Case study on Post menopausal

bleeding and HBsAG +ve

PRESENTED TO:-
Dr. RAJVEER SINGH
ASSITANT PROFESSOR
JAIPUR NATIONAL
UNIVERSITY PRESENTED BY :-
SUSHAMA DEB
PHARMD(5THE
YEAR)

ROLLNO. :-21
 INTRODUCTION:-

 Post menopausal bleeding is any vaginal bleeding

 that occurs after 12 months of amenorrhea in a post menopausal women.
 The age of menopause is different but for most women the age for menopause
is 51.
 Causes for postmenopausal uterine bleeding are :-
 Atrophic Vaginitis:- 60 -80%
 Estrogen Treatment:- 15 – 25 %
 Polyp cervical- uterine- 2-12%
 Endometrial hyperplasia- 5-10%
 Endometrial Cancer – 10%
 Idiopathic-10%
HEPATITIS B

• Hepatitis B is part of a group of hepatitis viruses that attack the liver.

It is spread through blood and bodily fluids. It is most commonly
passed on via unprotected sex (sex without a condom or dental
dam), from a mother to her child during birth, or through
contaminated needles.
• In adults, it often causes no obvious symptoms and can pass in a few
months without treatment. Children are more likely to develop a
long-lasting (chronic) infection. Without appropriate treatment and
care, children and adults with a chronic infection can become
seriously ill and be at risk of liver damage or death.
Patient Demographic details
• Patient name :- ABC
• Age:- 66 years
• Sex:- Female
• DOA:-19.09.22
• DOD:- 03.10.22
• Case of:- Post menopausal bleeding , HBsAG
positive
  COMPLAINTS ON ADMISSION

• C/O:- Bleeding per vaginal (p/v) on and off

since 3 month
• C/O :- passage of clots 1-2 pads used per
day
 Past history :-
 H/O asthma (on and off medication for 20 year)
 H/O 2PRBC.transfusion last month
 S/O adenomyosis
 S/O calcified granuloma bronchitis
 Social history:- non smoker, tobacco intake for past 6 year , non alcoholic
• Residence :- Uttar Pradesh
• Past Medication History :- Asthalin inhaler
 Surgical History :-
 H/O hip surgery 5 year back .
 H/O Cervical polypectomy on 18/8/22
 H/O Cholecystectomy 10 year back
 MENSTRUAL HISTORY :- menopause 10 year back
 Obstetric history:-
 Family History :-NS
 SOAP
ANALYSIS:-
 Subjective evidence:-
• C/O Bleeding P/v on and off since 3 Month
• C/O passage of clots 1-2 pads used
per day
• Dyspnea and Chest pain on exertion
 Objective evidence :-
HBsAg positive
Endometrial biopsy 24/9/22 :- Endometrial and cervical tissue mixed with
abundant blood clots. Scanty endometrium shows secretory activity endocervical
tissue shows extensive squamous metaplasia
USG 23/9/22:-Adenomysis
 Histopathology examination:-Clinical history :- Abnormal Uterine bleeding
Received uterus with cervix with attached right adenexa and separate left side
adnexa uterus with cervix measure 10 x6 x 4 cm cervix measure 4 cm in length
Microscopy :- CERVIX- Chronic Cervicitis
Endometrium:- Senile Atrophic endometrium
Myometrium:- Monckeberg Sclerosis
Right Adnexa :- Corpus Albicans
Left Adnexa :- Corpus albicans
CERVICAL POLYP was detected in 22 /8 /22 to which polypectomy was
performed in 28/8 /22 also presence of reactive atypia
 ASSESSMENT:-

With the above objective and subjective evidence we can

asses that the patient is having postmenstrual bleeding disorder
with Hepatitis B positive
 THERAPEAUTIC GOALS

