Case 1

(Established under Section 3 UGC Act 1956 )
under category ‘A’ by MHRD, Gol Accredited with

‘A+’Grade by NAAC
NGSM Institute of Pharmaceutical Sciences

CASE PRESENTATION SUBMITTED AS A PARTIAL FULFILLMENT OF
THE M. PHARM PROGRAMME
Name of the student :Ameena riza
University register number : NU22PHPP01
Course : M Pharm
Specialization : Pharmacy Practice
Semester : 2nd
Year : 2022-2023
Subject : pharmacotherapeutics II
Topic : Case on Meningitis and Hyperthyroidism
Date of submission : 0/06/2023
Signature of the student Signature of the staff in charge
Date: Date:
Case on Meningitis and Hyperthyroidism
PROBLEM LIST
▪ Meningitis
▪ Hyperthyroidism
SOAP Analysis
SUBJECTIVE EVIDENCE
▪ c/o fever with chills since 7days
▪ Nausea since 3days
▪ Multiple joint pain
OBJECTIVE EVIDENCE
▪ General examination :conscious co-operative and well oriented to time place , pallor present
▪ Routine biochemical examination:
Hb-11.2(13-17)
T.billi-4.01(<1.0mg/dl)
D.billi-3.71(<0.25mg/dl)
Sgot-44(<40 U/I)
Sgpt -64.8(<40 U/I)
ASSESSMENT:
▪ Final diagnosis : Based on subjective and objective evidence, the present case is found to be a case
of Meningitis and hyperthyroidism.
▪ Etiology: viral and bacterial infection
▪ Is therapy indicated? Yes, therapy is required in the patient to prevent the complications of brain
damage, hearing loss, risk of stroke, heart disease.
Standard treatment algorithm
Current therapy:
SL BRAND NAME GENERIC NAME DOSE FREQUENCY DURATION
NO
1 Inj xone ceftriaxone 1mg 1-0-1 D1-D9
2 Inj pan Pantoprazole 40mg 1-0-0 D1-D9
3 Inj emeset Ondansetron 4mg 1-1-1 D1-D10
4 Tab limcee Vitamin C 500mg 1-0-1 D1-D10
5 Tab neurobion forte Thiamine 1-0-1 D1-D10

hydrochloride
pyridoxine
hydrochloride
cyanocabalamine
ASSESMENT OF CURRENT THERAPHY:

1)INJ. XONE (1-0-1)(d1-d9)
▪ Category : cephalosporin antibiotics
▪ Indication : empirical therapy .
▪ MOA :works by inhibiting the mucopeptide synthesis in the bacterial cell wall.
▪ Std dose:1g IV every 12 hours
▪ ADR: Diarrhea (3%) , thrombocythemia (5%)
▪ Justification:Ceftriaxone sodium, a new cephalosporin with a very broad spectrum of action and a very
long serum half-life, was administered to 127 patients in the treatment of 133 severe infections at our
institution in Lausanne, Switzerland. Eighty infections had previously been treated unsuccessfully with
other antimicrobials to which the pathogens were most often resistant. Sixty-five episodes were treated
with two daily injections until there was an improvement in the patient's clinical condition, while 67
infections were treated from the start by a single daily injection. The results in the two groups were
similar. One hundred fifteen infections (86%) were cured or improved, ten (8%) did not respond to
therapy or recurred, and eight (6%) were not evaluable. The treatment was well tolerated, even by the
18 patients who received the drug for more than four weeks.
2)INJ PAN (40mg)(1-0-0)(d1-d9)
▪ Category : Proton Pump Inhibitor
▪ Indication :Gastroesophageal reflux disease (GERD)
▪ Moa : proton pump inhibitor, suppresses gastric acid secretion by inhibiting the parietal cell H+/K+
ATP pump.
▪ Std dose: 40mg OD B/F
▪ ADR: depression (≤2%), dizziness (≤4%), headache (≥4%)
▪ Justification: Thirty-six subjects received pantoprazole in a three-way crossover design study.
Ambulatory 24-h intragastric pH and distal esophageal pH were monitored at baseline and on the last
day of each treatment period. Safety was evaluated by incidence and severity of adverse
events. Pantoprazole demonstrated a linear dose- dependent suppression of gastric acidity over the dose
range 10-40 mg. All pantoprazole doses were well tolerated. Pantoprazole demonstrates a dose-related
effect in the range 10-40 mg once daily. The once-daily dose of 40 mg provides the highest and most
consistent control of gastric pH
3)INJ EMESET(4mg)(1-1-1)(d1-d9)
▪ Category:anti-emetics
▪ Indication:control nausea and vomiting due to certain medical conditions like stomach upset.
▪ MOA: Ondansetron is a selective 5-HT3-receptor antagonist which blocks serotonin, both peripherally
on vagal nerve terminals and centrally in the chemoreceptor trigger zone
▪ ADRs: Diarrhea, fatique, constipation
▪ Justification:Seventy-one patients participated in the study; 36 in the ondansetron group (receiving 8
mg intravenous ondansetron), and 35 in the placebo group (receiving isotonic NaCl solution).
Measurements of heart rate and arterial blood pressure were taken every 5 minutes after spinal
anesthesia was performed with 4 mL 0.5% hyperbaric bupivacaine solution. Decreases in mean,
systolic, and diastolic arterial pressure as well as in heart rate, compared with baseline values were
observed in both groups. Minimal systolic and mean blood pressure values obtained over a 20-minute
observation period were significantly higher in the ondansetron group. There were no significant
differences in diastolic blood pressure and heart rate values between the groups. Ondansetron given
intravenously attenuates the fall of systolic and mean blood pressure, but does not have an influence
on diastolic blood pressure or heart rate
4)TAB LIMCEE (500MG)(1-0-1)(D1-D9)
▪ Category :Vitamin, Water Soluble
▪ Indication :To boost immunity and protect the body against flu and seasonal allergies.
▪ MOA :Ascorbic acid is an electron donor used for collagen hydroxylation, carnitine biosynthesis, and
hormone/amino acid biosynthesis.
▪ Std dose: one tablet once or twice daily
▪ ADR: Diarrhoea, Nausea, Heartburn, Dizziness
5)TAB NEUROBION FORTE (1-0-1)(D1-D10)
▪ Category :vitamins
▪ Indication :improves the nervous systems health, metabolism the immune system and helps treat
vitamin deficiencies
▪ Moa :Vitamins B1, B6, B12 contains neurotropic vitamins (B1, B6, B12) that support, protect and can
repair damaged nerve cells which may cause tingling and numbness. Thiamine mononitrate (Vitamin
B1) is essential for metabolism of carbohydrates and maintain nerve fibers.
▪ Adr :nausea,vomiting,diarrhoea,constipation
6)Cap doxy (100mg)(1-0-1)(d1-d10)
▪ Category : tetracycline antibiotics.
▪ Indication : used to treat different bacterial infections.
▪ Moa : inhibits protein synthesis by binding with the 30s and possibly the 50s ribosomal subunit(s) of
susceptible bacteria may also cause alteration in the cytoplasmic membrane.
▪ Std dose:100 to 200mg/day in 1 to 2 divided dose
▪ Adr : abdominal pain(1%), diarrhea(5%), upper abdominal pain(2%).
▪ Justification:
doxycycline moderately antagonized the bactericidal effect of ceftriaxone in vitro, while it had no
measurable effect on bacterial clearance from CSF in vivo. Therefore, it appears more likely that the
marked protective effect of doxycycline on several parameters in this model was a result of its anti-
inflammatory activity rather than interference with bacteriolysis induced by the beta-lactam antibiotic
PLANNING
General treatment goals:
▪ To reduce mortality and morbidity
▪ To improve patient’s quality of life
▪ To reduce complications
Patient specific goals:
▪ To reduce the symptoms
▪ To improve patient’s quality of life
Therapeutic monitoring parameters:
▪ Thyroid function test (TSH, T4, T3)
▪ HB
Toxicity monitoring parameters:
▪ Ceftriaxone - Platelet count
Advice on discharge:
SL NO BRAND NAME GENERIC DOSE FREQUENCY
NAME
1 Tab thyrowel Mecobalamin, 0-1-0 3weeks
cyanocobalamin
2 Tab dolo acetaminophen SOS 6 tab
3 Tab pan pantoprazole 1-0-1 3week
4 Tab neurobion forte Thiamine 1-0-1 3week

