/publications/issue/2007/2007-09/2007-09-6798

case STUDIES

Author: Lauren S. Schlesselman, PharmD

CASE ONE:

JH, a 27-year-old elementary school teacher, approaches the pharmacy counter. She asks the pharmacist to refill her prenatal vitamin prescription. While the pharmacist is filling the prescription, JH and the pharmacist discuss how her pregnancy is progressing.

JH is thrilled that she has not experienced any problems during her first 2 trimesters. Despite an easy time thus far, she expresses concern for her unborn child?s health, because she was exposed to a student with chickenpox yesterday. The student?s mother had sent him to school, believing that the rash covering her child could not be chickenpox because he had been vaccinated. The school nurse insisted that the child had chickenpox and sent him home, but JH already had been exposed.

JH asks the pharmacist whether there is anything she can do to reduce her risk of developing chickenpox. Are any preventive measures available for JH?

CASE TWO:

JM, a student currently enrolled in his last year of pharmacy school, is seeing patients with a medical intern at the family practice clinic, when the attending physician asks them to treat the woman in Examination Room 3. When they enter the room, the patient explains that she has been experiencing severe dizziness for 3 days. The dizziness has been accompanied by nausea and vomiting. She says that it is worse when she changes position.

Her symptoms have been so severe that she needs her husband to support her during the short walk to the bathroom. The intern asks the patient whether she has recently had an upper respiratory infection. The patient confirms that she is just getting over a cold. During the examination, JM notices that the patient?s eyes make involuntary rapid movements from side to side when the intern asks her to follow his fingers with her eyes.

The intern believes that the patient?s severe spontaneous vertigo is caused by labyrinthitis, also known as otitis interna. He explains that otitis interna is an inflammation of the inner ear that causes sudden onset of nausea, vomiting, vertigo, loss of balance, and nystagmus.

The intern informs the patient that the severe symptoms should last only a few days, with all symptoms resolving completely within 4 to 6 weeks. Although there is no immediate cure for labyrinthitis, the intern does vaguely remember that some medications are useful for symptomatic control. He asks JM to assist him in remembering what medications are useful.

How should JM respond?

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A N S W E R S

CASE ONE:

For individuals at high risk of complications?such as those with HIV or malignancies, those who are pregnant, or those who are receiving steroid therapy?the Centers for Disease Control and Prevention recommends prophylaxis with varicella zoster immune globulin at a dose of 125 units/10 kg body weight (maximum dose, 625 units). The dose should be given within 96 hours of exposure. If a high-risk patient develops chickenpox, acyclovir 800 mg 5 times a day should be initiated within 24 hours of start of rash.

CASE TWO:

Although no specific treatments are available for labyrinthitis, symptomatic improvement is achieved through bed rest and antivertigo medications. Meclizine 25 mg qid as needed may prove helpful. For severe dizziness, diazepam 5 mg tid as needed also is helpful.