• Patient specific goals for premenstrual bleeding:-

 To ensure that malignancy is presence or not
 Treat the endometrial hyperplasia
 Avoid irrational use of antibiotics
Prevent progression of the symptoms to malignancy if detected in initial stage
To improve quality of life
To provide relief from pain , swelling
To maintain a fine balance of the hormones
• Patient specific goals for Hepatitis B
 To improve quality of life
 To decrease patient discomfort
 Prevent disease progression and HCC development , cirrhosis , liver failure .
 Reduce the mortality by preventing liver related deaths associated with the
development of hepatocellular carcinoma and decompensated cirrhosis
 Disease Specific goal for post menopausal
bleeding:-
• Avoid Tobacco .
• Maintain hygiene.
• Maintain a healthy diet .
• Get consistent, high quality sleep .
• Try Stress reduction techniques.
• Go for early detection in case you bleed after menopause.
• Avoid such medicine which may trigger loss of endometrium.
 Disease Specific goal for hepatitis B:-
• Avoid alcohol.
• This can happen through blood , and other serum transfusion so do not share
syringes
• Do not share your toothbrushes and other personal equipment's like razors
which
may spread hepatitis B
• Consider the risks if you are thinking about tattooing, body piercing, or
acupuncture – are the instruments properly sterilized
 PHYSICAL PARAMETERS
Paramet D1 D2 D3 D4 D5 D6 D7 D8 D9 D10 D11 D12 D13
ers

BP 126/70 108/66 123/75 103/7 110/ 113/7 108/6 107 / 109/ 122/ 124/76 123/7 122/
mmhg mmhg mmhg 7 mm 62 2 mm 8 mm 71 61 74 3 79
hg mm hg hg
hg

PR/min 86/min 76/ 74/min 64 / 73/ 61/ 87/ 72 73 / 75 72 /min 77/ 72

/min /min /min
min min min min min min min

RR/min 20/min 22/min 20/min 20 20/m 22/mi 20 22/mi 20/m 22/m 20/min 22/ 20/m
/min in n /min n in in min in

Temp c 98.4c 98.2 c 98.1 98.1c 97.4 98.1c 98.2c 97.6 98 98.2 98.1 98 98.4
 HEMATOLOGICAL
REPORT:-
Parameters Normal D1 D2 stat
range
Blood Hemoglobin 13-18 mg/dl 12.3mg/dl 1 1.1 (L) LOW
11.5-16.5mg/dl
TLC(/cumm)Adults 4000-11000cumm 12.6 (H) 15.27 (H) HIGH
Neutrophilis 45-75 (%) 65.8(%) 80.4(H) HIGH
Lymphocyte 20-45(%) 19.1(L)(%) 12.3(L) LOW
TRBC 3.5- 4.01 /cumm 3.73/Cumm LOW
5.5million/cumm
PCV 32-45(%) 35.8(%)(L) 33.7%(L) LOW
Eosinophil 1-6 0.3(L) 0.4(L) LOW

PDW 10.0 %-17.9% 20.8(H) 22.8(H) HIGH

MON# 0.20 – 0.80 -- 1.09(H) HIGH

NEU # 1.50 – 7.00 -- 8.52 mm^3(H) HIGH

TNC 4.00 – 10.00 12.60(H) -- HIGH

 Test- Reference value D1 STAT

Serum bilirubin(total) 0.2-1.2mg/dl 0.47mg/dl N

Serum bilirubin(direct) 0.0-0.25mg/dl 0.12mg/dl N

Serum bilirubin(indirect) 0.2-1.0mg/dl 0.35 mg/dl N

SGOT 0-35U/L 22 u/L N

SGPT 0-35U/L 23U/L N
Serum alkaline
80-290IU/L 70U/L N
phosphatase
S.Total protein 6-8(g/dl) 6.5g/dl) N
S.albumin 3.8-5.2(g/dl) 3.5 (g/dl)(L) LOW
s.Globulin 2.3-3.6(g/dl) 3.04(g/dl) N
APTT test 30 -40 20.6(L) LOW
Prothrombin time 11-16 12.1 N
Plasma glucose level 60 – 139 mg/dl 98 N
Prothrombin time (0.0 -2.0 ) 12.4 N
Free T4 (0.78 -2.19 ) 0.76(L) LOW
Test Reference value D1 STAT

