Case 1

Mr HA is a 50-year-old accountant who was admitted 2 days ago to hospital following a

blackout whilst watching a football match with his son.
His preliminary examination reveals bruising to his left arm and upper thigh for which he
has been prescribed paracetamol 1g four times daily and as required ibuprofen 400
mg three times a day.
His past medical history indicates that he is on no medication and seemed to be a
reasonably fit man for his age with no existing diagnosed medical conditions.
On examination he is slightly overweight at 81 kg, he smokes 20 cigarettes per day and
drinks approximately 30 units of alcohol per week. His blood pressure on admission was
165/80 mmHg with a heart rate of 90 beats per minute. This degree of raised blood
pressure and heart rate has been maintained over the last 48 hours. He is subsequently
diagnosed as having hypertension.

Question:
1. What is hypertension?
2. What are the appropriate treatment targets for this patient’s blood pressure?
3. Besides blood pressure, what other advice and treatment does this patient
require to ensure his risk of a cardiovascular event is reduced? Give clear
reasons for your advice and explain the risks associated with not taking this
advice.
4. What are the main classes of drug used to treat hypertension?
5. Which class of drug would be appropriate first-line treatment for Mr HA?
6. For one of the classes of drugs mentioned in question 4 indicate the following:
a. A drug from that class
b. A suitable starting dose and frequency
c. The maximum dose for hypertension
d. Three contraindications
e. Three common side-effects.
6- In view of Mr HA’s age he requires cardiovascular risk assessment. How would you
assess this patient’s cardiovascular risks?
 Case 2
(Ph. Shrouk Sherif)
Mr.Mark is a 52-year old man who presented with a 2-week history of polyuria, polydipsia,
polyphagia, weight loss, fatigue, and blurred vision. A random glucose test performed 1
day before presentation was 352 mg/dl. The patient had symptoms of numbness, tingling
in hands or feet, dysuria, sometimes he had chest pain, cough . He had history of diabetes
and no family history of diabetes, also he said that he always eat fast food.

Admission non-fasting serum glucose 248 mg/dl (N=<180 mg/dl), HbA1c 9.6% (N=4-
6.1%). Electrolytes, BUN and creatinine were normal, total serum cholesterol 266 mg/dl
(N: <200 mg/dl), high-density lipoprotein (HDL) cholesterol 29 mg/dl (N: >35 mg/dl),
triglycerides 285 mg/dl (N: <200 mg/dl)Physical examination revealed weight of 180
pounds, height 5'5.5" (IBW 140-145). The rest of the examination was unremarkable, i.e.,
no signs of retinopathy or neuropathy.

The patient was taught self-monitoring of blood glucose and begun on 5 mg glyburide
once a day and Atorvastatin (Lipitor).He was instructed in diet (1800 cal ADA). Blood
glucose levels ranged from 80 to 120 mg/dl within 2 weeks of starting glyburide, his
symptoms disappeared and weight remained constant.

During the next two months, blood glucose levels decreased to 80 mg/dl, and glyburide
was stopped. Patient did not return until one year later; fasting serum glucose was 190
mg/dl, and HbA1c 8%. He again had polyuria and nocturia. Weight was unchanged from
time of presentation. The physician put him on 5 mg/day of glyburide. His blood sugar
one month later remained at 180 mg/day. At this point, his physician decided to put him
on insulin alone, 20 units/day at bedtime. Two weeks later, his fasting plasma glucose
was 120 mg/dl.

Questions:

1. What is diabetes mellitus, types, which type dose Mr. Mark have?
2. What are the sings and symptoms that Mr.mark have ?
3. What are the factors responsible for the disease that the patient have and
does he have risk factors for cardiovascular disease ?
4. What are the complications that can happen if the patient did not take the
right treatment?
5. Mention the drugs used to treat the patient and their mechanism of action?
6. Mention the drugs used in treatment of Diabetes mellitus?
7. What are other factors that can help in patient treatment?
 Case 3

Jim is a three-month-old baby born at 35 weeks’ gestation. He has been in hospital since
birth with a variety of problems. He is now feeding enterally via a bottle, but is not thriving
and his weight is falling off the centile chart. He has been on feed thickeners and ranitidine
for the last month for gastrooesophageal reflux, but symptoms still persist.

