CASE 1- CONSTIPATION
Scenario
MrE is an 84-year-old man who is brought to your pharmacy by his wife to
ask advice on his constipation. On discussion with him you establish that he
has recently been experiencing back pain, which prevents him from getting
about as much as he used to. His wife says that she was given some brown
tablets when she was constipated. He asked if he can try them. He asked also
if he should perhaps have something gentle, like a herbal medicine.
1.
2.
3.
4.
How is constipation defined?
Is it common?
Why do you think Mr E may have constipation?
What sort of laxative do you think Mrs Eshould take? Explain your
answer.
5. What life-style changes would you recommend Mr E should take?
Whatcounselling would you give him?
6. What would you suggest if your first recommendation fails?
1
CASE 2- GASTRO-OESOPHAGEAL REFLUX DISEASE
Mr. A is a twenty five years old man. He came to your pharmacy and asked
you to give him something to relieve his heart burn sensation. Hesuffered
this burning sensation the whole day especially after meals and during lying
down. Commonly used antacids were not that effective with him. His friend
told him to try ranitidine.
1.
2.
3.
4.
5.
6.
What is gastro-oesophageal reflux and what are the main symptoms?
Do certain foods increase reflux?
What is an appropriate approach to treatment of GERD?
What is the rationale behind the ranitidine treatment?
WHAT if heartburn isn’t GERD?
What are the important life style changes?
2
CASE 3- WEIGHT LOSS
Mrs. M is a 42 years old woman came to your pharmacy. She is obese and
wanted you to give her something to help her to lose some of her weight.
She asked you for Drug X (CNS Appetite suppressant) to help her lose her
weight rapidly. Especially that she suffered from pain in her knees during
walking.
1.
2.
3.
4.
5.
6.
Define obesity
Give examples of drug X
IS this type of drugs suitable for the case? Explain
What other classes of drugs can be suitable?
What is your advice to this woman?
What are life-style changes would you suggest?
3
CASE 4- COUGH
A 23 year old heavy smoker comes into the pharmacy with complains a
cough with phlegm. He complains that after taking a cough suppressant he
felt even worse.
Questions
1. What is cough? Why do we cough?
2. What are the types of cough?
3. What type of cough did he suffer?
4. Was his first medication wrong or not? why?
5. What would you advise him to do?
4
CASE 5 - EYE INFECTION
Rania is an 18 years girl, she comes into the pharmacy with red inflamed
eyes. Rania is a national swimmer. She is worried about not being able to
join the competition next week. Her eyes produce some white exudates
while sleeping. She complains that her contact lenses hurt while sleeping
too.
1. What is the problem with Rania's eyes?
2. What would you advise her to do?
3. What medication would you offer her? If your first choice was not
that efficient, what would you recommend?
4. What would you advise her concerning her lenses?
5
CASE 6 - COMMON COLD
Hassan is an athlete, he was jogging while raining, a day later he comes to
your pharmacy with a running nose, headache, and general body ache. He
asks you for Augmentin tablet 1000 mg.
1.
2.
3.
4.
5.
What is common cold?
Would you give him Augmentin?
What would you prescribe for him?
What would you advise him to do?
If you knew he suffered high fever and cough, would your treatment
strategy differs? If yes, what would that be?
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CASE 7 - SUN BURN
Sherine enters the pharmacy with her right hand and forearm burnt. She says
that hot oil from a frying pan splashed onto her. She quickly rinsed these
areas with cool water. In addition, she placed a layer of toothpaste over it to
relief the burning sensation. Now she has patchy areas of erythema on her
hand and forearm that “burn and sting.”
1. Have the patient took any treatment to relief pain?
2. What are the major therapy for the treating the patient’s problem and
the alternatives?
3. Discuss with the patient the possible complications if not using the
treatment correctly.
4. If blisters appear, what would you recommend the patient to do? Shall
she remove the dead skin? What are the possible complications of that
step?
7
CASE 8 - DIAPER RASH
Magda is a worried mother that comes to you in the pharmacy with her
child. The mother turns back the diaper to show you a red area on the child's
lower back. She states that the rash on her 3 months old baby began
yesterday. The child's formula has not been changed. She wonders if an
antibiotic could be the cause "I gave her the antibiotic I got here for her ear
infection a couple of days ago and she got a diarrhea, then the rash started.
