jeudi, novembre 20, 2008

a lesson taught..

I had my pharmacology case discussion just now. We were given a case to study & to find the correct drug / treatment to b given to d particular patient in d case. My group got this case as how i'm about to type below:

Mrs Sylvia, 47 years old, has a fever of 2 days and blocked nose since 3 days ago. She was earlier diagnosed with cirrhosis. From the examination done on her, we found that her BP= 110/70 mm Hg, HR= 84x/minute, RR= 14x/minute, temp = 38°c. Other tests are recorded within normal range. Choose the p-drug that could overcome Mrs Silvia's fever

After lengthy thinking, consideration & countless journals, articles, text books.. yada yada yada.. i decided to try on Paracetamol.. yes I noe it's hepatotoxicity is very high, thus safety of the patient's liver is at risk. However, i read a memorandum report saying that hepatologists agreed that paracetamol at a max of 2g per day is still within safe borders. Paracetamol is known to lower the level of glutathion in liver thus, causing toxicity to the liver which later would lead to necrosis of the liver & by which is fatal to patients with current liver disease. Well, not knowing the onset of my patient's cirrhosis, i therefore went very sure with prescribing paracetamol thrice a day, max 2g daily, max 5 days.. Accompanied by antioxidant to replenish glutathion in the liver. However, i mistook a small fact that the antiinflammation effect of paracetamol is so small that it almost couldn't help to cure my patient's blocked nose. But then again, after the differential diagnosis done to figure out the cause of her block nose, i came to a conclusion that the block nose could be treated with just proper rest & some other non-pharmacological therapy. This is mainly cause my patient has liver disease.. malas nk tambah2 toxic for her liver to metabolise. [for normal patients, maybe a decongestant would do the trick]

And so.. with all the knowledge gathered, i [with my groupmates] presented the case.. and after numerous questions about

  1. "lowering the dosage, wouldn't it effect the efficacy of the drug & the conc of the drug in blood & the bioavailability?"
  2. "how many dosage would u recommend per consumption since it has to be a maximum of 2g per day"
  3. "your counterargument was d drug, aspirin.. y both very hepatotoxic drug? suggest another drug less toxic.. coz our group would suggest mefenamic acid"
  4. "it is known that the antiinflammatory effect of paracetamol is very very weak.. & this surely wouldn't be enough to overcome the blocked nose. If u still say that paracetamol is ur drug of choice, please explain the mechanism of action of paracetamol that could combat the blocked nose"

fuhh! kiri kanan kene tanya soalan.. mmg penat menjawab.. coz u see, the beauty of minds.. different perception gives different understanding.. & from there i did went "ohh.. yea.. good thinking"

but however.. guess wut?? even the other group that got the same case got the drug wrong.. theirs were mefenamic acid (ponstan).. guess what was the correct drug?? (according to dr indri)

aspirin? no

paracetamol? certainly no.. "emang benar dosisnya bisa kamu beri seperti itu (2g max per day).. tapi gmana kalo pasiennya pintar sendiri.. tmbh2 dosis gara2 panasnya gak sembuh.. siapa yg diperslhkan nanti kalo bukan kamu??"

mefenamic acid?? antipyeretic effect toooo weak.. usually used in children unresponsive to paracetamol..(eg: with complication of cist...)

panadol?? paracetamol la tuu.. xleyy..

haa fikir.. bukak textbook.. mesti tak jumpa sebab.. confirm. coz u would only know the answer to this with experience of real patient & real clinical scenario..

so folks.. according to my guru.. ibuprofen is the drug of choice in this case.. why?? "ibuprofen has very weak antipyretic effect..thus not so effective in blocking the over production of prostaglandin, the fever mediator"

menurut kata dr indri.. "efek antipiretiknya lebih bagus dari asam mefenamat.. & obat ini kurang hepatotoksik.. jika panasnya sulit turun, harus di kontrol dari dietnya.."

grrr.. carilah buku or journal mana pun.. takkan jumpa jawapan ni.. only ur very experienced doctors (lecturers) could teach u,, no book could.. a lesson learned.. a knowlegde.. i'm one step smarter than yesterday :)

ohya.. kalau nk tau, ibuprofen ni usually org guna as painkiller.. jrg guna untuk demam.. (as far as how my books take me la..)

--medicine.. a lifelong study.. --

3 commentaires:

Adam Z a dit…

eeee pening iiii...*wabbit guling2*

nadhirah mohd shakri a dit…

def jgn bg paracetamol la babe!!
cirrhosis dh tuu.. =p

ntah la bg ape..i dh lupe farmako..
haha..NSAIDs yg byk

:+:+: Ashikyn :+:+: a dit…

hehe.. study byk2.. it's gonna be very useful ble u guys msuk hosp nnt, believe me! slamat blaja u guys! hehe... blaja farmako mmg capek man..