Case Study


INDEX CONTENTS History of Patient Diagnostic test Prescribed Drugs Drugs Detail General information First Aid 2 3 4 5 7 8 .

45 yrs. DIAGNOSIS:HI with EDH Left frontal region with depressed fracture frontal bone left side.NAME OF THE PATIENT: .Right NSRL and left dilated Vitals BP 130/90 Pulse 80 per minute Rhythm rate.24/minute .kamal Parshad SEX: -Male AGE: . drowsy and disoriented Pupils. HISTORY OF ILLNESS:H/O RSA at around 2pm on 02/02/2012 H/O LOC for about 10-15 minutes Nasal bleed present Oral bleed present Multiple injuries on face and forehead present First aid and suturing outside No H/O ASTHMA/DM/HTN/Drug allergy EXAMINATION: Patient conscious.

1.NAD ECG.26. accepting orally. talkative.B positive HIV/HCV/Hbs Negative HOSPITAL COURSE Left frontal craniectomy and removal of fractured bony fragments and removal of underlying EDH done under GA. Discharged on Request in better condition without stitch removal. place and person .6 Creatinine. Patient became conscious.Chest NAD Abdomen NAD INVESTIGATION:CTHP 02/02/2012 EDH left frontal region with depressed fracture frontal bone left side. Patient’s condition improved.7 gm Urea.11. moving about. X-ray chest AP view.WNL Hb. CONDITION AT DISCHARGE Patient conscious Well oriented to time.03 Blood group.

100 mg (Thrice daily) Indication: . TDS OD BD TDS TDS TDS DETAILS OF PRESCRIBED DRUGS EPTOIN Dose: . ADME: - .Irritable Vitals: within normal limits Accepting orally Moving about TREATMENT ADVISED Tab Eptoin 100 mg Tab Pantocid 40mg Tab Cetil 500 mg Tab Donn-Plus I tab Ciplox eye drops Neomycin eye oint. clonic and partial seizures.An antiepileptic drug used to control tonic.

It undergoes enterohepatic recycling and is excreted in urine. but may be dose-related. confusion. thrombocytopenia. agranulocytosis. in either free or conjugated form. folic acid deficiency. insomnia. vomiting. Rifampicin decreases the serum phenytoin levels. headache.N. Stevens-Johnson Syndrome or phenytoin hypersensitivity syndrome which may be manifested by (rash. Contraindications:AV Block Side effects:Lupus erythematous. It is extensively metabolized in the liver to inactive metabolites. May reduce the effectiveness of oral contraceptives. constipation. chiefly 5(4-hydroxy phenyl)-5-phenylhydantion. mood or mental changes.Epitoin is slowly and almost completely absorb from GIT. trembling of hands. Ethosuximide increases its plasma levels. C. most being absorbed from upper intestine and the absorption is affected by presence of food. mainly as its hydroxylated metabolite. hepatitis or nephritis). local or generalized lymphadenopathy. Drug Interactions:Anticoagulant effect of warfarin may be altered. Treatment of blisters and erosion in epidermolysis bollosa . Prevention and treatment of seizures during and following neurosurgery. lack of appetite. Cyclosporine levels in the blood may be reduced. increased frequency of seizures. Indications:Control of grand mal and psychomotor seizures. tenderness and hyperplasia of the gums particularly in younger patients.S toxicity (Nystagmus. It is largely insoluble at the acid pH of the stomach. dizziness. slurring of speech. nausea. PANTOCID . hirsutism. nervousness and irritability) usually with long-term use. Chloramphenicol increases the serum phenytoin levels causing toxicity.

acruginosa. abdominal pain. Ciprofloxacin does not disturb normal anaerobic intestinal flora and. third generation cephalosporins and other fluoroquinolones. GI tract. urinary tract. Not recommended for use in children and adolscents. Gonorrhoea. vomiting. gastric ulcer. Indications: Respiratory tract. Intra-abdominal gynaecological.ATPase enzyme which is responsible for acid secretion in the parietal cells of the stomach. Potassion. Side –effects: Diarrhoea. restlessness and arthalgia. Duodenal ulcer.It is a proton pump inhibitor i. Indications: For the symptomatic improvement and healing of gastrointestinal diseases which require a reduction in acid secretion. skin and soft tissue. Contradictions: Hypersenstivity to any of the constituents. . headache. Rarely skin rashes. Bone and joint and severe systemic infections. Moderate and severe reflux oesophagus. has significant post-antibiotic effect and thus prevents regrowth of bacteria.e It inhibitsspecifically and dose proportionally the gastric Hydrogen ion.g. Its antibacterial apectrum is wider than that of aminoglycosides. CIPROFLOXACIN A fluoroquinolone antimicrobial agent wit potent activity against a broad spectrum of gram-positive and gram-negative bacteria including. pruritis and dizziness. Contra-indications: Hypersensitivity to ciprofloxacin or any other quinolone derivative. ENT. Side effects: Headache or diarrhea. e. Enterobacteriaceae and Staph aureus.