Could it be the antibiotic causing this? If it is so, I will stopgiving it to her."
The baby has no hives or rash on any part of the body except the diaper area.
As a pharmacist, how could you help this worried mother to relief her baby?
1.Is the baby suffering from an allergic reaction to the antibiotic?
2. Can antibiotics cause diaper rash? How?
3. What are the common causes of diaper rash?
4. Does age as a factor have a significant contribution to diaper rash?
5. Would you recommend this mother to stop her child's antibiotic on her
own?
6. What are your general recommendations to the mother?
7. What product would you prescribe for her to be safe and effective?
8
CASE 9
A 52 year old man was seen by a physician 12 months ago complaining of
dyspepsia, which occurred sometimes after eating. The discomfort was
relieved by eating a meal or taking antacids. The physician diagnosed the
case as peptic ulcer and prescribed a drug, which provided rapid symptmatic
reliefwithin 2 days. The patient continued to take the drug for 1 month and
had no further dyspepsia for 6 months. However, over the next few months,
the symptoms recurred and grew progressively worse.
Now, on a return visit to the same physician, further investigations have
demonstrated the presence of a duodenal ulcer, while the culture showed the
presence of Helicobacter pylori. This time the physician prescribed another
therapeutic regimen.
1. Discuss different therapeutic regimen of PUD.
2. Explain why the ulcer relapsed, Specify the drugs probably prescribed
on the second visit.
3. Discuss the pathophysiology of PUD.
4. What about GERD? Mention the different therapeutic regimen.
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CASE 10
Mrs Shaimaa is a 70- years- old woman weighing 75 kg and is 165 cm tall.
Her BMR is 30 kg/m2 . Her past medical history includes osteoarthritis and
hypertension. Her medications include:
Diclofenac 50 mg three times daily.
Paracetamol 1 g four times daily.
1.
2.
3.
4.
5.
Discuss the pathophysiology of osteoarthritis.
What are the disease risk factors?
Discuss the non-pharmacological therapy of osteoarthritis.
Mention the different therapeutic approaches of osteoarthritis.
What about Mrs. Shaimaa's therapy? Is it following the latest
guidelines?
10
CASE 11
A 31-year-old woman on a Nile cruise presented to the cruise ship physician
with dilated pupils and a complaint that she could not read the lunch menu.
She mentioned that she has received a medication before the journey to
counteract nausea and vomiting which she used to complain from in such
journeys.
1. What is the motion sickness? Discuss the pathophysiology.
2. Define cycloplegia?
3. Mention the different line of therapy for nausea & vomiting
generally?
11
CASE 12
Mrs Noha is a 77-year-old woman who has been admitted to the orthopaedic
ward where you work as the clinical pharmacist. She has slipped on the wet
floor in asupermarket and has been diagnosed with a fractured lower limb.
She is normally fit and well and doesn't take any regular medications or have
anyrelevant past medical history. She is 157 cm tall and weighs 49 kg. She
lives alone and has never smoked. Mrs Noha was in considerable pain from
her fracture and was prescribed paracetamol 1 g four times daily and codeine
30 mg four times daily when required. She was still complaining of
pain.Later in the week Mrs Noha had surgery to repair her fracture. She was
also diagnosed with osteoporosis?
1. What is the difference between primary and secondary osteoporosis?
2. Which drugs may be implicated in the development of osteoporosis?
3. What are the signs and symptoms of osteoporosis? Mention the
diagnostic test for osteoporosis.
4. What are the risk factors for osteoporosis and which does Mrs Noha
have?
5. Discuss the options for the treatment of osteoporosis and decide which
you think would be the most suitable for Mrs Noha.
6. Suggest a regimen therapy according to the latest guidelines.
7. List the main drug or food interactions associated with suggested
therapy.
12
CASE 13
A 40 year old man was seen by a physician 12 months ago complaining of
dyspepsia, which occurred sometimes after eating. The discomfort was
relieved by eating a meal or taking antacids. The physician diagnosed the
case as peptic ulcer and prescribed a drug, which provided rapid
symptomatic relief within 2 days. The patient continued to take the drug for
1 month and had no further dyspepsia for 6 months. However, over the next
few months, the symptoms recurred and grew progressively worse.
