RT Book, Section
A1 Jobst, Erin E.
A1 Panus, Peter C.
A1 Kruidering-Hall, Marieke
SR Print(0)
ID 1192818554
T1 Antifungal and Antiparasitic Agents
T2 Pharmacology for the Physical Therapist, 2e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781259862229
LK accessphysiotherapy.mhmedical.com/content.aspx?aid=1192818554
RD 2024/04/24
AB CASE  STUDYA.G.  is  a  29-year-old  woman  who  returned  from  a  military  deployment  in  the  Middle  East  2  months  ago.  She  was  admitted  to  a  military  rehabilitation  hospital  4  days  ago  for  an  amputee  rehabilitation  program.  She  sustained  a  transtibial  amputation  of  the  left  lower  extremity  1  week  ago,  secondary  to  a  traumatic  injury  that  occurred  during  a  military  operation.  Prior  to  injury,  A.G.  was  functionally  independent  and  an  avid  basketball  player.  At  admission,  A.G.  was  noted  to  have  several  crusted  raised  lesions  that  were  up  to  1  inch  in  diameter  on  her  face,  neck,  and  left  forearm.  She  reported  that  the  lesions  were  much  larger  and  painful  several  weeks  ago.  An  infectious  disease  physician  sampled  skin  scrapings  of  the  lesion  and  diagnosed  the  condition  as  cutaneous  leishmaniasis.  A.G.  was  started  on  a  20-day  intravenous  course  of  sodium  stibogluconate,  which  she  receives  once  per  day,  immediately  prior  to  afternoon  physical  therapy  sessions.  A.G.  is  very  motivated  to  return  to  her  prior  level  of  function  and  has  been  participating  in  physical  therapy  twice  per  day  since  admission.  During  the  first  week,  she  met  each  therapy  goal  regarding  residual  limb  edema  control,  stretching,  strengthening,  and  pregait  activities.  She  was  making  remarkable  gains  in  therapy  until  5  days  after  initiation  of  IV  sodium  stibogluconate  when  her  energy  level  began  declining,  and  she  was  unable  to  complete  an  hour  of  physical  therapy.  Today,  while  exercising  in  the  parallel  bars,  she  had  to  sit  down  twice  secondary  to  dizziness.  A.G.  complains  of  severe  hip  and  knee  pain,  as  well  as  gluteal,  quadriceps,  and  back  muscle  soreness.  Although  A.G.’s  symptoms  may  be  the  result  of  her  vigorous  participation  in  rehabilitation,  the  physical  therapist  noted  that  some  symptoms  might  be  adverse  effects  of  the  new  drug  therapy.  The  therapist  encouraged  A.G.  that  these  symptoms  were  likely  to  dissipate  once  the  full  course  of  drug  therapy  had  been  completed.  A.G.  stated  that  the  drug  treatment  “has  been  far  worse  than  these  little  sores.”  She  states  her  intention  to  tell  the  doctor  that  she  is  no  longer  going  to  take  the  prescribed  medication,  so  that  she  can  “get  on  with  rehab.”