Page 43 of 44

PH8.1-11 | Antimicrobial and Chemotherapy Pharmacology — Assignment

Grading Rubric — Antimicrobial and Chemotherapy Pharmacology — Case Study Rubric

Criterion	Points	Full-marks descriptor
ATT Hepatotoxicity Management (PH8.5)	7 pts	Exceeds (6–7): Accurately identifies all three hepatotoxic ATT drugs (INH > PZA > RIF) with mechanisms; applies WHO stopping criteria (ALT >3× with symptoms, >5× without); outlines sequential rechallenge protocol; explains INH-associated pyridoxine depletion as compounding factor in diabetic neuropathy; identifies appropriate monitoring schedule (LFT at baseline, 2w, 4w, 8w and symptoms-triggered).
HIV-ATT Drug Interactions and ART Selection (PH8.5, PH8.10)	8 pts	Exceeds (7–8): Correctly selects TDF+3TC+DTG with DTG 50mg BD (not once daily) when co-administered with rifampicin; explains rifampicin CYP3A4/UGT1A1 induction reducing DTG AUC by 75%; compares rifampicin-EFV interaction (dose adjustment required but less critical) vs rifampicin-PI interaction (contraindicated); explains amlodipine CYP3A4 metabolism and rifampicin-induced reduced efficacy (BP rise risk); provides 3 accurate patient counselling points.
Cryptococcal Meningitis — Antifungal Plan and Toxicity Management (PH8.8, PH8.10)	10 pts	Exceeds (9–10): Diagnoses cryptococcal meningitis correctly; explains Cryptococcus escapes phagocytic clearance at CD4 <200; prescribes complete WHO 2022 3-phase plan (induction: AmB + flucytosine × 2 weeks; consolidation: fluconazole 400mg/d × 8 weeks; maintenance: fluconazole 200mg/d × 12 months or until CD4 >200 × 3 months); AmB nephrotoxicity mechanism (renal tubular vasoconstriction + direct tubular toxicity → K+/Mg2+ wasting); 3 evidence-based strategies (NS pre-loading, liposomal AmB, avoid nephrotoxins); anticipates IRIS at 4–8 weeks post-ART initiation, manages with corticosteroids NOT stopping ART.