Now, on a return visit to the same physician, further investigations have
demonstrated the presence of a duodenal ulcer, while the culture showed the
presence of Helicobacter pylori. This time the physician prescribed another
therapeutic regimen.
1.
2.
3.
4.
Discuss drugs that are used to relieve the symptoms of peptic ulcer
Discuss the pathophysiology of PUD.
Specify a therapeutic regimen for PUD after relapse.
Mention the difference between gastric and duodenal ulcer from
pathophysiology and treatment.
13
CASE 14
Mrs KR is a 70- years- old woman weighing 80 kg and is 162 cm tall. Her
BMR is 30 kg/m2 . Her past medical history includes osteoarthritis and
hypertension. Her medications include:
Diclofenac 50 mg three times daily.
Paracetamol 1 g four times daily.
1.
2.
3.
4.
Discuss the pathophysiology of osteoarthritis.
What are the different therapeutic regimen of osteoporosis?
What non-pharmacological remedy of osteoarthritis?
What are the diagnostic tests of osteoarthritis?
14
CASE 15
A 24-year-old woman on a Nile cruise presented to the cruise ship physician
with dilated pupils and a complaint that she could not read the lunch menu.
She mentioned that she has received a medication before the journey to
counteract nausea and vomiting which she used to complain from in such
journeys.
1. Which drug is most likely responsible for her symptoms?
2. Why she couldn't read the menu?
3. What is the most probable cause of her nausea and vomiting that
likely to occur in such journeys?
15
CASE 16
Mrs. Sarah is a 67-year-old woman who has been admitted to the
orthopaedic ward where you work as the clinical pharmacist. She has slipped
on the wet floor in asupermarket and has been diagnosed with a fractured
lower limb. She is normally fit and well and doesn't take any regular
medications or have anyrelevant past medical history. She is 157 cm tall and
weighs 49 kg. She lives alone and has never smoked. Mrs. Sarah was in
considerable pain from her fracture and was prescribed paracetamol 1 g four
times daily and codeine 30 mg four times daily when required. She was still
complaining of pain.Later in the week She had surgery to repair her fracture.
She was also diagnosed with osteoporosis?
1. What is the difference between primary and secondary osteoporosis?
2. Which drugs may be implicated in the development of osteoporosis?
3. What are the signs and symptoms of osteoporosis? Mention the
diagnostic test for osteoporosis.
4. What are the risk factors for osteoporosis and which does Mrs. Sarah
have?
5. Discuss the options for the treatment of osteoporosis and decide which
you think would be the most suitable for Mrs. Sarah.
6. Suggest a regimen therapy according to the latest guidelines.
7. List the main drug or food interactions associated with suggested
therapy.
16
CASE 17
MAHA IS A 25 YEARS OLD FEMALE WHO ENTERS
YOUR
PHARMACY
COMPLAINING
OF
DYSURIA,
FREQUENCY AND PAIN IN THE SUPRAPUBIC
AREA.
SHE ALSO COMPLAINED OF SLIGHT FEVER.
1. IN YOUR OPINION, WHAT ARE THE POSSIBLE CAUSES
FOR THESE SYMPTOMS?
2. DO YOU THINK THAT THIS IS AN INFECTION? CAN
THESE SYMPTOMS BE PRESENT WITHOUT INFECTION?
3. WHAT ARE THE COMMON CAUSATIVE ORGANISMS
FOR THIS CASE?
4. WHAT IS THE LABORATORY DIAGNOSIS IN THIS CASE?
5. WHAT ARE THE QUESTIONS YOU WOULD LIKE TO ASK
ABOUT THIS CASE TO HELP IN ITS EVALUATION?
6. WHAT ADVICE WOULD YOU GIVE THIS PATIENT
ACCORDING TO THE INFORMATION YOU OBTAINED?
7. WHAT OTC DRUGS WOULD YOU RECOMMEND FOR
THIS CASE?
8. IS ANTIMICROBIAL THERAPY HELPFUL FOR THIS
PATIENT? EXPLAIN YOUR POSITION AND MENTION
WHICH ANTIMICROBIAL AGENTS WILL BE USED.
MENTION THEIR PHARMACOLOGY.