Questions

1. What is gastro-esophageal reflux and what are the main symptoms?

2. What is the rationale behind the ranitidine treatment already started?
3. What alternative class of drug may work in the same way as ranitidine, but
bemore effective?
4. What are the practical problems of using this second class of medicine in
aninfant?
5. Name three prokinetic agents which could be added to the regimen at this stage?
6. What is the rationale of use of these products?
 Case 4
A 40 years old female complains that she has tried 3 Antinal® capsules daily for 3 days
to stop diarrhea, but with no relief. The patient says that she occasionally complains from
abdominal pain, cramping or bloating that is typically relieved or partially relieved by
passing a bowel movement and sometimes alternating bouts of diarrhea and constipation
and also she experienced a Mucus in the stool. She also said that her husband had
passed away 5 months ago. She also said that she had constipation 2 weeks ago and
lasted for 5 days.
1. What is IBS?
2. What are the causes of IBS?
3. What are the signs and symptoms?
4. What are the risk factors?
5. What are the Complications?
6. How to prevent IBS?
 Case 5

An 80 year old man presented with impairment of brain functions, alterations of mood and
behavior. His family reported that he was having progressive disorientation and memory
loss over the past 6 months. He had trouble handling money and paying bills. He repeated
questions, took longer to complete normal daily tasks, had poor judgement, and had
developed mood and personality changes.

There was no family history of dementia. The routine blood, urine and C.S.F. analysis did
not reveal much. After a computerized tomography (CT) scan and the histopathological
examination of the brain tissue, the patient was diagnosed to have Alzheimer’s disease.

Questions:

1) What is the pathophysiology of this disease?

2) What are the laboratory investigations required for diagnosis?

3) What it its prognosis of this case?

4) How can this case be managed/ treated?

 Case 6

A 66-year-old woman notices that she is having trouble performing some everyday tasks
such as doing up buttons on her blouse and chopping up vegetables in her cooking. She
complains that her muscles feel stiff, and it is taking her longer than it did to walk to the
local shops. She is anxious about these problems since she lives alone and has to do
everything for herself. She has noticed a little shakiness which she ascribes to anxiety.
Her daughter has told her that it is becoming increasingly difficult to read the small writing
in
the letters she sends. She is a retired journalist and has no significant past medical
history. There is no disturbance of her bowels or micturition. Her appetite has been good
and her weight steady. She complains that she has been sleeping poorly and is,
consequently, rather tired. She does not smoke tobacco and drinks only occasionally.
She has hypertension and takes atenolol 50 mg daily.
Examination
Her pulse is 60/min and regular, blood pressure is 134/84 mmHg. There are no
abnormalities in the cardiovascular or respiratory systems. On neurological examination
there is no muscle wasting. She has generally increased muscle tone throughout the
range of movement and equal in flexors and extensors. There is a slight tremor affecting
mainly her right hand, which is suppressed when she tries to do something. She has
problems with fine tasks such as doing up buttons. Power, reflexes, co-ordination and
sensation are all normal. When asked to walk she is a little slow to get started and has
difficulty stopping and turning. There is evidence in the history and examination of tremor,
rigidity and bradykinesia. Her writing shows micrographia secondary to the rigidity and
slowness of movement so she had been diagnosed to have Parkinson’s disease. Her
hypertension is well controlled on the beta-blocker

Questions
1. What is Parkinson’s disease?
2. What is the difference between Parkinson’s and parkinsonism?
3. What are the causes of Parkinson’s disease?
4. How would you investigate and diagnose this patient?
5. What are the signs and symptoms?
6. What are the risk factors?
7. What are the Complications?
8. How to manage Parkinson’s disease?
 Case 7

An 18-year-old man, VB, presents with a history of recurrent episodes of wheeze after
walking 200 meters. VB has recently started to go to a gym and his episodes of wheeze
have worsened. He goes to see his GP. He can talk in sentences but his respiratory rate
is increased. His peak flow is 420 L/min which is 80% of predicted result. A diagnosis of
mild asthma is made. He is started on salbutamol metered dose inhaler (MDI) two puffs
when required and beclometasone (Qvar) 50 micrograms twice daily.

