DEPARTMENT OF PHARMACOLOGY

V.C.S.G.G.M.S&R.I. Srinagar, Pauri-Garhwal,

Uttrakhand

CLINICAL CASE SHEETS

SUBMITTED BY-
• Chandraprabha upadhyay
• Roll no. 21
• Batch - 2015
 1. CLINICAL CASE
NAME: Ms. Mamta REG. NO.: 88850
AGE/GENDER: 21 years, Female DEPARTMENT: Medicine
ADDRESS: Kuniyali, rudraprayag
c/o- The patient presented to medicine OPD on 25/07/2017 with chief complaints of -
• Fever –: 8days
• Headache-: 7days
• Vomiting-: 5 days
HISTORY -:
• HISTORY OF PRESENT ILLNESS
The patient was apparently asymptomatic 8 days back when she complained of –
• Fever- Onset- acute
Associated with- headache
Nature- remittent, low grade fever
Diurnal variation- more in the evening
• Headache- Onset- acute
Site- forehead
B/L or U/L- bilateral
Progression-increasing and decreasing in severity
Duration- continuous
Character- sharp
Aggravating factor- none
Relieving factor- not relieved on medication
Radiation-: no
• VOMITING- Frequency- 3-4times
Amount- copious approx. 1 glass
Appearance- contain food particles
Nature-: Projectile
Odour-: mal-odour
The patient feels better after vomiting
•NEGATIVE HISTORY-: No history of decreased level of consciouness and photophobia
•HISTORY OF PAST ILLNESS-: No significant past medical and surgical history.
•PERSONAL HISTORY-: Non- vegetarian by diet and has normal bladder and bowel habits.
•FAMILY HISTORY-: No relevant family history
EXAMINATION
The patient is conscious, sitting comfortably on bed & is well oriented time, place & person.
GENERAL PHYSICAL EXAMINATION-:PALLOR-: absent
ICTERUS-: absent
CLUBBING-: absent
CYANOSIS-: absent
LYMPHADENOPATHY-: absent
EDEMA-: absent
SYSTEMIC EXAMINATION-: RESPIRATORY EXAMINATION-: B/L air entry present
CVS-: S1 & S2 heard
GIT-: non- tender, no palpable mass present
CNS-: (i) Kernig’s sign -: positive
(ii) Nuchal rigidity-: positive
(iii) Reflexes are within normal limits
 INVESTIGATIONS:
• Hb: 10.8g/dl (Normal: 10.5 – 12.5g/dl)
• TLC: 7200/mm3 (Normal:6000-17500/mm3
• DLC: Lymphocyte- 70%(Normal:40-70%)
• Polymorphs- 87% (Normal:30-65%)
• Lymphocytes- 12% (Normal: 20-45%)
• Eosinophil-01% (Normal :2-8%)
• PCV: 32.6%
• MCV: 79.3%
• Platelet count: 1.30 lakhs/mm3 (140000-400000/mm3)
• RBS:182mg/dl (Normal:40-150mg/dl)
• Blood urea- 37g/dl ( Normal:15-40g/dl)
• Serum creatinine -0.7mg/dl (Normal:0.6-0.9mg/dl)
• Serum bilirubin: 0.4 mg/dl (Normal- upto 1.1mg/dl)
• Serum bilirubin – direct (conjugated)- 0.1mg/dl (Normal- upto 0.3mg/dl)
• Serum protein (total)- 6.7gm/dl (Normal- 6.6-8.7gh/dl)
• Serum albumin- 2.3gm/dl (Normal- 3.5-5.5gm/dl)
• SGPT (ALT)- 97 ( Normal- 5-40 U/L)
• SGOT(AST)- 127 (Normal- 5-45 U/L)
• Serum alkaline phosphate (ALP)- 69 U/L (Normal- 28-98 U/L)
• Test for scrub typhus- +ve
CONCLUSION
• Test for scrub typhus-: positive
• Meningeal signs -: positive
FINAL DIAGNOSIS-:SCRUB TYPHUS
 DRUGS DURING HOSPITALISATION-:
S.NO. DOSAGE DRUGS DOSE DURATION ROUTE
FORM & DOSE
INTERVAL
1. Inj. Ceftriaxone 2gm (20ml) BD iv
2. Inj. Mannitol 100mg(as TDS iv
20% sol.)
3. Inj. Dexona 8mg( 2ml) TDS iv
4. Inj. Onden 1 ampule SOS iv
(4ml)
5. Tab. Paracetamol 500mg QID Oral
6. Inj. Diclofenac 1 SOS -
ampule(3ml)
7. Inj. Ringer 1 unit 50ml/hr iv
lactate
8. Tab. Azithromycin 500mg OD oral
 DRUGS TO BE TAKEN AFTER DISCHARGE-:
S.NO. DOSAGE DRUGS DOSE DURATION & ROUTE
FORM DOSE
INTERVAL
9. Tab. Cefixime 200mg BD*5days Oral
10. Tab. Azithromycin 500mg TID*10days Oral
11. Tab. Prednisolone 20mg*10days OD Oral
10mg*5days OD
10mg*5days A/D

