CASE STUDY

ALVI VARGHESE
ROLL NO:4
• 52 year old male patient came with
complaints of pain on the left knee for more
than 2 weeks, the pain is more during
activities.No history of fall or trauma
 DEMOGRAPHIC DETAILS
• NAME: MR.ISSAC PI
• AGE:57
• SEX:MALE
• DOA:16-01-15
• DOD:24-01-15
• DEPT:ORTHOPAEDICS DEPT
 SUBJECTIVE
Presenting Complaints
• C/O pain on knee > 1 week
Past History
• No h/o Co morbidities
Social Economic Class
• Middle class
Dietic history
• Mixed diet
 General examination
• Patient concious,oriented
• PR-80/min
• BP-140/90 mmHg
• No PICCLE
• Systemic Examination
• RS:B/L air entry equal,NVBS,No added sounds
• CVS:S1 S2 heard
• P/A:soft,non tender,no organomegaly
 LOCAL EXAMINATION OF LEFT KNEE

• Generalised swelling of left knee present

• Parapatellar fossa
• Suprapatellar fullness present
• No palpable swelling,abrations or lacerations
• Local rise of temp (+)
• Patellar tap (+)
• Synovial thickening present
• Medial,lateral,patello femoral tenderness (+)
• Tenderness at the medial and lateral edge of
patella
• No femoral chondyle tenderness
• ROM left knee:0-80 flexion associated with
pain,cerpitus
• No sensory deficits
• Peripheral pulses palpable
• Reflexes-normal
 LAB VALUES
HAEMATOLOGY
PARAMETERS INFERENCE REFERRENCE INTERPRETATION
Hb 11.9% 11-16gm% Normal
PCV 35.5% 35-47% Normal
Total WBC 12500cumm 5000- Elevated
11000cumm
DC poly 64% 40-75% Normal
Lymph 20% 20-45% Normal
eosi 08% 1-8% Normal
mono 08% 2-10% Normal
Platelet count 4 lakh/cumm 1.5-4 lakh Normal
ESR 125mm/hr 0- Elevated
20mm/hr
 BIOCHEMISTRY

PARAMETERS INFERENCE REFERRENCE INTERPRETATION

Urea 29mg/dl 15-40mg/dl Normal

Creatinine 0.88mg/dl 0.6-1.5mg/dl Normal

Fluid total 6.4gm/dl 5-9gm/dl Normal

protein
Blood Sugar 53mg/dl <110gm% Normal

RBS 121mg/dl 70-130mg/dl Normal

Uric acid 3.6mg/dl 3.5-7.7mg/dl Normal

 Investigations
• X-ray Left knee AP-Degenerative changes(+)
• MRI Left knee
Synovial effusion with thickened wall and
enhancement-Possibility of sinovitis
ASSESSMENT:OSTEOARTHRITIS
SEPTIC ARTHRITIS
HYPERTENSION
 DISCUSSION ON THERAPY
BRAND NAME GENERIC NAME CLASS ADVERSE INTERACTION
REACTION

INJ.ROXIM CEFOTAXIME Cephalosporin Thrombocytopenia, amikacin causing

eosinophilia,CNS kidney damage
toxicity,nausea

INJ.DYNAPAR AQ DICLOFENAC NSAID Nausea,vomiting,an _

SODIUM orexia,diarrhoea

T.MAGICHEAL TRYPSIN+RUTIN+ Anti Flatulence,nausea _

BROMELAIN inflammatory

T.KYRAB DEXRABIPRAZOLE Proton pump Headache,abdomin _

+DOMPERIDONE inhibitor al pain,constipation

C.MOVJOY DIACERIN,GLUCO Glucosamine Nausea,heartburn,

SAMINESULPHAT Diarrhoea,constipat
EPOTASSIUM ion,drowsiness
CHLORIDE,METH _
YLSULPHONYLME
THANE
INJ.AMIKACIN AMIKACIN Aminoglycoside Hearing and _
SULFATE kidney problems
T.CLOPIVAS CLOPIDOGREL ANTIPLATELET Abdominal Amikacin causing
pain,constipation kidney
,bleeding,fatigue, damge,aspirin-
rash bleeding
T.ECOSPIRIN ASPIRIN NSAID, Nausea,vomiting, Amikacin causing
migraines,fatigue kidney
,jaundice damage,clopidog
rel-bleeding
C.METOLAR XR METOPROLOL Beta blocker Headache,confus _
ion,hallucination,
T.COVATIL CV CEFUROXIME cephalosporin Convulsions,naus
AXETIL+CLAVULANI ea,vomiting,steve _
C ACID ns-johnson
syndrome
T.ETOSHINE ETORICOXIB COX 2 inhibitor Nausea,headach _
e,rash,heart
failure
INJ.DOLONEX PYROXICAM NSAID Anemia,rashes,di _
zziness,headache
 TREATMENT CHART
BRAND NAME GENERIC NAME DOSE ROUT 1 1 1 1 2 2 2 2 2
E 6 7 8 9 0 1 2 3 4