17
CASE 18
A MOTHER COMES TO YOUR PHARMACY WITH HER 5 YEARS OLD
CHILD COMPLAINING OF SORE THROAT, HEADACHE AND COUGH.
THE MOTHER TELLS YOU THAT SHE HAS MEASURED THE CHILD’S
TEMPERATURE AND FOUND IT TO BE 40 O C.
1. WHAT ORGANS ARE INVOLVED IN THE SENSATION OF
SORENESS OF THE THROAT?
2. WHAT ARE THE COMMON CAUSATIVE ORGANISMS FOR
SORE THROAT?
3. WHAT ARE THE TYPES, TRIGGERS AND PHYSIOLOGICAL
MECHANISMS OF COUGH?
4. WHAT IS THE LABORATORY DIAGNOSIS IN THIS CASE?
5. WHAT ARE THE QUESTIONS YOU WOULD LIKE TO ASK
ABOUT THIS CASE TO HELP IN ITS EVALUATION?
6. WHAT ADVICE WOULD YOU GIVE THIS MOTHER
ACCORDING TO THE INFORMATION YOU OBTAINED?
7. WHAT OTC DRUGS WOULD YOU RECOMMEND FOR THIS
CASE?
8. IS ANTIMICROBIAL THERAPY HELPFUL FOR THIS
PATIENT?
EXPLAIN YOUR POSITION AND MENTION
WHICH ANTIMICROBIAL AGENTS WILL BE USED.
MENTION THEIR PHARMACOLOGY.
18
CASE 19
MONA AGED 28 YEARS OLD COMES TO YOUR PHARMACY ,
AFTER 7 DAYS OF ABORTION COMPLAINING OF FEVER
GREATER THAN 38 O C , CHILLS, MALAISE AND PAIN OR
TENDERNESS IN THE UTERUS.
1. IN YOUR OPINION, WHAT ARE THE POSSIBLE CAUSES
FOR THESE SYMPTOMS?
2. DO YOU THINK THAT THIS IS AN INFECTION? CAN
THESE SYMPTOMS BE PRESENT WITHOUT INFECTION?
3. WHAT ARE THE COMMON CAUSATIVE ORGANISMS
FOR THIS CASE?
4. WHAT IS THE LABORATORY DIAGNOSIS IN THIS CASE?
5. WHAT ARE THE QUESTIONS YOU WOULD LIKE TO ASK
ABOUT THIS CASE TO HELP IN ITS EVALUATION?
6. WHAT ADVICE WOULD YOU GIVE THIS PATIENT
ACCORDING TO THE INFORMATION YOU OBTAINED?
7. WHAT OTC DRUGS WOULD YOU RECOMMEND FOR
THIS CASE?
8. IS ANTIMICROBIAL THERAPY HELPFUL FOR THIS
PATIENT? EXPLAIN YOUR POSITION AND MENTION
WHICH ANTIMICROBIAL AGENTS WILL BE USED.
MENTION THEIR PHARMACOLOGY.
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CASE 20
A MOTHER COMES TO YOUR PHARMACY WITH HER 7
YEARS OLD CHILD COMPLAINING OF REPEATED SORE
THROAT, FEVER PAINFUL AND TENDER JOINTS, RED,
HOT
SWOLLEN JOINT.AND THIS SYMPTOMS ARE
RECURRENT.
1. IN YOUR OPINION, WHAT ARE THE POSSIBLE CAUSES
FOR THESE SYMPTOMS?
2. DO YOU THINK THAT THIS IS AN INFECTION? CAN
THESE SYMPTOMS BE PRESENT WITHOUT INFECTION?
3. WHAT ARE THE COMMON CAUSATIVE ORGANISMS
FOR THIS CASE?
4. WHAT IS THE LABORATORY DIAGNOSIS IN THIS CASE?
5. WHAT ARE THE QUESTIONS YOU WOULD LIKE TO ASK
ABOUT THIS CASE TO HELP IN ITS EVALUATION?
6. WHAT ADVICE WOULD YOU GIVE THIS PATIENT
ACCORDING TO THE INFORMATION YOU OBTAINED?
7. WHAT OTC DRUGS WOULD YOU RECOMMEND FOR
THIS CASE?