12. Syp. Glycerol 2 tsp. OD*15days Oral

13. Cap. Omeprazole 20mg OD oral
Q.1 Is the name of drug written legibly ? 1 2 3 4 5 6 7 8 9 10 11 12 13
Y Y Y Y Y Y Y Y Y Y Y Y Y

Q.2 Is the strength written or not ? 1 2 3 4 5 6 7 8 9 10 11 12 13

N N N N N N N N N N N N N

Q.3 Is the dose of prescribed medication written? 1 2 3 4 5 6 7 8 9 10 11 12 13

Y Y Y Y Y Y Y Y Y Y Y Y Y

Q.4 Is the dosage form mentioned ? 1 2 3 4 5 6 7 8 9 10 11 12 13

Y Y Y Y Y Y Y Y Y Y Y Y Y
Q.5 Is the frequency of drug prescribed ? 1 2 3 4 5 6 7 8 9 10 11 12 13

N Y Y Y Y Y Y Y Y Y Y Y Y

Q.6 Is the route of administration mentioned ? 1 2 3 4 5 6 7 8 9 10 11 12 13

Y Y Y Y Y N Y Y Y Y Y Y Y

Q.7 Is the Abbreviation used ? 1 2 3 4 5 6 7 8 9 10 11 12 13

Y Y Y Y Y Y Y Y Y Y Y Y Y

Q.8 Are all the drugs administered on time ? 1 2 3 4 5 6 7 8 9 10 11 12 13

Y Y Y Y Y Y Y Y Y Y Y Y Y
Q.9 Is Antibiotic prescribed or not. If yes then name them?: YES –Cetriaxone, azithromycin,
cefixime

Q.10 Is patient suffering from any adverse drug reaction ? :NO

Q.11 Total No. of drugs prescribed ?: 13

Q.12 Medicine used by generic name & brand name :

Medicine used by generic name : Ceftriaxone , Paracetamol, Mannitol, Diclofenac,
Azithromycin, Glycerol, Cefixime, Omeprazole , Ringer lactate
Medicine used by brand name : Dexona (Dexamethasone), Onden (Ondansetron)
Q.13 Any Ayurvedic/Homeopathic medicine used :NO
PROS-:
•Drugs names are written legibly.
•Frequency of all except omeprazole is mentioned.
•Dosage form of all prescribed drugs are written.
•All drugs are administered on time.

