CHILKUR BALAJI COLLEGE OF PHARMACY
Aziznagar, Hyderabad, Telangana - 500075
Affiliated to -
Century Super Speciality Hospital
Presented by
Pranavi Bandari
Pharm D, IV year
Roll no.18GD1T0019
• No:of Cases collected: 13
• No:of Cases analysed: 9
1. Case on CKD
2. Case on Complicated Malaria
3. Case on Seizure Disorder-generalized Tonic-
Clonic seizure.
4. Case on Viral pyrexia
5. Case on Severe Anaemia- Nutritional Iron
Deficiency.
6.Case on Wernicke’s Encephalopathy
7.Case on Cholelithiasis
8.Case on Left Ovarian Cyst
Types of seizures:
Focal Generalized Unknown
Seizures Seizures onset
simple partial absence
seizures seizures
complex partial
seizures Tonic seizures
Atonic seizures
Clonic seizures
Myoclonic
seizures
Tonic-clonic
seizures
• Focal seizures: result from abnormal electrical activity in one area
of the brain.
• Generalized seizures: result from
abnormal electrical activity
involvingall areas of the brain.
• Tonic-clonic seizures:
previously known as
"grand mal seizures". As implied by the
name, they combine the characteristics
of tonic and clonic seizures. Tonic means
stiffening and clonic means rhythmical jerking.
Pathophysiology:
Diagnosis:
• Electroencephalogram (EEG)
• Computerized tomography (CT) scan
• Magnetic resonance imaging(MRI)
Treatment:
Soap Analysis
Subjective evidence:
Demographic details:
Name: Abc IP No. 2107025352
Age: 75 Yrs DOA: 19-07-2021 At 1:40 a.m
Sex: MALE DOD:
Reason for admission: A male patient of 75years old was presented to the ER
with chief complaints of fall down at home around 11pm, bleeding from
mouth+, passing urine involuntarily, trembling of both hands+, tongue bite+,
generalized weakness, urinary incontinence- 1hr prior to admission in ER.
History of past illness:
K/C/O HTN
CAD- RBBB
H/O -S/P - cervical spine surgery
H/O- BPH with PVR
H/O on and off giddiness fall since 2-3 years.
Family History: No significant family history.
On examination:
Sensorium: awake/oriented Temp:98.6°F PR:88/min
CNS: GCS-E4V5M6 BP:140/80mmHg RR:20/min
Right tongue bite+ SPO2: 98%
Objective evidence:
Laboratory Data:
19/07/2021 20/07/21 Normal values
Hb% 10.9g/dl 11.7g/dl 13.5 - 17.5g/dl
PCV 30.7% 32.6% 40 - 54%
Platelets 75000 microlitre 80000 microlitre 1,50,000 –
4,50,000microlitre
Creatinine 0.9mg/dl - 0.7 - 1.2mg/dl
Na+ 140mmol/l - 136 - 146mmol/L
K+ 4.0mmol/l - 3.5 - 5.0mmol/L
Cl 107mmol/l - 102 - 109mmol/L
Investigations:
MRI brain with stroke protocol, RP-2,ECG,EEG,2D-ECHO,Dengue
serology,VITAMIN-B12.
Investigation Report:
MRI Brain: no evidence of acute infarcts, multiple periventricular ischemic
changes+
EEG: no ischemic changes.
Dengue serology: negative.
Vitamin B12- vit b-12 deficiency.
Provisional diagnosis:
Seizures
Acute infarcts
Thrombophlebitis
Day-wise assessment:
• Day-1: c/o backpain+
Treatment: Tab.flexura-D - 1tab
• Day-2: c/o occasional cough, Constipation
Treatment: syp.ascoril 10ml
Caps.karvol plus
Syp.duphalac 30ml
• Day-3: no fresh complaints.
Assessment:
• Based on subjective and objective evidence it is assessed
that patient is suffering from “Generalized Tonic-Clonic
Seizures”.