Questions:

1-What is asthma?
2-What are the risk factors for developing asthma?
3-What are the risk factors does this patient have?
4-Describe the pharmacokinetic and pharmacodynamics of beta2-agonists and
inhaled corticosteroids
5-What are the side-effects of beta2-agonists?
6-What are the available pharmaceutical formulations of salbutamol and
corticosteroids available in the market for treatment of Asthma? And what are the
advantages and disadvantages of each type?
7 -Describe how to use an MDI.
 Case 8

AW, a 25-year-old Afro-Caribbean man, has been admitted to your ward with a sickle cell
crisis. AW has a raised temperature and complains of severe pain in his limbs, chest and
lower back.

His regular medications are:

 Phenoxymethylpenicillin 500 mg twice a day.
 Folic acid 5 mg daily.

AW’s blood results are as follows:

 WBC: 13.1 × 109/L (4.0–11.0 × 109/L)
 RBC: 3.5 × 109/L (3.8–4.8 × 109/L)
 Hb: 8.5 g/dL (12.0–15.0 g/dL)
 Hct: 0.33 (0.36–0.46)
 Bilirubin: 45 micromol/L (3–17 micromol/L)

Blood film showed increased reticulocytes, sickle cells and presence of target cells.

Please answer the followings:

1. What is the cause of sickle cell anemia?
2. What is a sickle cell crisis? What situations may precipitate a sickle cell crisis?
3. What do you think may have precipitated AW’s crisis?
4. The doctor caring for AW asks your advice regarding analgesia. So far, he has
prescribed regular paracetamol and full-dose dihydrocodeine but AW is still in severe
pain. What recommendations can you make regarding analgesia for AW?
5. Comment on AW’s blood results.
6. What other acute management may be necessary for AW?
7. Why is AW taking phenoxymethylpenicillin and folic acid?
8. What are the prognosis and long-term complications for patients with sickle cell
anemia?
9. Due to AW’s frequent crises the medical team caring for him is considering initiating
hydroxycarbamide (hydroxyurea). What evidence is there to support the use of
hydroxycarbamide in the management of sickle cell anaemia?
10. How is hydroxycarbamide thought to work in the management of sickle cell anaemia?
11. State the different types of sickle cell anemia.
12. What are the types of hemoglobin?
13. State the type of mutation occurs in sickle cell anemia. Explain.
 Case 9
A 10 years old child came with his mother to your pharmacy complaining of vomiting,
abdominal pain, severe pallor, yellowish eyes and brownish liquorice urine. His mother
stated that her son had eaten a meal that included fresh salad a few days ago in a restaurant.

1. What is the diagnosis for this case?

2. What is the possible organism[s]?

3. What is the mode[s] of transmission?

4. What is the laboratory diagnosis in this case?

5. What drug do you think the physician will prescribe?

 Case 10
A 12 year old girl presents with fever, rash, headache, weight loss and fatigue. Her
knees, ankles, elbows, and wrists showed warmth, swelling, redness, and tenderness.
Firm, painless nodules on the extensor surfaces of the wrists, elbows, and knees were
noticed. She displayed rapid, purposeless movements of the face and upper extremities. It
was revealed that she had suffered from pharyngitis three weeks earlier and had a history
of repeated attacks of sore throat.

1. What is your diagnosis?

2. How do you diagnose this condition?

3. What is the pathogenesis of ARF?

4. How is the diagnosis of ARF made with laboratory tests?

5. Why is anti-streptolysin S not used?

6. How can the onset of ARF be prevented?

 Case 11
A 46 year old febrile man was admitted to the hospital. He had been coughing with
yellowish expectoration. Physical examination revealed high fever (38°C), tachycardia,
tachypnea and appeared confused. He also complained of chest pain. Breath sound appear
crackled. Chest X-ray suggested dense left lower lobe consolidation. Hematological
examination revealed leucocytosis and CRP was elevated.