CONS-:
•Strength of the prescribed drugs is not written.
•Route for diclofenac is not mentioned.
RATIONALITY OF PRESCRIBED MEDICINES (DURING HOSPITALISATION)
• CEFTRIAXONE-: Third generation cephalosporin which has a highly augmented action against
gram –ve and some gram +ve bacteria like pneumococci. It inhibits cell wall synthesis by
inhibiting cross linking formation. rational here as the patient was a suspected case of pyogenic
meningitis.
• MANNITOL-: It is an osmotic diuretic. It can also be used to decrease, increased intracranial
tension. Its use irrational here as the patient had no signs of increased intracranial pressure i.e.
Drowsiness or diminished level of consciousness.
• DEXONA-: (Dexamethasone) Very potent and highly selective corticosteroid . It inhibits synthesis
of IL-1DIIB and TNF-a by macrophages. Thus decreases meningeal inflammation. The use of
this drug is rational here as the patient is a suspected case of pyogenic meningitis.
• ONDEN-: (Ondansetrone)
Antiemetic. It blocks 5-HT3 receptors on vagal efferents in GIT as well as NTS and CTZ.The use of
this drug is rational here as the patient had complains of vomiting.
• PARACETAMOL-: It is an analgesic and antipyretic. rational here as the patient had complains of
fever.
• DICLOFENAC-: Analgesic- antipyretic- antiinflammatory drug. Inhibits PG synthesis and is
somewhat COX-2 selective. rational here as the patient has complains of headache.
• RINGER’S LACTATE-: It is a mixture of sodium chloride, sodium lactate, potassium chloride and
calcium chloride in water. It is given to recover the fluid loss from the body. As the patient has
already had 2-3 attacks of vomiting. So, administering this is rational here.
• AZITHROMYCIN-:macrolide. Acts by inhibiting protien synthesis. It is active against gram +ve and
few gram –ve bacteria. It is one of the drug used for scrub typhus.The drug was started after the
test results came +ve for scrub typhus so, the drug is rational.
 DRUGS AFTER DISCHARGED
• CEFIXIME-: Third generation cephalosporin highly active against enterobacteriaceae. It is not
the drug of choice for scrub typhus so, it is irrational.
• PREDNISOLONE-:Selective glucocorticoid. It also acts as an anti-inflammatory agent. The use
of drug is rational here as patient has signs of meningeal irritation.
• GLYCEROL-: Oral osmotic diuretic. Used to relieve increased intracranial pressure. As the
patient has no signs of increased intracranial pressure so its use is irrational here.
• OMEPRAZOLE-:Proton pump inhibitor. Its main pharmacological action is dose dependent
suppression of gastric acid secretion. As all the drugs are orally administered so, its use is
rational here.
CONCLUSION:

• The use of mannitol and glycerol is irrational here as patient had no signs of increased
intracranial tension.
• The use of cefixime is also not clear as it is not administered in case of scrub typhus .
• Drug combination if used: NO.
 (2) CLINICAL CASE SHEET
NAME: Ms. Meenal REG. NO.: 88856
AGE/GENDER: 25years, Female DEPARTMENT: Dermatology
ADDRESS: srikot

The patient presented to dermatology OPD on 15/09/2017 with chief complaints of -

• Itching and rashes x1day
HISTORY -:
 HISTORY OF PRESENT ILLNESS
• The patient was apparently asymptomatic
• 7 days back when she developed a low grade fever, body ache, and headache which lasted
one day.
• After 5 days the patient developed itching and rash (Exanthem).
 HISTORY OF PAST ILLNESS-: There is no previous history of chickenpox but patient was
diagnosed with hepatitis A infection 15 -20 days back
 PERSONAL HISTORY-: Patient is vegetarian by diet and has normal bladder and bowel
habits.
 FAMILY HISTORY-: No relevant family history
 EXAMINATION -:O/E fluid filled vesicles were found over:-Lower part of neck ,Back, Dorsal
aspect of palm near third metacarpophalangeal joint
 FINAL DIAGNOSIS
The diagnosis of chickenpox is usually made by looking at the characteristic rash i.e.
maculopapules which then convert to vesicles within hrs to days.
The final diagnosis made is chickenpox.