other illnesses they may have. Absorption reduced by pethidine. GENERAL INFORMATION An accurate diagnosis of the type of epilepsy is very important in choosing the best treatment. your doctor usually has made a diagnosis of epilepsy. antacids decreases ciprofloxacin absorption. aluminium calcium. Here list of some of the most common drugs currently used to treat epilepsy. Absorption increased by metaclopramide.Drug-interactions: Magnesium. Potentiates oral anticoagulants. It is important to openly discuss with your doctor the pros and cons of the different medicines that are available to treat your kind of epilepsy. Indications: Pain. The type of medication prescribed will also depend on several factors specific to each patient. It is not uricosoric. These medicines do not actually "fix" the problems that cause seizures. and which delivery method is acceptable. But medications can control seizures in most people. It does not stimulate respiration or alter acid base balance and causes less gastric irritation and have no effect on cellular metabolism or clothing factors. such as which side effects can be tolerated by the patient. leukopenia is rare Drug-interactions: Enhances oral anticoagulant activity. Alcohol (chronic use) potentiates hepatotoxicity by paracetamol. Instead. There is no known cure for epilepsy. iron and zinc. fever Side-effects: Nausea. PARACETAMOL Paracetamol is a valuable central analgesic but weak peripheral anti-inflammatory agent and exhibits good and prompt antipyretic action. propanthine. rifampicin reduces serum concentration of ciprofloxacin. Before suggesting treatment with a seizure medicine (also called an antiepileptic drug or AED). Drugs which we can also prescribed for partial seizure :- . they work by stopping the seizures from occurring. CNS excitation occur with concurrent administration of quinolones and NSAIDs. rashes.

weight gain. which may increase the risk of fractures associated with falls.This drug would have taken the place of Epitoin as it has very mild side effects such as tiredness. rash. wandering. they have some things in common: .Tegretol would have been given as the side effects of thus drug are quite less as compared to Epitoin that are fatigue. nausea. dry mouth. or fumbling movements of the hand may be present. Common side effects include dizziness. and difficulty with concentration/attention. FIRST AID With this type of seizure the person may appear unresponsive and confused. Topamax Used with other drugs to treat partial seizures. Keppra Used withother epilepsy drugs to treat partial seizures. emotional. headache. and behavioral changes Lyrica Used to treat partial seizures. weakness. Most common side effects are tiredness. Gabitril Used with other epilepsy drugs to treat partial and some generalized seizures. Side effects are less than epitoin. vision changes. He or she may display inappropriate behaviour that may be mistaken for alcohol or drug intoxication. VitaminD may help people with epilepsy by: Increasing low bone mass density Protecting against diseases that are risk factors for epilepsy Low bone mass is a problem for people with epilepsy. Trileptal Treats partial seizures. Due to large number of side effects of Epitoin .TegretolFirst choice for partial. dizziness. Automatic movements such as smacking of the lips. dizziness.Side effects include dizziness. sleepiness (somnolence).. fatigue. peripheral edema. weakness. or sensory functions of the brain. blurred vision. Things To Remember:Although partial seizures affect different physical.

• You can’t stop them. or drowsiness are all possible aftereffects of seizures. In an emergency. Confusion. Remember that people may get back their ability and understand before they speak again. • Stay back until the episode has ended if the person appears obviously agitated or belligerent. • Be reassuring and helpful as awareness returns. although people may be confused and need a lot more time afterwards to recover fully. the following steps may help: • Reassure others. • Don’t restrain the person during a complex partial seizure. Except in rare cases. • Guide gently away from anything that could be dangerous. • They are not dangerous to others. establish supportive communication and ask if they are OK. the brain has its own way of bringing the seizure safely to an end after a minute or two. . Handling Partial Seizures:Simple partial seizures don’t require any special response except to recognize what’s happening and be supportive until the seizure is over. • Watch the time. like an open fire or a busy street. Most partial seizures last a minute or two. agitation. too unorganized. belligerence. Explain that any unusual behaviour is a temporary condition brought on by a seizure and that it will end in a few minutes. But people may feel confused for up to half an hour afterwards. depression. non-stop seizure to an end. and too confused to threaten the safety of anyone else. • They end naturally. The movements produced by a seizure are almost always too vague. However. Longer periods of confusion may mean that seizure activity is continuing and the person needs medical help. • Remove hazards or anything that might injure someone who doesn’t know where he is or what he’s doing. As the seizure finishes. For complex partial seizures. especially if he is already agitated or confused. First aid or partial seizures:During a partial seizure you may need to gently guide the person past obstacles and away from dangerous places. irritability. the average person can’t do anything except wait for the seizure to run its course and try to protect the person from harm while consciousness is clouded. Efforts to restrain may produce an unconscious aggressive response. Call an ambulance if the person doesn’t start to recover after 5 minutes. Most last only a minute or two. doctors may use drugs to bring a lengthy.• They don’t last long.

hat. leaving the carving to someone else. and sharp objects are all potential hazards when people are unaware of what they’re doing and don’t feel pain. • Using a regular knife for carving. • Padding sharp corners and carpeting floors. certain machinery. heights. Things like fire.Living with Partial Seizures:As we’ve seen. . there may be ways to reduce obvious risks. For example: • Using a microwave oven for cooking instead of a gas or electric range. • Making sure open fires have guards and that electric or other space heaters can’t be tipped over. • Not smoking and not carrying lighted candles or hot ashes from the fireplace through the house. However. People who live with frequent complex partial seizures may face many challenges. • Setting the water heater low enough to prevent scalding during a seizure and taking sit down showers if drop attacks are frequent. • Taking plates to the oven or the stove to serve oneself to avoid having to carry pans of hot food or liquid. if possible. not an electric knife or. One involves personal safety. • Keeping electric mixers and other electric appliances far away from the sink or source of water. water. partial seizures take many forms and medical treatment does not always control them.

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