8. IS ANTIMICROBIAL THERAPY HELPFUL FOR THIS
PATIENT? EXPLAIN YOUR POSITION AND MENTION
WHICH ANTIMICROBIAL AGENTS WILL BE USED.
MENTION THEIR PHARMACOLOGY.
20
CASE 21
FARIDA IS 30 YEARS OLD PREGNANT DIABETIC AND
OBESE
FEMALE
WHO
ENTERS
YOUR
PHARMACY
COMPLAINING OF SEVERE VAGINAL ITCHING AND
WHITE CHEESE SECRETION IN THE VAGINA.
1. IN YOUR OPINION, WHAT ARE THE POSSIBLE CAUSES
FOR THESE SYMPTOMS?
2. DO YOU THINK THAT THIS IS AN INFECTION? CAN
THESE SYMPTOMS BE PRESENT WITHOUT INFECTION?
3. WHAT ARE THE COMMON CAUSATIVE ORGANISMS
FOR THIS CASE?
4. WHAT IS THE LABORATORY DIAGNOSIS IN THIS CASE?
5. WHAT ARE THE QUESTIONS YOU WOULD LIKE TO ASK
ABOUT THIS CASE TO HELP IN ITS EVALUATION?
6. WHAT ADVICE WOULD YOU GIVE THIS PATIENT
ACCORDING TO THE INFORMATION YOU OBTAINED?
7. WHAT OTC DRUGS WOULD YOU RECOMMEND FOR
THIS CASE?
8. IS ANTIMICROBIAL THERAPY HELPFUL FOR THIS
PATIENT? EXPLAIN YOUR POSITION AND MENTION
WHICH ANTIMICROBIAL AGENTS WILL BE USED.
MENTION THEIR PHARMACOLOGY.
21
CASE 22
A 40 YEAR OLD MAN WAS SEEN BY A PHYSICIAN 12 MONTHS
AGO COMPLAINING OF DYSPEPSIA, SLIGHT FEVER,
AND HEART
BURN, WHICH OCCURRED SOMETIMES AFTER EATING. THE
DISCOMFORT
WAS
RELIEVED
BY
TAKING
ANTACIDS.
THE
PHYSICIAN DIAGNOSED THE CASE AS PEPTIC ULCER AND
PRESCRIBED A DRUG, WHICH PROVIDED RAPID SYMPTMATIC
RELIEF WITHIN 2 DAYS. THE PATIENT CONTINUED TO TAKE THE
DRUG FOR 1 MONTH AND HAD NO FURTHER DYSPEPSIA FOR 6
MONTHS.
HOWEVER,
OVER
THE
NEXT
FEW
MONTHS,
THE
SYMPTOMS RECURRED AND GREW PROGRESSIVELY WORSE.
1. IN YOUR OPINION, WHAT ARE THE POSSIBLE CAUSES
FOR THESE SYMPTOMS?
2. DO YOU THINK THAT THIS IS AN INFECTION? CAN
THESE SYMPTOMS BE PRESENT WITHOUT INFECTION?
3. WHAT ARE THE COMMON CAUSATIVE ORGANISMS
FOR THIS CASE?
4. WHAT IS THE LABORATORY DIAGNOSIS IN THIS CASE?
5. WHAT ARE THE QUESTIONS YOU WOULD LIKE TO ASK
ABOUT THIS CASE TO HELP IN ITS EVALUATION?
6. WHAT ADVICE WOULD YOU GIVE THIS PATIENT
ACCORDING TO THE INFORMATION YOU OBTAINED?
7. WHAT OTC DRUGS WOULD YOU RECOMMEND FOR
THIS CASE?
8. IS ANTIMICROBIAL THERAPY HELPFUL FOR THIS
PATIENT? EXPLAIN YOUR POSITION AND MENTION
WHICH ANTIMICROBIAL AGENTS WILL BE USED.
MENTION THEIR PHARMACOLOGY.
22
CASE 23
AN 18- YEAR OLD MALE PATIENT COMES TO YOUR PHARMACY
COMPLAINING WITH LOW GRADE NIGHT FEVER (37.7 O C), LOSS OF
APPETITE & CONSIDERABLE WEIGHT LOSS, WEAKNESS AND
FATIGUE , ABDOMINAL PAIN, RASH AND CONSTIPATION.