DRUGS PRESCRIBED TO PATIENT

S.NO. DOSAGE DRUGS DOSE DURATION ROUTE
FORM & DOSE
INTERVAL

1. Tab. Acyclovir 800mg Five times a Oral

day

2. Tab. Vitamin C 500mg QID Oral

3. Tab. Atarax 25mg QID Oral

4. Cap. Sivylar 140mg TID Oral

Q.1 Is the name of drug written legibly ? 1 2 3 4
Y Y Y Y

Q.2 Is the strength written or not ? 1 2 3 4

N N N N

Q.3 Is the dose of prescribed medication written? 1 2 3 4

Y Y Y Y

Q.4 Is the dosage form mentioned ? 1 2 3 4

Y Y Y Y

Q.5 Is the frequency of drug prescribed ? 1 2 3 4

Y Y Y Y

Q.6 Is the route of administration mentioned ? 1 2 3 4

Y Y Y Y

Q.7 Is the Abbreviation used ? 1 2 3 4

Y Y Y Y

Q.8 Are all the drugs administered on time ? 1 2 3 4

Y Y Y Y
 Q.9 Is Antimicrobial prescribed or not. If yes then name them?: YES (ACYCLOVIR)

Q.10 Is patient suffering from any adverse drug reaction ? :NO

Q.11 Total No. of drugs prescribed ?: 04

Q.12 Medicine used by generic name & brand name :

Medicine used by generic name : Acyclovir
Vitamin C
Medicine used by brand name :Atarax(Hydroxyzine), Sivylar (Silymarin)
Q.13 Any Ayurvedic/Homeopathic medicine used :NO

PROS-:
•Drugs names are written legibly.
•Dosage form of all prescribed drugs are written.
•All drugs are administered on time.

CONS-:
•Strength of the prescribed drugs is not written.
 RATIONALITY OF PRESCRIBED MEDICINES

• Acyclovir-:
Acyclovir is converted to acyclovir monophosphate by virus specific thymidine kinase then
further converted to acyclovir triphosphate. It inhibhits DNA polymerase activity resulting in
termination of DNA replication
Its use is rational here.
• Vitamin C:
Ascorbic acid is necessary for collagen formation and tissue repair . Its use is irrational here
• Atarax (hydroxyzine)-:
It is a first generation antihistamine. The use of this drug is rational here as it reduces itching
& scratching from chickenpox as scratching can cause scar formation.
• Sivylar(silymarin)-:
Antioxidant that protects hepatocyte membrane and enhances liver parenchyma
regeneration and increases glutathione levels. The use of this drug is rational here as the
patient was diagnosed with hepatitis A 15 to 20 days back.
CONCLUSION
• All drugs used are rational except vitamin C.
• Drug combination if used: No.
 3. CLINICAL CASE SHEET
Name of Patient : Smt. Rita Devi Sex : Female
Age : 32 years Registration no : 75564
Address : pauri Garhwal Department : Surgery ward 3rd
c/o-The patient came to surgery department & presented with the complaints of-
- pain in right upper quadrant of abdomen radiating to right shoulder (since 1 month)
- nausea (since 1 month)
-abdominal discomfort after eating food (since 1 month)
HISTORY-:
 HISTORY OF PRESENT ILLNESS:
PAIN: Site: Right hypochondrium
onset: gradual
Duration: irregular pain lasting for weeks since 1 month.
Character: griping pain
Radiation: radiated to right shoulder & inferior angle of right scapula
Association: with nausea & become worse after eating fatty food
Relieving factors: pain was relieved by taking rest.
 NEGATIVE HISTORY: No history of burning micturition, vomiting ,fever, jaundice
 PAST HISTORY: No relevant past history
 PERSONAL HISTORY: Non smoker & non alcoholic ; mixed diet; appetite mildly decreased;
normal bladder & bowel movements, proper hygiene
 FAMILY HISTORY : No family history of Diabetes mellitus, hypertension.
 ALLERGIC HISTORY: No allergic history
EXAMINATION
Patient is conscious oriented to time, place and person .
• GENERAL EXAMINATION pallor – absent
icterus – absent
clubbing- absent
cyanosis - absent
lymphadenopathy – absent
edema – absent
• RESPIRATORY SYSTEM –:Bilateral air entry, no additional sound
• CVS-:S1 and S2 heard, no additional sound heard
• CNS -:Within normal limits
• P/A-: soft , no organomegaly, tenderness present in right hypochondrium.
• INVESTIGATION:
1. Hb: 12.8 gm/dl
2. TLC: 12000 per cumm
3. DLC: -P =72% ,L=23% ,M=3% ,E=2%
4. Serum creatinine: 0.7mg/dl
5. Blood glucose: 115mg/dl
6. Serum bilirubin: 0.3mg/dl
7. Serum sodium: 146mmmol/L
8. Serum potassium: 4.2mmmol/L

