KY is a 12-year-old boy who has been diagnosed recently with acute lymphoblastic leukaemia (ALL). He has been admitted to hospital for treatment.
KY’s initial therapy will comprise the corticosteroid dexamethasone, as well as the cytotoxic agent’s vincristine, L-asparaginase, daunorubicin, methotrexate and cytarabine. He experiences gastrointestinal upset but responds well to therapy; however, he does require close monitoring of his condition. KY receives adjunct therapy with the colony stimulating factor filgrastim.
KY’s four siblings are tissue-typed for bone marrow transplant. One of the children is considered a good match. While awaiting transplantation, KY develops a fever. He receives intravenous therapy with doxycycline to reduce the risk of sepsis. This crisis passes. After bone marrow transplant, KY makes good progress and moves into remission.

Answer the following questions:
1. Describe the mechanism of action of the corticosteroids and indicate the adverse effects that require monitoring during treatment with these drugs. (6 marks)

2. To which cytotoxic drug groups do each of the drugs in the case study belong? (5 marks)
3. Describe the mechanism of action of each of the drug groups identified in question two
(5 marks)
4. What are the common immediate and delayed adverse reactions associated with cytotoxic drugs? (4 marks)
5. Describe the clinical management of a client with increased susceptibility to infection. (5 marks)
6. To which antimicrobial drug group does doxycycline belong? Is it considered a bactericidal or bacteriostatic agent? Explain. (3 marks)

7. Define the term ‘antimicrobial drug spectrum of activity’. What is the spectrum of activity of doxycycline? Why choose a drug with this spectrum of activity? (2 marks)

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