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Old 04-14-2013
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ObGyn vancomycin in pregnancy

Q) a 6 month old male child is taken to a pediatrician by his parents for evaluation..they complain that since the birth of the child ,there are hypopigmented patches on his thigh and cheek...recently he developed reddened facial lesions associated with leathery plaques which appear as shagreen....past history include 2 episodes of seizure like activity which are controlled without medication..family history is insignificant. there is no associated food alteration habits. his general milestones are not up to mark. which of the following medication can be helpful for this patient in the future.?

a) thyroxine
b) topical erythromycin
c) valve replacement
d) ACTH
e) topical puromycin
f) pegvisomant


q) i have another doubt guys.........can vancomycin can be given in pregnancy..?
because i did a question in kaplan qbank which state vanco as answer for pregnant with 34 wk G.A.....i googled it but i'm not sure,so wanna make it confirm..


thanks
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Old 04-14-2013
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1st qn -diagnosis -Tuberous sclerosis, ACTH can be useful in future in case of infantile spasms (West syndrome)
Pegvisomant is GH receptor antagonist used in acromegaly.

I think vanco can be given in pregnancy, not sure abt that.
The potential ototoxic and nephrotoxic effects of vancomycin on infants were evaluated in a limited, controlled study involving intravenous administration of vancomycin during the second and third trimester of pregnancy to women with serious staphylococcus infections. No sensorineural hearing loss or nephrotoxicity was attributed to the vancomycin therapy. Vancomycin is only recommended for use during pregnancy when benefit outweighs the risk

Hope this info helps.
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Old 04-14-2013
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really thankful @dhanvanthri80 for clearing me the 2nd question...

yup, 1st Q-->ACTH is the correct one

tuberous sclerosis is the neurodegenerative disorder with infantile spasms, shagreen patch ,ashleaf macule,adenoma sebaceum ,retinal hamartoma, cardiac rhabdomyoma, psychomotor retardation--------->there is no definitve treatment for this disorder apart from treating the symptoms
infantile spasms are most commonly seen during 1st year of life in tuberous sclerosis patients--->EEG shows --hypsarrhythmic wave patterns
treated by --->ACTH -1st line followed by vigabatrin(s/e-psychosis -so limited use)

A) thyroxine isnt much helpful though there is growth retardation ; it's rarely used in this patient and also not in 1st yr of life..

B)/E) --topical antibiotics arent much helpful for retinal lesions presented in this pt.

C) valve replacement isnt useful,although cardiac surgery may be done for rhabdomyoma but not valve replacement

f) pegvisomant--> yup, it's used in acromegaly

thanks
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