9. Serum protein: 7.2mg/dl

10. SGPT: 29U/L
11. SGOT: 34 U/L
12. ALP: 52U/L
USG : Shows calculus of size upto 16.4 mm in gallbladder lumen.

CONCLUSION:
• Murphy’s sign +ve
• TLC slightly raised
• USG showing calculus measuring upto 16.4 mm in gall bladder lumen.
FINAL DIAGNOSIS: CHRONIC CHOLECYSTITIS WITH CHOLELITHIASIS
S . No . DOSAGE DRUG DOSE ROUTE DURATION
FORM

1 Tab . OFLOXACIN 200mg Oral BD

2 Tab . METRONIDAZOLE 400mg Oral TDS

3 Tab. SPASMIZOLE Oral SOS

4 Cap. CYLIP 1 CAPSULE Oral OD

5 Cap. OMEPRAZOLE 20mg Oral BD

6 Tab. ALBENDAZOLE 400mg Oral HS

QUALITY OF PRESCRIPTION :
1 . Is the name of drug written legibly ? 1 2 3 4 5 6
Y Y Y Y Y Y
2 . Is strength written or not ? 1 2 3 4 5 6
N N N N N N
3. Is the dose of the prescribed medicine mentioned ? 1 2 3 4 5 6
Y Y N Y Y Y
4. Is Dosage form mentioned ? 1 2 3 4 5 6
Y Y Y Y Y Y

5 . Is the frequency of drug prescribed ? 1 2 3 4 5 6

Y Y Y Y Y Y
6 . Is the Route of drug administration mentioned ? 1 2 3 4 5 6
Y Y Y Y Y Y
7 . Is Abbreviation used? Yes – Cap. , Tab.
8 . Is antibiotic prescribed or not ? Yes – OFLOXACIN, METRONIDAZOLE
9 . Is patient suffering any ADR ? No
10 . Total no. of drugs prescribed ? - 6
11 . Drugs used by generic name and brand name
Medicines prescribed by generic name :-OFLOXACIN,OMEPRAZOLE,ALBENDAZOLE
Medicines prescribed by brand name:- SPASMIZOLE, METRO, CYLIP
12 . Any Ayurvedic or Homeopathic medicine? –No.
13 . Any Drug combination used ? Yes - SPASMIZOLE( Paracetamol +Dicyclomine)

Conclusion :
Pros :
• Drug name is written legibly.
• Drug dosage form, dose and route of administration is mentioned for all drugs
except for Spasmizole.
• Frequency of all drugs are mentioned.
• All drugs are administered on time.
• Abbreviations are used.
Cons :
• Strength of prescribed drug is not mentioned.
• Dose of Spasmizole is not mentioned.
 RATIONALITY OF PRESCRIBED MEDICINES
Ofloxacin-
• This flouoroquinone is active against the gram negative bacteria, gram positive ones
and certain anaerobes. It inhibits the bacterial DNA gyrase enzyme, Topoisomerase IV
enzymes required for DNA replication, transcription. So use of antibiotic is rational in
this case.
Metronidazole –
• Nitro group of metronidazole is reduced to highly reactive nitro radical by redox
proteins that operates in anaerobic microbe and these radicals exerts cytotoxicity. It is
particularly added for the anaerobic coverage of the bacteria that can complicate
inflammation further. So its use is rational in this case.
SPASMIZOLE
Is a combination of Paracetamol and Dicyclomine
• PARACETAMOL- it is a para-amino phenol derivative with analgesic antipyretic.
• DICYCLOMINE- It is anticholinergic in action and used as antispasmodic & has smooth
muscle relaxant property.
Its use is rational in this case as it is used to relieve pain by increasing the pain threshold
and relieving smooth muscle spasms.

