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