#ar"an # n "*e )e-e#0F(ll( n "*e )e-e#0

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A+er#e ee-"#6o C(99(n6 Ang(ee9a, Ba-: a-*e, Hea 7an,

9!#-le


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C0 N(n;7*ar9a-(l(g- 4anage9en" 2ADA re-(99ena"(n#a0 Da8e"- e"

(0o+ fat and lo+ salt inta'e80 Weg*" re!-"(n

(1ercise atleast -234 mins everyday)

-0 Bl(( #!gar an BP 9(n"(rng

D0 P*ar9a-(l(g- "rea"9en"

A0 S!l)(n'l!rea#a0 Gl7@e, Gl9e7ere,Gl'8!re

B0 Bg!ane#a0 4e")(r9n

C0 Gl"ne#a0 na"eglne#, re7aglne#

D0 Al7*a;gl!-(#a#e n*8"(r

a0 A-ar8(#e, 4gl"(lE0 T*a@(lne(ne#

a0 R(#gl"a@(ne, 7(gl"a@(neF0 In-re"n#

a0 S"agl7"n, Eena"eG0 A9'ln anal(g

a0 Pra9ln"eE0 Ien")' "*e Dr!g () -*(-e an Ba##Na9e () Pa"en"6 CDAge6 && 'r# (l

R4e")(r9n &>> 9g X%> "a8#

(5lucopha#e)Sg0 Ta:e 1 "a8 "


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Ba##6 T*e 7a"en" # -!rren"l' "a:ng 4e")(r9n &>> 9g PO BIDan agn(#e () T'7e II D4 3 9(n"*# ag(0 B!" #"ll "*eGl!-(#e le+el an "*e HBA1- nJ" rea-* "*e n(r9al +al!e#an 7a"en"# -(n"(n 9a' 7r(gre## "*e #'97"(9# !e "( "#-(9(r8"e# -(n"(n #!-* a# HPN, #'#"e9- 8a-"eral

In)e-"(n, e7re##(n an O+er, 8' "!8!lar #e-re"(n

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B(a+ala8l"'6 1>>In"al ee-"6 1 *rPea: 7la#9a "9e6 ;3 *r4a ee-"6 ;/ *rD!ra"(n6 / *rD#"r8!"(nV6 0 LPr("en 8(!n6 0&

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4e"a8(l#94e"a8(l@e e"en#+el' 8' *e7a"- P/&> en@'9e C5PC "(le##;a-"+e 9e"a8(l"e#4e"a8(l"e#6 C'-l(*e'l *'r(' 9e"*'l er+a"+e 241 9ll'a-"+e an "*e -ar8('l er+a"+e 24 na-"+e

El9na"(nHal);l)e6 &; *rT("al 8(' -learan-e6 /0 9L9nE-re"(n6 Urne 2%> )e-e# 2/>

PAGE /1IV0 DEPRESSION

A0 WHAT IS THE BASIS OF THE PROBLE4?

a History of depression. Patient was diagnosed with

depression 9 months ago.b Loss of a family member (Deceased father and husband,

and ! years ago, respecti"ely.#c $eparation from relati"es% two daughters li"e in $amar.

B THERAPEUTIC OBECTIVE

&. to a"oid further complications

'. to assess the appropriate regimen for the patient

!. to achie"e normal lifestyle as posible.to impro"e sign and symptoms and lessen the probability of

suicide.

C0 NON PHAR4ACOLOGIC 4ANAGE4ENT

&. Psychotherapy to correct interpersonal con)icts and to help womende"elop interpersonal skills'. Cogniti"e*beha"ioral therapy to correct negati"e thinking andassociated beha"ior+

30E7(#e '(!r#el) "( a l""le #!nlg*" e+er' a'0$unlight can helpboost your mood. ake a short walk outdoors, ha"e your co-ee outside,enoy an al fresco meal, people*watch on a park bench, or sit out in thegarden. /im for at least & minutes of sunlight a day. 0f you li"esomewhere with little winter sunshine, try using a light therapy bo1.

Tal: a8(!" '(!r )eelng# "( #(9e(ne '(! "r!#", )a-e;"(;)a-e0$hare what you2re going through with the people you lo"eand trust. /sk for the help and support you need. 3ou may ha"e

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retreated from your most treasured relationships, but they canget you through this tough time. 0f you don2t feel that you ha"eanyone to con4de in, look to build new friendships. $tart byoining a support group for depression.

Tr' "( :ee7 !7


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adrenaline le"els, and le"els of cortisol, a hormone released inresponse to stress."ction steps6of 3
http://www.webmd.com/mental-health/guide-to-psychiatry-and-counselinghttp://www.webmd.com/depression/default.htmhttp://www.webmd.com/depression/ss/slideshow-depression-overviewhttp://www.webmd.com/women/features/set-reach-goalshttp://www.webmd.com/fitness-exercise/ss/slideshow-7-most-effective-exerciseshttp://www.webmd.com/depression/depression-assessment/default.htmhttp://www.webmd.com/brain/picture-of-the-brainhttp://www.webmd.com/mental-health/guide-to-psychiatry-and-counselinghttp://www.webmd.com/depression/default.htmhttp://www.webmd.com/depression/ss/slideshow-depression-overviewhttp://www.webmd.com/women/features/set-reach-goalshttp://www.webmd.com/fitness-exercise/ss/slideshow-7-most-effective-exerciseshttp://www.webmd.com/depression/depression-assessment/default.htmhttp://www.webmd.com/brain/picture-of-the-brain


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How much e1ercise do you need 3ou don2t need to run marathons to

get a bene4t. ust walking a few times a week can help.