S.urea 10-50 mg/dl 21.31 normal

S.Creatinine 0.6-1.6 gm/dl 0.73 gm/dl normal

Sodium 142.4 135-145 normal

Potassium 3.6 -5.0 3.44 Low

 MEDICATION CHART :-
DRUG DOS ROUT FRE 19 20 21 22 23 24 25 26 27 28
E E Q.
Tab MVI 1 tab P/O OD √ √ √ √ √ √ √ √

Inj .RL 500 IV 125 √ √ √ √

ml ml/hr

TRANAX 5 ml IV 8 √ √
EMAIC Hourl
ACID y

NORETH 10mg P/O BD √ √

ISTERO
NE
 CONT
..
DRUG DOSE ROU
TE
FRE 21
Q.
22 23 24 25 26 27 28

IVF NS 500 IV 120 √ √ stop -- -- -- -- --

ml ml/h
r
INJ 1 gm IV BD √ √ stop -- -- -- -- --
CEFTRIAX
ONE
INJ. 500 IV BD √ √ - -- -- -- -- --
AMIKACIN ml stop
TAB 600 P/O BD √ √ stop -- -- -- -- --
MISOPROS mg
TOL
INJ. 100 IV TDS √ √ - -- -- -- -- --
METRONI ml stop
DAZOLE
INJ 40 mg IV OD √ √ - -- -- -- -- --
PANTOP stop
R AZOLE
 CONT
..
DRUG DO FRE 21 22 23 24 25 26 27 28
RO
SE UTE Q.

INJ 4mg IV SOS √ √ -- -- -- -- -- --

ONDANSET
RON
INJ.BUSCOP 20 IV BD √ √ -- -- -- -- -- --
AN mg
Tab 500 P/O BD -- √ √ √ √ √ √ √
LEVOFLOX mg
ACIN

Tab 150 p/o BD -- √ √ √ √ √ √ --

RANTIDINE mg

Tab P/O TDS -- √ √ √ √ -- √ --

DICLOFEN
AC
SERRATIO-
PEPTIDASE

TAB 2 P/O HS -- -- -- -- -- -- √ --
BISACODYL
 POST OPERATIVE MEDICATION:-
DRUG DOSE ROUTE FREQ 28 29 30 1 2 3

100 ml √
IVF RL 500 cc IV √
/hr
100 √
IVF DNS 500 cc IV √
ml/hr
√ √ √ √ √
INJ.PIPERACILLIN
4.5 gm IV TDS
/TAZOBACTUM

√ √ √ √ √
INJ. GENTAMICIN 80 mg IV BD

√ √
INJ.METRONIDAZOLE 100 ml IV TDS

√
8 √
INJ .RANTIDINE 50 mg IV
hourly

8 √
INJ. METACLORPROMIDE 10 mg IV √
hourly
√
8 √
INJ. DICLOFENAC 75 mg IV
hourly

√
√
INJ . PROMETHAZINE 0.5 mg IV HS

8 √ √ √ √ √
INJ.TRANEXAMIC ACID 500 mg IV
hourly
CON
DRUGS DOSE ROUTE FREQ 28 29 30 1 2 3
T..
INJ. CEFTRIAXONE 1 gm IV BD
√
√ √ √

√ √ √ √
√
INJ. AMIKACIN 500 mg IV BD

INJ. √
40 mg IV OD
PANTOPRAZOLE

INJ.
4 mg IV TDS √ √
ONDANSETRON

INJ. HYOSCINE
10 mg IV √ √
BUTYL
BROMIDE
TAB.LEVOFLOXA √ √ √ √
500 mg p/o OD
C IN
√ √ √ √
Tab RANTIDINE 100 mg p/o BD

SERRATIOPEPTIDA √ √ √
50 mg p/o TDS
SE DICLOFENAC
Tab √ √ √
P/o OD
MULTIVITAMI
N
SYP LACTULOSE 30 ml p/o HS √ √ √
CREAM √ √
l/a
CLOTRIMAZOLE

