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Jose has been suffering from recurrent bouts of chronic bronchitis. He had been a heavy smoker and coffee drinker for decades. He has given up smoking entirely, though he continues to drink 8-10 cups of coffee daily. Bacteriological examination of his sputum reveals the presence of H. influenzae susceptible to several fluoroquinolones. He is treated orally with ciprofloxacin. Although the patient responds to the treatment, he complains of restlessness and agitation at nights. The doctor advises him to cut down his coffee drinking. Jose protests that he cannot function without coffee and as he has been practically weaned on the beverage, it is unlikely to be the culprit. He tells the doctor that it is the drug that is to blame. When the doctor switches him onto ofloxacin, a related compound, the symptoms lessen and disappear.


This problem served to reintroduce students to another key concept -- drug interactions at a pharmacokinetic level. The problem is brief but the crucial elements are presented. The students are presented with a problem to solve but need to acquire a good deal of basic information before they can do so.

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