Question

Aragorn and Arwen are newlyweds who have just returned from honeymoon in Mozambique. They spent most of their afternoons walking on the beach sand, though have noticed a fungal infection of their toenails. Their doctor confirms their suspicions, and they are put on griseofulvin therapy.

a. What would the implication be of the prescription if they were trying to get pregnant?

b. The couple manages to conceive and a healthy baby is born. While Arwen is breastfeeding she develops cytomegalovirus retinitis and a second nail fungal infection. Her doctor prescribes butenafine for the fungal infection and a DNA polymerase inhibitor for the retinitis. Comment on the appropriateness of this prescription and justify your rationale.

c. Arwen notices that on both times she was on antifungal therapy she developed gastrointestinal disturbance. What do you think could have been the cause of this?

Answer 1

a.Griseofulvin is a category X pregnancy drug.Women who are trying to get pregnant should be not take any X category drug.If a woman take griseofulvin during the first 3 months of pregnancy it can cause birth defects to baby.Studies has shown that griseofulvin is harmful to the foetus.

b.Arwen was prescribed butenafine for fungal infection and it is relatively safe during breastfeeding.Butenafine is poorly absorbed, it rarely reach the blood stream of the infant and cause any adverse effects in breastfed babies.Care should be taken and infant's skin should not come in contact with skin that has been treated.

Arwen has cytomegalovirus retinitis (viral infection) which can cause inflammation of retina . It is important to diagnose and treat the disease immediately or it can lead to blindness.Doctor has prescribed dna polymerase inhibitor drug to limit the progress of retinitis.Arwen is required to use this drug to avoid blindness.Advise Arwen to feed the infant before taking her medicine so that drug concentration in milk is at lowest.

c. Antifungal medication can cause stomach upset, diarrhea and stomach pain .All this are sideeffects of antifungal drugs.Most of the time these effects are mild and go away within few days.Arwen got gastrointestinal disturbance due to sideeffect of antifungal medicines.