. Ea" *eal"*'0here is no magic diet that 41es depression. 0t:s a

good idea to watch what you eat, though. 0f depression tends to make

you o"ereat, getting in control of your eating will help you feel better.

/lthough nothing is de4niti"e, Cook says there:s e"idence that foods

with omega*! fatty acids (such as salmon and tuna# and folic

acid(such as spinach and a"ocado# could help ease depression.

. Ge" en(!g* #lee70Depression can make it hard to get enough

shut*eye, and too little sleepcan make depression worse.

5hat can you do $tart by making some changes to your lifestyle. 8o

to bed and get up at the same time e"ery day. ry not to nap. ake all

the distractions out of your bedroom ** no computer and no ?. 0n time,you may 4nd your sleepimpro"es.

E. Ta:e (n re#7(n#8l"e#0 5hen you2re depressed, you may want

to pull back from life and gi"e up your responsibilities at home and at

work. Don:t. $taying in"ol"ed and ha"ing daily responsibilities can help

you maintain a lifestyle that can help counter depression. hey ground

you and gi"e you a sense of accomplishment.

0f you:re not up to full*time school or work, that2s 4ne. hink about

part*time. 0f that seems like too much, consider "olunteer work.

F. C*allenge nega"+e "*(!g*"#00n your 4ght against depression, a

lot of the work is mental ** changing how you think. 5hen you:re

depressed, you leap to the worst possible conclusions.

he ne1t time you:re feeling terrible about yourself, use logic as a

natural depression treatment. 3ou might feel like no one likes you, but

is there real e"idence for that 3ou might feel like the most worthless

person on the planet, but is that really likely 0t takes practice, but in

time you can beat back those negati"e thoughts before they get out of

control.G. C*e-:


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9. D( #(9e"*ng ne


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Ser("(nn an n(re7ne7*rne re!7"a:e n*8"(r#

2SNRI#are another newer form of antidepressant medicine such as

Dulo1etine,


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6uspirone (6u$par#

6uspirone is marketed as an antian1iety medication+ howe"er, itmay ha"e antidepressant e-ects at doses abo"e mgNday. heantidepressant e-ects may increase when buspirone is used in

combination with $$@0s and C/s in patients with treatment*resistant depression. 6uspirone is a partial *H&/ agonist withserotonergic and some dopaminergic e-ects in the CK$. 0t hasan1iolytic e-ects but may take up to '*! weeks for full eMcacy.

NICE TO KNOW6

ST0 (*nJ#


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/ll a"ailable antidepressants appear to work "ia one or more of thefollowing mechanisms&'GI %

Presynaptic inhibition of uptake of *H or K=

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/ntagonist acti"ity at presynaptic inhibitory *H or K= receptorsites, thereby enhancing neurotransmitter release

/ntagonism of K= beta or serotonin *H' receptors K* 9g 8* reason $$@0 produces less to1ic e-ectsamong other antidepressant considering that treatment for depressionis long term so 0 suggest this drug to a"oid untowards e-ects duringthe course of the treatment as well as patient is with other co morbid

disease under treatment though this condition should not be o"erlookas it may lead to suicidal ideation if left untreated.

SSRI SNRI TCA 4AOI=Mcacy OOO OOO OOO OO$uitability OOO OO OO OO$afety OOO OO OO OCost OO OO OOO OO

F0 DISCUSS THE PHAR4ACOKINETICS ANDPHAR4ACOD5NA4ICS OF THE CHOSEN DRUG

FLUOETINEbrand names ( /D=P$$0@, D=P@0/C, D@/0K,


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&harmacodynamics

he serotonin transporter ($=@# is a glycoprotein with &'transmembrane regions embedded in the a1onerminal and cell body membranes of serotonergic neurons. 5hen

e1tracellular serotonin binds to receptors on thetransporter, conformational changes occur in the transporter andserotonin, Ka O , and Cl R are mo"ed into the cell.6inding of intracellular S O then results in return of the transporter toits original conformation and the release ofserotonin inside the cell.

$$@0s allosterically inhibit the transporter by binding the receptorat a site other than acti"e binding site forserotonin. /t therapeutic doses, about G7Q of the acti"ity of thetransporter is inhibited.

$$@0s ha"e modest e-ects on other neurotransmitters. AnlikeC/s and $K@0s, there is little e"idence that$$@0s ha"e prominent effects on T adrenoceptors or thenorepinephrine transporter, K=. 6inding to the serotonintransporter is associated with tonic inhibition of the dopamine system,although there is substantial interindi"idual"ariability in this e-ect.

he $$@0s do not bind aggressi"ely to histamine, muscarinic, orother receptors.

Pregnancy Category C

6ses:luo1etine is a selecti"e serotonin reuptake inhibitors ($$@0#antidepressant. luo1etine a-ects chemicals in the brain that maybecome unbalanced and cause depression, panic, an1iety, orobsessi"e*compulsi"e symptoms.luo1etine is used to treat maor depressi"e disorder, bulimia ner"osa(an eating disorder# obsessi"e*compulsi"e disorder, panic disorder, andpremenstrual dysphoric disorder (P


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"dverse e7ects: dry mou, 80 disturbances (nausea, "omiting,dyspepsia, constipation, diarrhea, anore1ia and weight loss#, e1cessi"esweating, pruritus, skin rashes, urticaria. /ngioedema, anapylacticshock, hyponatremia, hyperprolactinemia, galactorrhea, arthralgia,myalgia, chest pain and chills

Dru# interactions% synergistic e-ect with

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Case 3 CPT Compiled - TB

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