hydrochloride
pyridoxine
hydrochloride
cyanocabalamine
5 B protein powder 1-0-1 3week
Points to patient:
▪ About the disease: you are suffering from meningitis which is inflammation of protective membranes
covering the brain and spinal cord and it is viral and bacterial infection.
▪ About drugs:Tab thyrowel should be taken afternoon after lunch for 3weeks
➢ Tab dolo 650mg if necessary
➢ Tab pan (pantoprazole) should be taken before food morning and night for 3week
➢ Tab neurobion forte (Thiamine hydrochloride pyridoxine hydrochloride cyanocabalamine) should be taken
morning and night after food for 3week
➢ B protein powder 2spoons should be taken morning and night 3week
Follow up:
review after 3week with Raghava sharma with Hb,Tc,platelet, LFT,RFT,TSH,T3,T4
REFERENCES:
1. Baumgartner JD, Glauser MP. Single daily dose treatment of severe refractory infections with ceftriaxone:
cost savings and possible parenteral outpatient treatment. Archives of internal medicine. 1983 Oct
1;143(10):1868-73.
2. Tutuian R, Katz P O, Bochenek W, Castel D O. Dose-dependent control of intragastric pH by pantoprazole,
10, 20 or 40 mg, in healthy volunteers. Aliment Pharmacology Therapy. 2002; 16(4):829-836.
3. Shetty K, Shetty R, Bairy L, Rao P, Kiran A, Shetty M. A comparative study on clinical and biochemical
parameters in amlodipine and cilnidipine treated hypertensive patients. Journal of clinical and diagnostic
research: JCDR. 2017 May;11(5):FC01

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(Established under Section 3 UGC Act 1956 )

under category ‘A’ by MHRD, Gol Accredited with

NGSM Institute of Pharmaceutical Sciences

University register number : NU22PHPP01

Specialization : Pharmacy Practice

Topic : Case on Meningitis and Hyperthyroidism

Date of submission : 0/06/2023

Signature of the student Signature of the staff in charge

2 Inj pan Pantoprazole 40mg 1-0-0 D1-D9

3 Inj emeset Ondansetron 4mg 1-1-1 D1-D10

4 Tab limcee Vitamin C 500mg 1-0-1 D1-D10

5 Tab neurobion forte Thiamine 1-0-1 D1-D10

ASSESMENT OF CURRENT THERAPHY:

2 Tab dolo acetaminophen SOS 6 tab

3 Tab pan pantoprazole 1-0-1 3week

4 Tab neurobion forte Thiamine 1-0-1 3week

5 B protein powder 1-0-1 3week

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