INJ.ROXIM CEFOTAXIME 1.5gm IV    

INJ.DYNAPAR AQ DICLOFENAC 1amp IM    

SODIUM

T.MAGICHEAL TRYPSIN+RUTIN+B 48mg+ ORAL         

ROMELAIN 100mg
+90mg

T.KYRAB D DEXRABIPRAZOLE 10mg+ ORAL         

+DOMPERIDONE 30mg
C.MOVJOY DIACERIN,GLUCOS 50mg/ ORAL         
AMINE SULPHATE 750mg
POTASSIUM /250m
CHLORIDE,METHY g
LSULFONYLMETHA
NE
BRAND NAME GENERIC NAME DOSE ROU 1 1 1 1 2 2 2 2 2
TE 6 7 8 9 0 1 2 3 4
INJ.AMIKACIN AMINOGLYCOSI 1amp IV    
DE
T.CLOPIVAS CLOPIDOGREL 75mg ORAL       

T.ECOSPIRIN ASPIRIN 150mg ORAL       

C.METOLAR XR METOPROLOL 12.5mg ORAL       

T.COVATIL CV CEFUROXIME 500mg ORAL     

AXETIL+CLAVU
LANIC ACID
T.ETOSHINE ETORICOXIB 120mg ORAL    

INJ.DOLONEX PYROXICAM 40mg DEEP  

IM
 DISCHARGE MEDICATION
• T.DOLONEX DT 0-0-1
• T.KYRAB D 1-0-1
• T.MAGICHEAL 1-1-1
• C.MOVJOY 1-1-1
• T.GABANTIP AT 0-0-1
• T.HCQ 200mg 1-0-1
• CONTINUE REGULAR MEDICATIONS

REVIEW AFTER 2 WEEKS IN ORTHO 2 OPD

CURRENT STATUS:HE IS BEING DISCHARGED

ON A STABLE STATE
 PLAN
There are a number of treatments other than medications.
These can substantially improve arthritis symptoms, and they
are usually the first treatments recommended.
• Rest — Arthritis symptoms are typically worsened
by activity and are improved with rest. A
complete lack of activity can lead to a loss of
muscle and joint stiffness.
• Weight loss — Weight loss, even modest weight
loss, appears to lower this risk.
• Physical therapy and exercise programs —
Physical therapy and exercise improve flexibility
and strengthen the muscles surrounding the
joints. People who exercise regularly despite their
arthritis will typically have less pain and better
function than those who are inactive.
• Orthoses — Orthoses are devices that help to keep
the joints aligned and functioning correctly. There
are many different types of orthoses that can
reduce symptoms and that can help maintain
function in people with osteoarthritis (OA).
• Well-cushioned shoes and orthotic shoe inserts may
reduce stress on the joints of the spine and leg.
• Splints that immobilize the joints can reduce pain
and inflammation, and many splints can be worn
throughout the day and night. Braces can help
stabilize unstable joints
• Assistive devices — Canes, walkers, electric-powered seats
can reduce the stress on joints
• Vitamins — OA is less likely to worsen in people who have a
high dietary intake of vitamin C (ascorbic acid) and a high
dietary intake and high blood levels of vitamin D.
• Heat and cold therapy-applying heat and cold to arthritic
joints can help to control arthritis symptoms such as pain
and stiffness.
• Heat therapy – Heat relieves pain and stiffness in arthritic
joints. Heat can be applied to the joints with hot packs, hot
water bottles, heating pads, .
• Cold therapy – Cold relieves pain in arthritic joints and
reduces muscle spasms.
 PHARMACISTS INTERVENTION
 Amikacin can sometimes cause damage to the kidneys, and
using it with a cephalosporin antibiotic like cefotaxime may
increase that risk.
 Using amikacin together with aspirin and clopidogrel can
add to the side effects of amikacin and cause damage to the
kidneys.
 Aspirin along with Clopidogrel, may cause unusual blee
ding, severe abdominal pain, weakness, and the appearance
of black, tarry stools.
 Diclofenac sodium along with aspirin and clopidogrel may
increase the risk of developing gastrointestinal ulcers and
bleeding.
 REFERENCE
1. CIMS
2. PHARMACOTHERAPEUTICS,JOSEPH T DIPRO
3. DRUGS.COM