• Final Diagnosis:
• Seizure disorder- Generalized Tonic-Clonic Seizure
• Vitamin-B12 deficiency
• Thrombophlebitis
Treatment chart(inpatient medication chart):
Brand name: Generic name Dose Route Frequency
D1 D2 D3
Inj PAN Pantoprazole 40mg IV + + -
Tab.ecospirin Aspirin 75mg P/O + + +
Tab levipil Levetiracetam 500mg P/O + + -
Tab.dytor plus Spironolactone 10mg P/O + + +
Tab.PAN Pantoprazole 400mg P/O - - +
Tab.urimax d Tamsulosin 1 Tab P/O - + -
Inj optineuron - 1 Amp IV - + -
Syp duphalac Lactulose 30ml P/O - + +
Syp ascoryl Terbutaline 10ml P/O - + +
Tab amoxclav Amoxicillin 625mg P/O - + +
Tab atorva Atorvastatin 40mg P/O - + +
Caps.Karvol plus - 1 Caps P/O - + +
Tab. Flexura D Metaxalone, 1 Tab P/O - - +
diclofenac
Drug assessment:
1) Inj.PAN 40mg
moa: It works by reducing the stomach acid
2) Tab.Ecospirin av 75mg
moa: It works by reducing the formation of cholesterol and inhibiting the formation of blood clots.
3) Tab.Levipil - 500mg
moa: It works by suppressing brain sites responsible for abnormal activity and prevents the spread of
electrical signals that cause seizures.
4) Tab.Dytor plus- 10mg
moa: It acts by increasing the amount of urine production.
5) Cap.Urimax - 1 caps
moa: It works by blocking adeno receptors in prostate,urethra,bladder resulting in relaxation of smooth
muscles and allowing urine to flow freely.
6) Inj.Optineuron - 1amp
moa: It is a nutritional supplement and helps to improve the level of vitamins b6,b12,b2,b1 in body.
7) syp.Duphalac - 30ml
moa: works by increasing the amount of water and stool bulk in the bowel, promoting normal bowel activity.
Use: used to treat constipation.
8) Syp.ascoryl - 10ml
moa:It works by thinning the mucous in nose, windpipe and lungs.
9) Tab.amoxiclav - 625mg
moa: It works by stopping the growth of bacteria,used for several bacterial infections.
10) Tab.Atorva - 40mg
moa: It works by slowing and decreasing the amount of cholesterol that builds up on walls of arteries.
11) Caps.karvol plus - 1caps
moa: It works by thinning mucous and making it easier to cough.
12) Tab.Flexura-D - 1tab
moa: It works by blocking the actions of certain chemical messengers that cause pain.
DRUG INTERACTIONS:
DDI:
• Tab.Dytorplus+Syp.Duphalac
Interaction: Moderate DDI
Effect: combining these medications for prolonged period may increase the risk of dehydration and electrolyte
imbalance.
Planning:
patient is stable
no fresh complaints
no further episodes of seizures
vitals are stable
plan for further evaluation
Discharge medications chart:(outpatient)
Drug name Generic name Dose Frequency
Tab.ecospirin av Aspirin 75mg OD at 2p.m
Tab.dytor plus Spironolactone 10mg (1/2 Tab) OD at 2p.m
Tab levipil Levetiracetam 500mg BD at 8am-8pm
Tab.PAN Pantoprazole 40mg BID(before food) at 7am-
7pm
Tab.urimax d Tamsulosin 1 Tab OD at 2p.m
Syp duphalac Lactulose 25ml OD at 9p.m
Syp ascoryl Terbutaline 10ml BD for 5 days at 8am-8pm
Tab amoxclav Amoxicillin 625mg BD for 3 days at 8am-8pm
Caps.Karvol plus - 1 caps TID
Tab. Flexura D Metaxalone, diclofenac 1 tab BD at 8am-8pm for 3 days
Patient counseling:
• For seizures:
• For vitamin B-12 deficiency:
You can take steps at home to improve your health by eating a varied diet that includes meat,
milk, cheese, and eggs, which are good sources of vitamin B12.
• For thrombophlebitis:
Take a walk- once an hour.
Move your legs regularly.
Drink plenty of water or other nonalcoholic fluids to avoid dehydration.
Applying heat to the painful area, elevating the affected leg.
Wearing compression stockings.
THANK YOU