1. What is your diagnosis?

2. Which are the bacterial etiological agents of pneumonia?

3. What are the specimens collected?

4. How is the sputum specimen processed?

5. What are your observations?

6. How do you identify the growth?

7. What is quellung reaction?

8. What is optochin susceptibility?

9. What is bile solubility test?

10. What is the pathogenesis of pneumococcal pneumonia?

11. Which are the other infections produced by pneumococci?

12. Which are the antibiotics used in the treatment of this condition?

13. Which conditions can predispose to pneumococcal infections?

14. Are any vaccines available against pneumococcal disease?

 Case 12
A 23 old female complains of mild fever, increased frequency, urgency and burning
micturition. She also reported a sensation of bladder fullness, lower abdominal
discomfort and flank pain.

1. What is your diagnosis?

2. Which are the bacteria that can cause urinary tract infection?

3. What is the common source of UTI?

4. How are urinary tract infections classified?

5. How is the sample collected for laboratory diagnosis?

6. Which are the other techniques to collect urine specimen?

7. How long can the urine be held before testing?

8. Which investigations are performed on urine sample?

9. What is significant pyuria?

10. What is significant bacteriuria?

11. How is semi-quantitative culture performed?

12. What is your observation?

13. What factors must be borne in mind while interpreting urine culture reports?

14. What is sterile pyuria?

15. What is baceriuria without pyuria?

16. How is this condition treated?

 Case 13
A 23-year old man presented to skin clinic with multiple, annular-oval pruritic
lesions on the arms and legs. The borders of the lesion were erythematous, raised and had
few vesicles. The man reported that he owned a pet cat, which too had some skin lesions.

1. What is your diagnosis?

2. What is the specimen collected?

3. How is the sample transported?

4. Which the necessary investigations to be performed?

5. Describe the culture methods?

6. What is your observation?

7. What is your identification?

8. What are dermatophytes?

9. How are dermatophytes classified?

10. What are the major differences between these three genera?

11. Which group does the isolate from this patient belongs to and what is the

source of infection?

12. Which are the other dermatophytes that can cause tinea corporis?

13. How do you treat this condition?

14. Which are the other infections caused by dermatophytes?

 Case 14
A 53 year old female presented with fever, rigors, malaise, and headaches for the
past 2 days. She had lived in Zaire for 8 months, where she had been hospitalized with
similar complaints and treated empirically with chloroquine.

She returned to the US two days prior to admission. Her temperature was 102 degrees,
Pulse 90, and BP 130/70. On physical examination, the spleen tip was palpable. The
WBC count was 4100 cells / mm3, and the hemoglobin was 8.5 g /dl.

1. What test would help establish the diagnosis in this patient?

2. What plasmodium species is Likely to be causing her infection?

-List the species and their geographical distribution.

3. Which species causes the most severe diseases, and what complications

are seen with it?

4. What is the life cycle of the species you think is involved?

5. Why had she failed treatment previously?

-How would you treat this patient?

6. What control measures are available to prevent its transmission?

 Case 15
A 33-year old male tourist from Europe was admitted to a local hospital following
bouts of diarrhea. He had been having food and water from nearby street food stalls.
He had no fever or vomiting.

1. What is your diagnosis?

2. What is diarrhea?

3. What is traveler's diarrhea?

4. What is the pathogenesis of this condition?

5. Which are the other organisms that can cause diarrhea?

6. What is the specimen collected and what is the role of laboratory diagnosis?

7. What is your observation?

8. Isolation of E. coli from feces is normal, how do you identify the pathogen?

9. Which are the other enterovirulent E. coli and what do they cause?
 Case 16
A 10 year old child is brought to the hospital with high fever, neck rigidity, and
petechial rashes on the body. The child had complained of severe headache and had
vomited before being brought in. Photophobia and an altered mental status was also
noted. Physical examination showed Kernig's and Brudzinski's signs to be positive.

