A case presentation on cystitis

CASE PRESENTATION FOR DOCTOR OF PHARMACY STUDENTS

1. A CASE PRESENTATION ON CYSTITIS: CASE NO: 7 CASE COLLECTED ON: 4.4.18 REG NO: 381610805 PRESENTED BY M.ARUMUGAVIGNESH PHARM D SECOND YEAR BASED ON VIRUDHUNAGAR GOVERNMENT HEAD HOSPITAL CASESHEET

2. 2 PATIENT HISTORY: Patient name: zzz Ward: Female surgical ward Age: 65 years Sex: Female I.P. no: 2817 Date of admission: 20/03/18 at 11.55 p.m

3. 3 PROVISIONAL DIAGNOSIS: Cystitis Not a known case of hypertension, diabetes mellitus and ischemic heart disease Known case of psychiatric illness

4. 4 SUBJECTIVE EVIDENCES: Complaints of dysuresis Low abdominal pain Fever Pain Rarely bloody urine Dysuresis is defined as urination difficulty along with urinary retention.

5. 5 OBJECTIVE EVIDENCES: Pulse : 86/ minute ( Normal: 72/ minute ) Blood pressure: 120/80 mmHg ( Normal: 120/80 mmHg) Temperature: 98.4 farenheit ( Normal: 98.4 ) Respiratory rate: 22/ minute ( Normal: 16-20/ minute ) Systemic infection.

6. 6 ABOUT CYSTITIS: Cystitis is a fairly common lower urinary tract infection. It refers specifically to an inflammation of the bladder wall. Cystitis is most commonly caused by a bacterial infection. It is more common among females because they have short urethras.

7. 7 SYSTEMIC EXAMINATION: CVS: S1S2 Normal Respiratory system: No bilateral issues CNS: Non Focal Neurological Deficit USG Abdomen: Normal ADVICE: Hemoglobin Renal function Urine culture test

8. 8 X- Ray Of Kidney: Right: 10.9x4.3cm – Normal size Left: 10.1x4.1cm- upper pole renal cyst ASSESMENT: A cyst is a fluid containing sac. It is present normally in adults. It shows symptoms like fever, pain due to the presence of infection.

9. 9 TREATMENT PLAN: NAME DOSE DOSAGE FREQUENCY ROUTE CLASS Normal saline 500 ml Solution stat intravenous supplement Ringer’s lactate solution 500 ml Solution stat intravenous supplement Ciprofloxacin 200 mg Tablet b.d oral Quinolone Raniditine 150 mg Tablet b.d oral H2 blocker Dicyclomine 10 mg / ml Injection b.d intravenous antispasmodic Paracetamol 500 mg Tablet t.d.s oral analgesic B- complex 30.5 mg Tablet o.d oral supplement

10. 10 DRUG INFORMATION: 1. Ciprofloxacin: Indication: antibiotic Side effects: nausea, trouble in sleeping, headache MOA: it inhibits the enzyme topioisomerase 1 and 4 which are required for bacterial DNA replication. Contraindication: hypersensitivity and patients receiving tizanidine.

11. 11 2. Raniditine: Indication: Anti ulcer drug Contraindication: Hyper sensitive patients M.O.A: H2 receptor antagonist. Blocks H2 receptors of gastric parietal cells, leading to the inhibition of gastric secretions. Side effects: Head ache, alopecia

12. 12 3. Paracetamol: Indication: Anti pyretic Contraindication: Liver failure patients M.O.A: Arachidonic acid through COX 1 and COX 2 pathways produce prostaglandin. This chemical mediator is responsible for the elevation in body temperature. Paracetamol inhibits COX pathways. Side effects: hepatic and renal failure, head ache, vomiting.

13. 13 4. Vitamin B complex: Indication: Vitamin supplement Side effects: black stools, constipation, diarrhea, intense abdominal pain MOA: directly absorbed from the intestine Contraindication: nausea, vomiting, constipation.

14. 14 5. Normal saline: Indication: to treat dehydration and for fluid replenishment Side effects: infection at the site of injection, thrombosis, hypervolemia MOA: Directly enter into the plasma and have 100% bioavailability. It is nothing but 0.9% w/v sodium chloride. It gives fluid replenishment for this patient who is suffering from dehydration. Contraindication: hypernatriemia and hyperkalemia

15. 15 6. Dicyclomine: Indication: Irritable bowel syndrome Contraindication: GI obstruction M.O.A: Anti cholinergic/ Anti spasmodic , no effect on acid secretion but direct smooth muscle relaxant effects blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretion glands, CNS Side effects: Dizziness, blurred vision, weakness.

16. 16 7. Ringer’s lactate solution: ( hartmann’s solution ) Indication: fluid and electrolyte replenishment Side effects: hyperprolactenemia, hypercalcinemia, hyperkalemia, vasodilatory, inflammatory, MOA: directly enter into blood plasma and provide electrolytes Contraindication: Lactic acidosis, hypersensitivity

17. 17 DRUG INTERACTIONS: No drug- drug interactions are seen. PHARMACIST INTERVENTION: Raniditine and Vitamin B complex tablets are recreational drugs. The patient is suffering from psychiatric illness but no step is taken to treat it. Urine culture report is not well analysed.

18. 18 The left kidney shows upper pole cyst. It may lead to complications such as dysuresis. A puncture with needle and the cyst is filled with alcohol. This treatment was not given. Cystoscopy was not done. Urinary analgesics and antiseptics such as phenazopyridine hydrochloride are suggested.

19. 19 PATIENT COUNSELLING: Intake of water should be increased in order to flush out the bladder. The patient should not control the urination urge on any account. Apply heating pads to your abdomen or back. Take sitz baths to clean pelvic area.

20. 20 Avoid drinking coffee and caffeine products as this can irritate your urinary bladder. Blood pressure and blood glucose level should be monitored continuously. Keep your mind happy by doing yoga and meditation. This helps you to get rid out of psychiatric illness.