√
TAB ALPRAZOLAM 0.5 mg IV HS
 DISCHARGE MEDICATION
DRUG DOSE FREQ.
TAB.LEVOFLOXACIN 500 mg OD

TAB . MVI 1 Tab (15 day) OD

TAB. RANTIDINE 15 mg BD

TAB 60 mg/day TDS

SERRATIOPEPTIDASE
DICLOFENAC
BETADINE, H/S
VAGINAL
PESSARIES
SYRUP LACTULOSE 30 ml H/S

REVIEW AFTER 7 DAYS :- FOR SUTURE REMOVAL*

advised Cream Clotrimazole
OPERATION TECHNIQUE :-

• TLH + BSO Under general anesthesia done on 28.9 .22

POST OPERATIVE ADVICES
• Incentive Spirometry as the person have dyspnea and chest pain
on exertion also diagnosed with bronchitis on
7/8/22
- Early mobilization
- Head up 45 degree position
 MONITORING PARAMETERS:-

• TABLET MULTIVITAMIN:-
Tooth staining, increased urination, stomach bleeding, uneven heart rate, confusion, and muscle
weakness or limp feeling. Read the label of any multivitamin product you take to make sure you are
aware of what it contains.
• TABLET TRANEXAMIC ACID :– Anaphylaxis is a medical emergency. Symptoms of
anaphylaxis include:-
• Difficulty breathing, shortness of breath, fast heartbeat, chest pain or tightness, difficulty
swallowing,flushing in the face, swelling of the mouth, eyelids, or face, swelling of the arms or
legs, skin rash or hives ,itching,dizziness,fainting
• TABLET NORETHISTERONE:-Dizziness, Nausea, Uterine bleeding,Vaginal bleeding,
Absence of menstrual periods, Hypersensitivity reaction, Weight gain, Skin disorder, Injection site
reaction.
• TABLET METRONIDAZOLE:- Do not drink alcohol, while taking the tablets or liquids or
using the vaginal gel or suppositories. It can give you severe side effects such as feeling or being
sick, stomach pain, hot flushes, difficulty breathing, a pounding heartbeat (palpitations) and
headaches.
After finishing your treatment, wait for 2 days before drinking alcohol again. This allows the
metronidazole to leave your body.
But talk to your doctor or pharmacist if these side effects of metronidazole bother you or do
not go
away. There are things you can do to help cope with them:-
• Feeling or being sick (nausea or vomiting)
• Diarrhoea
• A metallic taste in your mouth or a furry tongue
• TABLET LEVOFLOXACIN:-Blisters,confusion,diarrhea (watery and severe) which may
also be bloody,pain, inflammation, or swelling in the calves of the legs, shoulders, or
hands,redness and swelling of the skin,severe mood or mental changes,stomach cramps or pain
(severe),skin rash, itching, or redness,trembling,unusual behavior.
• PANTOPRAZOLE– diarrhea, headache, dizziness, chest pain,pruritis, abdominal pain, facial
puffiness
• ONDANSETRON- Diarrhea, malaise, fever, jaundice, blurred vision , drowsiness, tired feeling
• MONOCEF-loose stools , diarrhea, nausea ,vomiting , hypersensitivity reaction , dark color urine ,
breathing problem ,severe tingling
• BUSCOPAN –Dizziness, Dryness in mouth pain etc.
• PROMETHAZINE:-Promethazine:-Convulsions (seizures),difficult or unusually fast breathing.,
fast heartbeat or irregular pulse., high fever, high or low (irregular) blood pressure,
increased sweating,loss of bladder control, severe muscle stiffness.
• AMIKACIN:- Agitation, black tarry stools, bloody or cloudy, urine bluish lips or skin
blurred vision
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
chest
pain,chill,coma,confusion,cough,decrease in the amount of urine, t,depression difficulty
with breathing
difficulty with moving dizziness, faintness, or lightheadedness when getting up suddenly
from a lying or
sitting position drowsiness dry mouth feeling of fullness in the ears, fever,headache ,hearing
loss.
• ALPRAZOLAM:Drowsiness.,lightheadedness.,headache.,tiredness.,dizziness.,irritability.,talkativen
ess,difficulty concentrating.
• BISACODYL:-The most common side effects are feeling sick (nausea), diarrhoea, stomach pain or
cramps.
• SYRUP LACTULOSE :-Diarrhea and abdominal pain occur due to a high dose. In such cases, the
 CLINICAL PHARMACIST INTERVENTION