1. What is your diagnosis?

2. Which are the bacteria that can cause pyogenic meningitis?

3. What is meningitis?

4. What is the pathogenesis of meningitis?

5. How is this condition diagnosed using laboratory techniques?

6. Which are the specimens collected?

7. Which are the necessary investigations performed?

8. What are your observations?

9. How is this disease treated and prevented?

 Case 17
A 77 year old man with past medical history significant for dementia,
hyperlipidemia, coronary artery disease (CAD), s/p coronary artery bypass graft
(CABG) and aortic valve replacement (AVR) who was referred to the Memory
Clinic for agitation.
He started having memory problems which worsened significantly later after his
CABG and AVR. At the time he presented to the clinic, he had functional deficits in
the following instrumental activities of daily living (IADLs) – handling finances,
driving, cooking and shopping.
The patient was noted to be easily agitated and irritable for some time, and was
referred to the Memory Clinic for exhibiting verbal and physical aggression towards
his wife as well as others. The patient was recently seen by his primary care
physician for this issue, and all of his laboratory exams were normal, and subsequent
MRI of the brain was also unremarkable.

The patient noted good appetite and denied problems with sleeping or weight
changes. He also denied any suicidal ideations and visual/auditory hallucinations.
However, he stated that he was depressed because he was worried about his memory
problems.

Questions:

 Explain the Diagnosis of Depression in Patients with Dementia

 Mention the pharmacological &Non-pharmacological Intervention should
be followed
 Case 18

Patient X was admitted to the psychiatry unit after being treated for a self-inflicted
gun shot wound. He is a male, in his mid-fifties, lives with his wife. He completed
high school and one year of college, and then started farming, where he had
experienced crop failure for 3 consecutive years; he is deeply in debt now, and in
danger of going bankrupt. He is obese, and diagnosed with type II diabetes about 10
years ago, he was also diagnosed with hypertension, and hyperlipidemia. He has
been taking insulin injection, lovastatin, furosemide, atenolol, and amitriptyline
(Tricyclics) since that time. He suffers from sleep disruptions, loss of interest, he
quit any exercise, and he drinks and smokes a lot. Lastly, episodic bradycardia had
been diagnosed last year.

Questions:

1- What does this patient suffer from?

2- Define hyperlipidemia?
3- What is the difference between type I and type II diabetes?
4- What is lovastatin, furosemide, and atenolol used for?
5- What is episodic bradycardia?
 Case 19

An 8 years old girl is brought in by her mother for evaluation of allergies. Each year
in the spring the child develops a runny nose; itchy, watery eyes; and sneezing. She
has been treated in the past with diphenhydramine, but the child teacher says that
she is very drowsy during school. She has no other medical problems and is on no
chronic medications her examination is unremarkable today. You diagnose her with
seasonal allergic rhinitis and prescribe fexofenadine.

1. Questions:
2. What is the mechanism of action of antihistamine medications?
3. What are the common side effects of antihistamine medications?
4. What is the pharmacological basis of switching to fexofenadine?
 Case 20
Mrs Q is a 37-year-old woman who comes to your pharmacy with a prescription for
Predsol enemas, one daily for four weeks. She tells you that she has recently been
diagnosed with ulcerative colitis and that this is her first prescription for an enema.
She says she would really rather have tablets but the doctor suggested that an enema
would be more appropriate for her.

Questions:

1. What is ulcerative colitis?

2. What is the aetiology (cause) of ulcerative colitis?
3. What sort of patient most commonly develops ulcerative colitis?
4. What is the active ingredient of Predsol and what class of drugs does it
comefrom?
5. How do these drugs exert their action in conditions such as ulcerative colitis?
6. What are the adverse effects of this type of drug?
7. Why do you think Mrs Q has been prescribed an enema rather than tablets?
8. What formulations of prednisolone are available which Mrs Q could self-
administer?
9. Describe the advantages and disadvantages of these formulations?
10.What counselling points should you make to Mrs Q about how to use
herenema?
 Case 21
A mother and her 6-year-old son present a post-dated prescription for penicillinV
syrup 250 mg q.d.s. × 10 days and ask to speak to the pharmacist. The childis
irritable, complains of pain when swallowing and appears flushed. Themother is
anxious to start antibiotic treatment straight away so that her son canget back to
school and she can get back to work, but the prescription is not validfor 3 more days.