OMEPRAZOLE:
• Is a proton pump inhibitor. It inhibits H+K+ATPase and decreases gastric acid secretion.
• It is preventive of NSAID induced GI damage and involved in management of dyspepsia.
Its use is rational here.
CYLIP:
• A multivitamin drug comprising mainly of Vit C & Vit A.
• It’s use is not clear in this case & therefore may be irrational.
Albendazole:
• It is an anti-helmintic drug. As no stool examination is done, use of this drug is not
specified in this case. So this drug may be irrational here.

FINAL REMARKS ABOUT RATIONALITY

• All the drugs were prescribed keeping in mind the importance of time , seriousness
and complication of disease.
• All the prescribed drugs are rational except Cylip & Albandazole.
 4.CLINICAL CASE SHEET
• NAME- anita D/O narendra singh REG NO- 19722
• AGE-18 months ADDRESS- karnaprayag
• GENDER- female DEPARTMENT- pediatrics
C/O-The patient came to pediatric OPD on 3rd july 2017 from where she was shifted to pediatric
ward.she presented with following chief complains.
-Fever since (1 day)
-Abnormal body movements with uprolling of eyes and loss of consciousness(1 day ago)
HISTORY
 HISTORY OF PRESENT ILLNESS-:
The patient was apparently asymptomatic 1 day back when she developed
 FEVER – Onset-Sudden
Duration-Since 1 day
Nature-Remittent
Aggrevating factors-nil
Relieving factors-by medication
 ABNORMAL BODY MOVEMENTS-- Duration-1-2 min
Generalised and contracted in nature-begins from hand and spread towards lower limbs and
was accompanied with loss of conciousness and uprolling of eyes. Because of these
complains her father took her to pediatric OPD and she was admitted on 3 rd july.
 On 4th july she also developed COUGH AND COLD- Onset-Sudden
Duration-since 1 day
Progressive in nature
Relieved by medication

NEGATIVE HISTORY-no head injury. No h/o abnormal body movements following immunisation
HISTORY OF PAST ILLNESS:-similar episode 1 month back.not taken any treatment for it
FAMILY HISTORY: no relevant family history
PERSONAL HISTORY-vegetarian by diet
 DRUG HISTORY-no relevant drug history
VITALS
• PR-124/min
• TEMPERATURE-100*F
• RR-24/min
• HR-124/min
• BODY WEIGHT-9Kg
• EXAMINATION
• RESPIRATORY SYSTEM-B/L air entry present
• CVS-S1 S2 heard
• P/A-Soft
• CNS-WNL
• SPO2-94%
INVESTIGATION
Hb: 9.2mg/dl
TLC: 17000/mm3
DLC; Lymphocyte- 60%
Polymorphs- 32%
Monocytes- 4%
Eosinophil-4%
Basophil-0%
Platelets-4.4 lakhs/cumm
RBS:122mg/dl
blood urea- 15g/dl.
PCV-27.7%
MCV-59.7
MCH-31gm%
MCHC-36gm%
Serum urea-15mg/dl
Serum creatinine-0.2mg/dl