• According to the patient history patient with the same problem in

previous hospital, before she was detected with polyps . The
diagnostic report shows only Ultrasonography but they should
firstly go for per speculum test .
• On the pre- operative days , 66 year old women was prescribed
with ceftriaxone and amikacin on the date 22nd of September and
23rd of September without any proper investigation or detail the
medication was stopped and again it was started after
operation which indicate inappropriate antibiotic
administration.
• Patient was asthmatic and was on continuous medication no
history of medication was maintained neither the patient was
prescribed with any medication from bronchitis or asthma .
 DRUG INTERACTION

• Amikacin and gentamicin both increase nephrotoxicity and

/or autotoxicity.Modify therapy / Monitor closely
 PATIENT COUNSELLING
DRUG SPECIFIC
TABLET MULTIVITAMIN:-
Oral capsule (Lipotropic with Multivitamins; Multiple Vitamins; Multiple Vitamins with Folic Acid
and Antioxidants; Therapeutic Multiple Vitamins; Vitamin A and D; Vitamin A, D, E and K; Vitamin B
Complex; Vitamin B Complex with C; Vitamin B Complex with C and Folic Acid; Vitamin C and E
Never take more than the recommended dose of a multivitamin. Avoid taking more than one
multivitamin product at the same time unless your doctor tells you to. Taking similar vitamin products
together can result in a vitamin overdose or serious side effects.
• Many multivitamin products also contain minerals such as calcium, iron, magnesium, potassium, and
zinc. Minerals (especially taken in large doses) can cause side effects such as tooth staining,
increased urination, stomach bleeding, uneven heart rate, confusion, and muscle weakness or limp
feeling. Read the label of any multivitamin product you take to make sure you are aware of what it
contains.,Take your multivitamin with a full glass of water.
• You must chew the chewable tablet before you swallow it.,Place the sublingual tablet under your
tongue and allow it to dissolve completely. Do not chew a sublingual tablet or swallow it who
Store at room temperature away from moisture and heat. Do not freeze, Store multivitamins in their
original container. Storing multivitamins in a glass container can ruin the medication.
• Avoid the regular use of salt substitutes in your diet if your multivitamin contains potassium. If you
are on a low-salt diet, ask your doctor before taking a vitamin or mineral supplement.
• Do not take multivitamins with milk, other dairy products, calcium supplements, or antacids that
contain calcium. Calcium may make it harder for your body to absorb certain ingredients of the
multivitamin.
• Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose.
Do not take two doses at one time.
 INJ . TRANAXEMIC ACID:-
• Tranexamic Acid is used in the treatment of bleeding. It is used to prevent or reduce bleeding for short
period of time in conditions like heavy periods, dysfunctional uterine bleeding, nosebleed, tooth
removal, after prostate surgery or after bladder surgery.
• Read the Patient Information Leaflet if available from your pharmacist before you start taking
tranexamic acid and each time you get a refill. If you have any questions regarding the
information,
consult your doctor or pharmacist.
• You should not use this medication if you are also using combination hormonal contraception
because it
may increase your chance of having a blood clot, heart attack, or stroke. Your risk is even higher
if you
are overweight, if you smoke cigarettes, or if you are over 35 years of age.
• Tell your doctor if there is a change in your bleeding pattern or heavy bleeding persists or
worsens.
• Inform your doctor if you have a history of kidney or liver disease.
• Inform your doctor if there is no improvement in your bleeding after using this medicine for
three
consecutive periods.
 PANTOPRAZOLE:-
• Should be taken 1 hour before a meal, preferably in the morning.
• It is a well-tolerated medicine and provides relief for a long time.
Some healthy tips to prevent acidity from happening:
• Avoid excessive intake of carbonated beverages/soft drinks, citrus juices, fried food, caffeinated beverages
like tea and
coffee.
• Avoid alcohol and smoking
• Inform your doctor if you get watery diarrhea, fever or stomach pain that does not go away.
• Inform your doctor if you do not feel better after taking it for 14 days as you may be suffering from some
 INJ .NORETHISTERONE:-
• Nortas CR tablet may be taken with or without food, but it is better to take it at the same
time each day. The dose and how often you take it depends on what you are taking it for.
Your doctor will decide how much you need so as to improve your symptoms. Swallow the
tablets whole with a drink of water. You should take this medicine for as long as it is
prescribed to you.
• The most common side effects of this medicine include headache, nausea, abdominal pain,
vaginal spotting, dizziness, and breast tenderness.
• Let your doctor know if these bother you or appear serious, as there may be ways of
