OIA1014

Introduction to Pharmacotherapy
Case study assignment

Name: Aida Kazempourfard

Student number: S2173760

Semester 1
2022/2023
Case 1
ZZ is a 4-year-old girl brought by her mother to the emergency department. Her
mother reported she had a high temperature (38.5°C) for the past three days.
Investigation reveals no obvious infection and no history of travel. ZZ received
Diphtheria-Tetanus-Pertussis (DPT) vaccine four days ago. The mother has
been giving her paracetamol to lower her temperature, which has helped
temporarily, but the temperature recurs. Her mother is wondering whether
there are differences if she purchased other anti-pyretic agents. However, after
3-days stay in the ward, Zara is allowed to be discharged.
Question 1: Fever is common in children. Explain briefly causes of fever in ZZ.
(5 marks)
Question 2: Compare and contrast paracetamol with NSAIDs in terms of their
mechanism of action, anti-inflammatory, analgesic and antipyretic effect. (5
marks)

Question 1: Fever in children can have many causes, including viral or bacterial
infections, vaccines, and certain medical conditions. In the case of ZZ, it is possible
that her fever is a reaction to the DPT vaccine she received four days ago. Vaccine-
induced fever is a common and usually benign side effect of vaccines. It is also
possible that she has a viral or bacterial infection that is not yet diagnosed.

Question 2: Both paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs)

are commonly used to reduce fever and relieve pain. However, they work by different
mechanisms. Paracetamol is thought to work by inhibiting the production of
prostaglandins in the brain, which are involved in the sensation of pain and fever. It is
primarily an analgesic and antipyretic, but has little anti-inflammatory effect. On the
other hand, NSAIDs work by inhibiting the activity of cyclooxygenase enzymes, which
are involved in the production of prostaglandins. This leads to decreased
inflammation, pain, and fever. It is important to note that while both classes of drugs
are effective at reducing fever and pain, they have different side effect profiles and
should be used with caution in certain populations, such as those with a history of
gastrointestinal or renal problems. Additionally, NSAIDs should be avoided in
children under 6months of age and used with caution in children under 12 years of
age.
Case 2
A 10-year-old boy with a history of dengue fever 2 years ago, presented with worsening
vomiting and diarrhea 1-day prior hospital admission. The boy complained of
abdominal pain, headache, muscle pain, poor diet and reduce urine output. At the
emergency, he was transfused with three-pint fluid. Upon physical examination, he is
febrile (39°C), tachycardic and looks lethargic. According to the boy’s mother, he has
been camping with friends at a nearby lake for 1 night. Upon further investigation, a
provisional diagnosis of dengue fever was made.
Question 1: State signs and symptoms of dengue fever exhibited in this boy. Briefly
explain the predisposing factor contributing to the provisional diagnosis. (5 marks)
Question 2: State appropriate laboratory tests for this boy with regards to his high-
grade fever. Justify your answers. (5 marks)
After being hospitalized for 5-days, the boy was discharged out from the hospitals. He is
no longer having fever nor any other symptoms. He was discharged with home
medications as follow:
1. Tab. Paracetamol 1 mg QID
2. Tab. Ibuprofen 400 mg PRN
3. Syrup Dextromethorphan PRN
Question 3: Briefly discuss potential or actual pharmaceutical care issue with regards to
the discharged medications. Recommend appropriate interventions. (10 marks)

Question 1: Signs and symptoms of dengue fever exhibited in this boy include fever,
abdominal pain, headache, muscle pain, poor diet, reduced urine output, vomiting,
and diarrhea. The predisposing factor contributing to the provisional diagnosis is that
the boy had a history of dengue fever 2 years ago, and has recently been camping at
a nearby lake, which is an area where dengue fever is prevalent.

Question 2: Appropriate laboratory tests for this boy with regards to his high-grade
fever include a dengue fever antigen test (such as the NS1 Ag test) to confirm the
diagnosis, as well as a full blood count to check for thrombocytopenia (low platelet
count) which is a common complication of dengue fever. Other tests that may be
useful include a serology test to confirm previous dengue virus infection and a blood
culture to rule out bacterial infections.

Question 3: The discharged medications have potential or actual pharmaceutical care

issues. Paracetamol and ibuprofen have potential for drug-drug interactions with
other medications the boy may be taking and also may have potential adverse
effects such as gastrointestinal bleeding. Syrup Dextromethorphan may have
potential for drug-drug interactions with other medications and potential for abuse.
Therefore, it is recommended to advise the boy's mother to read the medication
label carefully and follow the recommended dose, frequency and duration of use.
The mother should also inform the physician of any other medications the boy may
be taking and report any adverse effects or interactions that occur. It is also
recommended to advise the mother to keep the medication in a safe place and out
of reach of children. The boy should be followed up regularly to assess the efficacy
and safety of the medication regimen.