FINAL DIAGNOSIS-TYPICAL FEBRILE SEIZURE WITH ARI

 PRESCRIBED MEDICINES

S.NO DOSAGE DRUGS DOSE DURATION & ROUTE

FORM DOSE INTERVAL

1 Inj cefotaxime 450mg(4.5ml) B.D i.v

2. Inj. PCM 45mg B.D. i.m

3. Inj. Rantac 9mg B.D. i.v.

4. IVF. Isolyte P 300ml TDS i.v

5. syp PCM 5.5ml 6 hourly Oral

6. Tab Frisium 10 mg(1/2 B.D Oral

tab)=5mg
7 Syp Cefolac 100mg/5ml Oral
8 drop Sinarest S 1 drop 3rd hourly nasal
 Q.1 Is the name of drug written legibly ? 1 2 3 4 5 6 7 8
Y Y Y Y Y Y Y Y Q.2
Is the strength written or not ? 1 2 3 4 5 6 7 8
N N N N N N N N
Q.3 Is the dose of prescribed medication written ? 1 2 3 4 5 6 7 8
Y Y Y Y Y Y Y Y
Q.4 Is the dosage form mentioned ? 1 2 3 4 5 6 7 8
Y Y Y Y Y Y Y Y
Q.5 Is the frequency of drug prescribed ? 1 2 3 4 5 6 7 8
Y Y Y Y Y Y N Y
Q.6 Is the route of administration mentioned ? 1 2 3 4 5 6 7 8
Y Y Y Y Y Y Y Y
Q.7 Is the Abbreviation used ? YES
Q.8 Are all the drugs administered on time ?YES
Q.9 Is Antibiotic prescribed or not. If yes then name them?: YES –CEFOTAXIME,CEFOLAC
Q.10 Is patient suffering from any adverse drug reaction ? :NO
Q.11 Total No. of drugs prescribed ?:8
Q.12 Medicine used by generic name & brand name :
Medicine used by generic name : CEFOTAXIME,PCM
Medicine used by brand name :RANTAC,CEFOLAC,SINAREST,FRISIUM
Q.13 Any Ayurvedic/Homeopathic medicine used :NO
CONCLUSION :
Pros :
Drug name is written legibly, drug dosage form, dose and route of administration are written.
Abbreviations are used.
Drugs are administered in time.
Cons :
Strength of prescribed drug is not mentioned.

RATIONALITY OF PRESCRIBED MEDICINES

•CEFOTAXIME- third generation cephalosporin,exerts potent action on aerobic gram negative as
well as some gram positive bacteria.The bactericidal activity results from the inhibition of cell
wall synthesis via affinity for penicillin binding proteins. Its use is rational till any lab
investigations are done,on the basis of clinical observation it is use to cover the agents
responsible for seizures this is known as emperical use of antibiotics.
•PCM- Paracetamol(acetaminophen) has analgesic antipyretic and weak antiinflammatory
action .It raises pain threshold.it inhibits COX 3 present in the brain,COX3 involves in pain
perception and fever. Its use is rational as the patient is suffering from high fever.
RANTAC(RANITIDINE)-It’s a H2 receptor antagonist. It acts by competitively inhibiting H2
receptors on parietal cell and supress basal and food stimulated acid secretion. Its use is rational
here as pcm(syp)given to patient can cause gastric irritation and mucosal erosion
ISOLYTE P-Multi electrolyte injection to replenish ion loss by body.It is also a source of water for
dehydration. Its use is rational here as the antibiotics given can cause diarrhea
•FRISIUM(CLOBAZAM)-It is a benzodiazepine.It acts by enhancing presynaptic/postsynaptic
inhibition through a specific BZD receptor which is a integral part of GABA-A receptor Cl channel
complex.
•As the patient is suffering from seizures and frisium acts by enhancing frequency of Cl channel
opening and thereby inhibiting calcium dependent release of neurotransmitters,its use is
rational here.
•SINAREST S(OXYMETAZOLINE)-Its an alpha adrenergic agonist which on topical application as
dilute solution produce local vasoconstriction hence used as nasal decongestant therefore its
use is rational here.
•CEFOLAC(CEFIXIME)-Its orally active 3rd generation cephalosporin
•It kills the bacteria by attacking their cell wall,prevents the synthesis of a peptidoglycan in the
cell wall .
•As the patient is suffering from ARI hence its use is rational