1. IN YOUR OPINION, WHAT ARE THE POSSIBLE CAUSES
FOR THESE SYMPTOMS?
2. DO YOU THINK THAT THIS IS AN INFECTION? CAN
THESE SYMPTOMS BE PRESENT WITHOUT INFECTION?
3. WHAT ARE THE COMMON CAUSATIVE ORGANISMS
FOR THIS CASE?
4. WHAT IS THE LABORATORY DIAGNOSIS IN THIS CASE?
5. WHAT ARE THE QUESTIONS YOU WOULD LIKE TO ASK
ABOUT THIS CASE TO HELP IN ITS EVALUATION?
6. WHAT ADVICE WOULD YOU GIVE THIS PATIENT
ACCORDING TO THE INFORMATION YOU OBTAINED?
7. WHAT OTC DRUGS WOULD YOU RECOMMEND FOR
THIS CASE?
8. IS ANTIMICROBIAL THERAPY HELPFUL FOR THIS
PATIENT? EXPLAIN YOUR POSITION AND MENTION
WHICH ANTIMICROBIAL AGENTS WILL BE USED.
MENTION THEIR PHARMACOLOGY.
23
CASE 24
IN DAKALHIA WITH POOR SANITATION IN WATER, A FEMALE
PATIENT (29 YEARS OLD) HAD ABORTION FROM ONE WEEK
COME TO YOUR PHARMACY COMPLANING WITH DARK URINE,
ABDOMINAL PAIN, YELLOW SKIN AND EYES, FATIGUE AND
VOMITING.
1. IN YOUR OPINION, WHAT ARE THE POSSIBLE CAUSES
FOR THESE SYMPTOMS?
2. DO YOU THINK THAT THIS IS AN INFECTION? CAN
THESE SYMPTOMS BE PRESENT WITHOUT INFECTION?
3. WHAT ARE THE COMMON CAUSATIVE ORGANISMS
FOR THIS CASE?
4. WHAT IS THE LABORATORY DIAGNOSIS IN THIS CASE?
5. WHAT ARE THE QUESTIONS YOU WOULD LIKE TO ASK
ABOUT THIS CASE TO HELP IN ITS EVALUATION?
6. WHAT ADVICE WOULD YOU GIVE THIS PATIENT
ACCORDING TO THE INFORMATION YOU OBTAINED?
7. WHAT OTC DRUGS WOULD YOU RECOMMEND FOR
THIS CASE?
8. IS ANTIMICROBIAL THERAPY HELPFUL FOR THIS
PATIENT? EXPLAIN YOUR POSITION AND MENTION
WHICH ANTIMICROBIAL AGENTS WILL BE USED.
MENTION THEIR PHARMACOLOGY.
24
CASE 25 - ACNE
 Define the disorder
 Give examples for herbs or natural
products for treatment of this
disorder
 Herbal formulations for treatment of
this disorder
25
CASE 26 - NEUROLOGICAL DISORDERS
 Define the disorder
 Give examples for herbs or natural
products for treatment of this
disorder
 Herbal formulations for treatment of
this disorder
26
CASE 27 - URINARY TRACT INFECTIONS
 Define the disorder
 Give examples for herbs or natural
products for treatment of this
disorder
 Herbal formulations for treatment of
this disorder
27
CASE 28 - ANTHELMINTIC HERBS
 Define the disorder treated by those
herbs
 Give examples for herbs or natural
products for treatment of this
disorder
 Herbal formulations for treatment of
this disorder
28
CASE 29 - NAUSEA AND VOMITING
 Define the disorder
 Give examples for herbs or natural
products for treatment of this
disorder
 Herbal formulations for treatment of
this disorder
29
CASE 30 - COUGH
 Define the disorder
 Give examples for herbs or natural
products for treatment of this
disorder
 Herbal formulations for treatment of
this disorder
30
CASE 31- DENTAL AND MOUTH INFECTIONS
 Define the disorder
 Give examples for herbs or natural
products for treatment of this
disorder
 Herbal formulations for treatment of
this disorder
31
CASE 32 - HAIR AND NAIL CARE
 Define the disorder
 Give examples for herbs or natural
products for treatment of this
disorder
 Herbal formulations for treatment of
this disorder
32