reducing or preventing them. Some side effects may mean you should stop taking this
medicine, including if you develop jaundice, migraine, or changes to your speech or
senses
(eyesight, hearing, smell, taste, and touch).
 INJ CEFTRIAXONE:-
• Doctor has prescribed Ceftriaxone to cure infection and improve symptoms.
• Do not skip any doses and finish the full course of treatment even if you
feel better. Stopping it early may make the infection harder to treat.
• Discontinue Ceftriaxone and inform your doctor immediately if you get a
rash, itchy skin,
swelling of face and mouth, or have difficulty in breathing.
• Diarrhea may occur as a side effect but should stop when your course is complete. Inform
your doctor if it does not stop or if you find blood in your stools.
 ONDANSETRON
• This have been prescribed Ondansetron for prevention of nausea and vomiting caused after surgery
or due to chemotherapy and radiotherapy.
• It is fast-acting and starts working within 30 minutes.
• If you vomit within one hour of taking a dose, take another dose.
• Avoid heavy meals and try eating small nourishing snacks throughout the day. Also, sip water
regularly to help avoid dehydration.immediately report blurred vision, anxiety, slow heart rate,
shivering as these indicate serious side effects
AMIKACIN:-
Amikacin is given to cure your infection and improve your symptoms.
• Do not skip any doses and finish the full course of treatment even if you feel better. Stopping it early
may make the infection come back and harder to treat.
• It is given as a drip (intravenous infusion) or as an injection directly into a vein or a muscle.
• Your doctor may get regular blood, urine, or hearing tests while you are on this medication.
• Your doctor will ensure that you are well hydrated before and during treatment with this medicine.
• Inform your doctor if you are pregnant, planning to conceive, or breastfeeding.
• Discontinue Amikacin and inform your doctor immediately if you get a rash, itchy skin, swelling of
face and mouth, or have difficulty in breathing
 BUSCOPA
•NDoctor or nurse will give you this medicine. Kindly do not self administer.
• It SAFETY ADVICE
With Alcohol it’s unsafe Buscopan 20mg Injection may cause excessive drowsiness with
alcohol.
• Pregnancy
• CONSULT YOUR DOCTOR
• Buscopan 20mg Injection may be unsafe to use during pregnancy. Although there
are limited studies in humans, animal studies have shown harmful effects on the
developing baby. Your doctor will weigh the benefits and any potential risks before
prescribing it to you. Please consult your doctor.
• Breast feeding SAFE IF PRESCRIBEDBuscopan 20mg Injection is safe to use
during breastfeeding. Human studies suggest that the drug does not pass into the
breastmilk in a significant amount and is not harmful to the baby.
• Kidney :-Buscopan 20mg Injection should be used with caution in patients with
kidney
disease. Dose adjustment of Buscopan 20mg Injection may be needed. Please consult
your doctor.
• Warnings:-
• Liver
• Buscopan 20mg Injection should be used with caution in patients with liver disease.
Dose adjustment of Buscopan 20mg Injection may be needed. Please consult
your doctor.
 LEVOFLOXACIN:-
• Your doctor has prescribed Levofloxacin to cure your infection and improve symptoms.
• Do not skip any doses and finish the full course of treatment even if you feel better.
• Discontinue Levofloxacin and inform your doctor immediately if you get a rash, itchy skin,
swelling of face and mouth, or have difficulty in breathing.
• Diarrhea may occur as a side effect but should stop when your course is complete. Inform your
doctor if it doesn't stop or if you find blood in your stools.
• Notify your doctor if you feel pain in your tendons, numbness, or tingling sensations.
• Inform your doctor if you are pregnant or planning to conceive or breastfeeding.
 METRONIDAZOLE
• Metronidazole treats infections caused by bacteria and parasites.
• It may cause side effects like nausea, stomach upset, and a metallic taste in the mouth.
• Metronidazole used in a high dose or for a prolonged time increases the risk of side effects
such
as nerve damage. Take it only as prescribed by your doctor.
• Do not drink alcohol during or for 2-3 days after treatment with this medicine. You may develop
nausea, vomiting, flushing and headache.
• Inform your doctor if you have liver disease. Your dose may need to be adjusted in severe liver
disease.
  BISACODYL TABLET:-
• Together with Bisacodyl, taking a fiber-rich diet containing whole grain bread and cereals, bran,
fruits and green leafy vegetables, is essential to maintain healthy bowel function.
• Avoid taking a Bisacodyl for more than 1 week, unless prescribed by the doctor, as it leads to
dependency on the laxative action to produce a bowel movement.
• Take Bisacodyl after 2 hours from other medicines, as it may interfere with the absorption of
other medicines.
• Bisacodyl should be preferably taken at bedtime because it requires 6 to 8 hours to show
impact.