CONCLUSION
All the medicines were prescribed keeping in mind the seriousness of situation.
The use of all medicines was rational.
 5.CLINICAL CASE SHEET
NAME OF PATIENT : Mr. Vikas Rawat OPD NO :45676
AGE/GENDER :24 Years/Male DEPARTMENT/UNIT NO : ENT / 03
ADDRESS : chamoli

SYMPTOMS :
1.H/O –Sore Throat and productive cough since 3 days
2.H/O – Pain during swallowing
3.Low Grade Fever

INVESTIGATION :
1.Throat swab for culture and microscopy reveals presence of gram positive cocci in chain
2.Pulse rate :100/minute.
3.Temprature: 38.5 degree cent.
4. Normal lung sound
5.CVS : S1,S2 normal

FINAL DIAGNOSIS : Acute bacterial pharyngitis.

 PRESCRIBED MEDICINES
S NO DOSAGE DRUGS DOSE DURATION & ROUTE
FORM DOSE
INTERVAL

1. Tab. Amoxyclav 625mg BD Oral

2. Tab. Paracetamol 500mg TDS Oral

3. Tab. Levocetrizine 5mg BD Oral

4. Sol. Betadine 15 ml Twice daily Topical

Gargle for 3 days

Q.1 Is the name of drug written legibly ? 1 2 3 4

Y Y Y Y
Q.2 Is the strength written or not? 1 2 3 4
N N N N
Q.3 Is the dose of prescribed medication written? 1 2 3 4
Y Y Y Y
Q.4 Is the dosage form mentioned ? 1 2 3 4
Y Y Y Y
Q.5 Is the frequency of drug prescribed ? 1 2 3 4
Y Y Y Y
Q.6 Is the route of administration mentioned? 1 2 3 4
Y Y Y Y
Q.7 Is the Abbreviation used ? 1 2 3 4
Y Y Y Y
Q.8 Are all the drugs administered on time ? 1 2 3 4
Y Y Y Y
Q.9 Is Antibiotic prescribed or not. If yes then name them? : Amoxyclav
Q.10 Is patient suffering from any adverse drug reaction ? :NO
Q.11 Total No. of drugs prescribed ? : 4
Q.12 Medicine used by generic name & brand name :
Medicine used by generic name : Amoxyclav,PCM,Levocetrizine
Medicine used by brand name: (Betadine Gargle)
Q.13 Any Ayurvedic/Homeopathic medicine used :NO
Q.14 Drug combination if used :Amoxyclav = Amoxicillin + Clavulanic Acid
CONCLUSION :
Pros-
Drug name is written legibly, drug dosage form, dose and route of
administration are written.
Cons-
Strength of prescribed drug is not mentioned.
RATIONALITY OF PRESCIBED MEDICINE :
• Amoxyclav : Amoxicillin has bacteriocidal action on Gram + ve bacteria . It believed to
compete with TRANSPEPTIDASE to block trans- peptidation of peptoglycan wall.
Clavulanic acid is Beta Lactamase inhibitor which inhibits Beta Lactamase produce by some
penicillin resistant bacteria. It prevents hydrolysis of amoxicillin resulting in extending the
spectrum of amoxicillin to beta lactamase producing bacteria. rational
• Paracetamol : Is antipyretic to lower down the temperature by inhibiting COX. rational
• Levocetrizine : Is an 3rd generation, non sedating anti-histamine. It is given to reduce
edema. rational
• Betadine gargle (Povidone-iodine) : BROAD SPECTRUM ANTISEPTIC
Iodine can penetrate the cell wall of microorganisms quickly,and the lethal effects are
believed to result from disruption of protein and nucleic acid structure and synthesis. As
gargle can be done with warm saline thus is an irrationally given. Irrational

FINAL REMARKS ABOUT RATIONALITY

• All the drugs were prescribed keeping in mind the importance of time , seriousness and
complication of disease.
• All prescribed drugs are rational except for betadine gargle for ACUTE BACTERIAL
PHARYNGITIS .