QUESTIONS:

1 What are the causes of sore throat and how are they differentiated?

2aWho is at risk of sore throat and how common is it?

2b How serious is acute throat infection?

2c Are antibiotics effective for the treatment of sore throat and for how long
shouldyou treat?

2d When are antibiotics indicated for the treatment of sore throat?

3a What group of drugs does penicillin V belong to and how do they work?

3b What are the side-effects of penicillin V?

3c What are the alternatives to penicillin V for treatment of sore throat?

4a What is the oral bioavailability of penicillin V and what is the impact of

administration with food?

4b What are the storage conditions and shelf-life of penicillin V oral solution?

5a What are the disadvantages of prescribing antibiotics for sore throat?

5b How should this patient’s mother be counselled regarding the post-dated

prescription and symptom relief?

 Case 22
Mrs WL, a 70-year-old Chinese woman, reports to her GP because she has been
feeling very tired. Mrs WL informs her GP that she has been getting out of breath
when walking up stairs which she never had any problem with in the past. On
examination, Mrs WL has pallor of the skin, conjunctiva and nail beds and brittle
nails. Mrs WL is a strict vegetarian. The GP performs a blood count and the results
show that she has iron deficiency anaemia.

Questions:
1a. what is anaemia?
1b. what typical blood results might you expect in a patient with iron-deficiency
anaemia?
1c. what symptoms does Mrs WL have that support the diagnosis of iron-deficiency
anaemia?
1d. what risk factors does Mrs WL have for developing this condition?
2a. what is erythropoiesis and which human growth factor stimulates this?
2b. Describe the life cycle of a red blood cell, starting from the release of
erythropoietin and ending with its destruction.
3a.should modified-release iron preparations are used in the treatment of anaemia?
Justify your answer.
3b. what are the side-effects of iron preparations?
4a. what medication would you recommend for Mrs WL? (Give a preparation, dose
and frequency.)
4b. how would you counsel Mrs WL about the medication you have recommended?
4c. what follow-up should Mrs WL receive?
 Case 23
Mrs Smith, who is 35-years-old, comes into your pharmacy with her 1-year-old
daughter and gives you a prescription for levothyroxine 50-microgram tablets take
one daily. This is the first time she has taken the drug. She has gained a lot of weight
since the birth of her daughter and has not been able to shift it even by sticking to a
calorie-controlled diet. She feels cold all the time, even on a hot day, and her hair is
thinning. She has no energy at all, whereas before the birth of her daughter she used
to go to aerobics at least three times a week.
Questions:
1. What do the patient’s signs and symptoms indicate?

2. What are the possible causes of the disease?

3. What blood tests would she have for this condition?

4. What monitoring is required for this condition?

 Case 24

Mr KM is a 49-year-old man who has been diagnosed withasthma since childhood.

He also suffers from allergic rhinitiswith symptoms following exposure to grass
pollen in the earlysummer. He is also allergic to cats. Over the past 2 years
hisasthma has been steadily deteriorating with a marked reductionin his ability to
walk without becoming breathless. He nowexperiences daily symptoms and is
woken up at night severaltimes a week with shortness of breath which is
temporarilyrelieved using a salbutamol inhaler. His current medication
is:Salbutamol DPI 200 μcg when required (currently using threeor four times every
day)Seretide-250® evohaler® 2 puffs twice dailyMontelukast 10 mg at
nightAminophylline m/r (Phyllocontin®) 450 mg twice dailyHe has had five
exacerbations in the past 18 months, requiringhospitalisation. His last admission
was 1 month ago with a severeexacerbation requiring a short period of ventilation
support.He was discharged with a course of prednisolone 40 mg dailyfor 14 days
but has had to continue taking prednisolone andcurrently takes 10 mg daily.

Questions:

1. At which step of the BTS/SIGN guidelines is Mr KM, and what ishis likely
diagnosis?

2. What should be the next step in his management?

3. Is there a link between asthma and allergic rhinitis?

4. Mr KM has a positive skin prick test for animal dander and hisIgEtitre measures
425 IU/L. Is Mr KM suitable for treatment foromalizumab and, if so, for how long
should this be given?
 Case 25

A 40 years old male came to your pharmacy complaining of colic typically begins
in the flank and often radiates to below the ribs or the groin. He thinks he should
perhaps have something gentle, like a herbal medicine

What is the diagnosis of this case?