 RANTIDINE:-

• Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole.
Do not chew, crush or break it. Rantac 150 Tablet may be taken with or without food, but it is
better to take it at a fixed time.
SYRUP LACTULOSE:-

• Lactulose is used in the treatment of constipation and hepatic encephalopathy.

• It should preferably be taken at bedtime as it requires 6 to 8 hours to show effect.
It is usually taken once a day as needed for up to 2 weeks. Take it exactly as
prescribed by the doctor.
• Some healthy tips to prevent constipation from happening:
• Eat more fiber in your diet. Recommended daily intake is 20-35g
• Drink 8-10 glasses of water per day
Take it atleast 2 hours after taking other medicines, as it may interfere with the
absorption of other medicines.
Inform your doctor if you have a history of stomach disorders such as appendicitis
or a blockage in your bowel.
DICLOFENAC -SERRATIOPEPTIDASE
• This combination medicine helps relieve pain and inflammation.
• Take it with food to avoid getting an upset stomach.
• Take it as per the dose and duration prescribed by your doctor.
• It may cause dizziness and sleepiness. Do not drive or do
anything that requires mental focus until you know how
Diclofenac + Serratiopeptidase affects you.
• Avoid consuming alcohol when taking this medicine as it may cause
excessive drowsiness and increase the risk of liver damage.
• Your doctor may regularly monitor your kidney function, liver
function and levels of blood components if you are taking
this medicine for long-term treatment.
 DISEASE SPECIFIC
1. Heat
2. Use Castor oil
3.Use Turmeric
4.Choose anti-inflammatory foods
5.Foods to avoid in endometriosis
• Dairy
• processed foods high in refined sugars
• caffeine
• alcohol
Foods to increase include:-
 green leafy vegetables
 broccoli
 celery
 blueberries
 chia seeds
6. Pelvic massage
7. Control weight
8. Stop intake of alcohol, tobacco.
9. Maintain a perfect hormonal balance by taking some natural supplements like aswagandha ,triphala
and practice simple Yogas and pranayams
DISEASE SPECIFIC:-
• Do not inject drugs. If you do inject drugs, stop and get into a treatment
program. If you can’t stop, never share needles, syringes, water, or “works”
• Do not share personal care items that might have blood on them (razors,
toothbrushes)
• for health care or public safety worker, follow universal blood/body
fluid
precautions and safely handle needles and other sharps
• Consider the risks if you are thinking about tattooing, body piercing, or
acupuncture – are the instruments properly sterilized
• Avoid multiple partners
• Prefer for contraceptives
• Hepatitis B infection can be prevented by getting vaccine and HBIG
(hepatitis B immune globulin) soon after coming into contact with the virus.
• Persons who have recently been exposed to HBV should get HBIG and
vaccine as soon as possible and preferably within 24 hours, but not more than
2 weeks after the exposure.
• The patient was on continuous medication for asthma which was stopped
after her treatment started . Without any information to the patient.
THANK YOU