Presented By,

Alana Joy
Roll no : 3
3rd yr Pharm D
INTRODUCTION

A 43 yr old female who is a known

case of bronchial asthma was admitted to
the hospital with c/o pain on right knee
since 3 days.No h/o fall or trauma.
DEMOGRAPHIC DETAILS
NAME : Mrs Deepa S
AGE : 43
SEX : Female
DOA : 09/01/2015
DOD : 14/01/2015
DEPT : Orthopaedics
SUBJECTIVE
Presenting Complaints

c/o Pain on right knee since 3 days

Past Medical History

Known case of Bronchial Asthma

Dietic History
Mixed Diet

Immunization History

No Recent Immunization Taken

OBJECTIVE

General Examination

O/E Patient was conscious oriented

No PICCLE
Pulse : 80/min
BP : 130/80mmHg
Systemic Examination
R/S : Bilateral air entry equal,NVBS ,No
added sound
CVS : S1S2 Heard
P/A : Soft,Non tender,No organomegaly
CNS : No FND
Local Examination Of Right Knee

Diffuse swelling over right knee

Para patellar fossa is obliterated
Tenderness over medial joint line present
Synovial thickening present
No effussion
Movement of knee : Terminal flexion
restricted due to pain
No distal neuro vascular deficits
INVESTIGATIONS
HAEMATOLOGY(09/01/2015)

PARAMETER VALUE REFERNCE INFERENCE

Hb gm% 12.1 12-15 Normal
Platelets 2.9lakh/cumm 0.2-2 lakh/cumm Normal
lakh/cumm
WBC/cumm 8600/cumm 4000- Normal
11000/cumm
DC Poly % 61% 35-80% Normal
Lymphocytes % 30% 20-50% Normal
Eosinophils % 4% 0-7% Normal
Monocytes % 5% 2-12% Normal
ESR 51mm/hr <20mm/hr High
BIOCHEMITRY

PARAMETER VALUE REFERENCE INFERENCE

Urea 17mg/dl <40 mg/dl Normal

Createnine 0.7mg/dl 0.6-1.1mg/dl Normal

RBS 102mg/dl <140mg/dl Normal

Uric Acid 4.7mg/dl 2.4-6mg/dl Normal

 X RAY Examination

Degenerative disease : Grade 2 Osteoarthritis

SEROLOGIC TEST

Rheumatiod Factor : <20 IU/ml (Normal

upto 20 IU/l)
ASSESSMENT

Osteoarthritis
OSTEOARTHRITIS
Arthritis is the inflammation of the joints.
Osteoarthritis is one of the most common form of
arthritis and known as wear and tear arthritis.It is
associated with a breakdown of cartilage in joints and
can occur in almost any joint in the body.It
commonly occurs in the weight-bearing joints of the
hips, knees, and spine.It also affects the fingers,
thumb, neck, and large toe. Osteoarthritis does not
affect other joints unless previous injury ,
excessive stress or an underlying disorder of cartilage
is involved. Cartilage is a firm, rubbery material that
covers the ends of bones in normal joints
Etiology And Pathogenesis
Symptoms of Osteoarthritis

Joint aching and soreness, especially with

movement
Pain after overuse or after long periods of inactivity
Stiffness after periods of rest
Bony enlargements in the middle and end joints of
the fingers (which may or may not be painful)
Joint swelling
Diagnosis Of Osteoarthritis

 X ray
 Arthrocentesis(Joint fluid analysis)
 Arthroscopy
 By analysis of location,duration and character of the joint
symotoms and appearance of the joint.Therefore, Heberden's
nodes, Bouchard's nodes, and bunions of the feet can help the
doctor make a diagnosis of osteoarthritis.
Treatment Of OA

NSAIDs is the main drug of choice

Other Medications Include

Capsaicin, the ingredient that gives hot peppers,is also good

for relieving the pain. It works by affecting the release of
substance P, which is involved in transmitting the sensation of
pain.
Topical NSAIDs,like Diclofenac
Counterirritants use ingredients like camphor, menthol, and
eucalyptus to help relieve OA pain.
Treatment Algorithm
DISCUSSION ON THERAPY
BRAND GENERIC INDICATION ADR INTERACTIO
NAME NAME N
Inj.Dynaper Diclofenac Osteoarthrits Abdominal
cramps,
Flatulence,
Indigestion,
Nausea
Lyser D Diclofenac Osteoarthritis Rashes
sodium+Serrat Flatulence
iopeptidase Anorexia
Headache
Cyra Rabeprazole Proton Pumb Amnesia,
Inhibitor Headache,
Delirium,
Dysphagia
BRAND GENERIC INDICATIO ADR INTERACTI
NAME NAME N ON

Shelcal HD 12 CaCO3+Vitd3 Osteoarthritis Flatulence,

Urticaria,
Rashes,
Pruritis
Esiflo MDI Salmeterol+ Asthma Pharyngitis,
Fluticasone Cough
Bronchitis
TREATMENT CHART
Brand Name Generic Name Dose Route Freque 9 1 1 1 1 1
ncy 0 1 2 3 4

Inj.Dynaper Diclofenac IM BD      

Lyser D Diclofenac Oral BD      

sodium+Serratio
peptidase

T.Cyra Rabeprazole 20mg Oral BD      

Shelcal HD 12 CaCO3+Vit d3 Oral      

Esiflo MDI Salmeterol+Flut 250m Nasal 2 puff      

icasone cg BD
He was started with Quadriceps Strengthening
Exercise
 DISCHARGE MEDICATION

Quadriceps exercise

1)Tab Cyra 20mg BD

2)Tab Shelcal HD 12 OD
3)MDI Esiflo 250mcg 2 puff 1 weeks
4)Tab Voveran Plus BD
5)Tab Ultracet 1 sos

Review after 1 weeks in Ortho OPD

PLAN
• Proper medication adherence.
• Avoid falls and trauma.
• Take adequate rest.
• Exercise programs and quadriceps
strengthening can improve physical functioning
and can decrease disability,pain etc.
• Heat or cold therapy helps to maintain and
restore joint range of motion and also muscle
spasms.
REFERENCE
• CIMS
• Essentials of Pharmacology,K D Tripathi
• Lexicomp’s Drug Information Hand Book
• www.medcare.com
• www.mayoclinic.com
THANK YOU