What is definition of this disease?

What are the symptoms of renal colic?

What is the main cause of this disease?

What is the herbal medicine that he can take to relieve these symptoms?

What is the pharmaceutical action of kellagon?

 Case 26

CG has 35 year old, CG’s legs bothered her. It started when she was
pregnant. Then she gained a little weight. Over time, the veins in her legs
started looking gnarled – a classic symptom of varicose veins. At first she
thought it was a cosmetic issue. But as time passed, those veins became
painful, burning and heaviness in the legs. She remembered her
grandmother had severe varicose veins.

1. What are varicose veins?

2. What are the Causes of Varicose Veins? And What are the causes in this
case?
3. What is the type of this symptoms Mild or Severe symptoms and What are
the symptoms for each one?
4. Mention if present any Home treatment…
5. What is a Conventional medicine for this case?
6. Mention some of Folk Remedies that can be able to treat varicose vein or
decrease its symptoms including: Part use, Active Constituent and Help to
what?
7. Lifestyle tips for varicose veins
 Case 27

MZ, a 43 year old male, 175 cm, 78 kg, presents to your local pharmacy
suffering from a cough with a 4 day history. The patient requests your
assistant to prescribe an OTC drug that would help relieve his cough but
he asks for something herbal.

1) What product would you prescribe?

2) Describe the active constituents of the pre-mentioned
product.
3) Consult the patient on what dose he should take
4) Consult the patient about the appropriate storage conditions
for this product
5) Warn the patient about the expected side effects of this
product.
6) What contraindications should you make sure the patient
doesn’t have before dispensing this product for him?
 Case 28

BP is a 32-year-old man who asks for your recommendation for an OTC

supplement for alleviating the symptoms of jet lag. BP reports he has
been traveling back and forth across the country on business for the past
few weeks and that he can’t seem to acclimate to the time zone changes
and adjust his sleep patterns accordingly. He reports experiencing
insomnia and excessive daytime sleepiness, which are impacting his
work performance. BP reports suffering from a sulfa allergy and takes
loratadine 10 mg daily as needed for allergic rhinitis and ibuprofen 200
mg as needed for occasional tension headaches. What is Jet lag and
describe non pharmacological means to prevent Jet lag? What herbal
supplement is indicated for the prevention of “jet lag”? what are possible
side effects and doses of this herbal supplement? Is BP a candidate for
the use of this product?
 Case 29

Mrs. Farah comes into your pharmacy and is looking to buy

something for abdominal spasm when asked she states that she
doesn’t suffer from any other disease.

 What are the OTC drugs that can be used in this case?
 What are the causes of abdominal spasm?
 What are the side effects of the used treatments?
 How to avoid abdominal spasm?
 Case 30

Mrs. Toqa is a 55-year-old female who presents to your pharmacy

complaining that she had frequent burning abdominal pain and bloating
sensation for a couple of days. She said that the pain is worse after eating and
especially in the night.

Questions

1-What could be the diagnosis?

2-What are the medications (one example) that could have led to this problem?

3-What would you dispense for this case?

4-What other lifestyle tips you could provide to this patient to help reliving the
pain?

5-What are the side effects (if any) of the drugs you dispensed?

6-Are there any food-drug interactions for the drugs you had dispensed
 Case 31

A 31-year-old woman on a Nile cruise presented to the cruise

ship physician with a nauseating feeling, dizziness, clammy
hands, uneasiness, and vomiting. Which she used to complain
from in such journeys

1-What is the diagnosis of this case?

2-Mention herbal therapy for this case and explain how it work?
and give example of market product
 Case 32

A 29 year-old-women came to the pharmacy complaint from her

cough with sputum , pharmacist advise her to take bronchicum
elixir three times per day

Which type of cough had she?

What is the bronchium’s ingredients? and how it works?

mention other market drugs from plant origin for this case?