Tutorial 9: Case 1

Question 1

Ali, 38 years old enter the pharmacy asking to speak with the pharmacist. He is hoping you can help with his trouble going to the toilet at the moment. Ali asks “Can you give me something which can help me go the toilet please”.

A) Who is it for?

B) What are the symptoms?

C) How long have you had these symptoms?

D) Action taken

E) Medications being taken?

F) Medical conditions

G) Allergies

Answer 1

A) Myself

B) I am having trouble with my bowels, I am going to the toilet however only small pebbles are coming out. I find that I have to strain in the last few days when going to the toilet.

C) A few days or so ( about 3 weeks into Ramadan )

D) I tried increasing fiber in my diet with fruits and vegetables, pasta and breads however it isn’t having much effect. I also tried taking some lactulose syrup, but it doesn’t seem to be helping

E) Lactulose syrup for a few days

F) None

G) Peanuts and almonds

Question 2

Appropriate extended questions

1. Are there any other symptoms
2. Have you had this before
3. Can you describe your stools currently
4. Is this a significant change to your normal bowel habits
5. Any bleeding, pain or diarrhea?
6. Has anything changed recently with your diet? Any activities?
7. Do you have any preference for specific products?

Answer 2

1. Just discomfort in the lower abdomen
2. During Ramadan in previous years, I have found my stools do change due to the change in my eating habits and I tend to change my exercise routine for that time.
3. Small hard pebbles at the moment
4. Yes, I usually have no problems passing stools and tend to do a firm but easy to pass bowel motion every morning
5. No
6. During Ramadan, I eat differently and at different times. I do find i exercise less due to the changes in my routine, I probably don’t drink enough water either, which I have been trying to address the last few days
7. I want something that can work reasonably quickly to give me some relief, but I do not want to use anything locally in the rectum. I would prefer something to be taken orally.

Question 3

What is the diagnosis? Explain reasoning to patient.

Answer 3

Based on the signs and symptoms you have told me, I belie you have constipation. The small pebbles that are present when you defecate and the fact that you have to strain confirms my diagnosis. Constipation is when there is a significant reduction in bowel motion and its happening to you at the moment due to your change of diet.

Question 4

What product would you recommend for this patient? Provide IDARL.

(patient wants the oral product)

Answer 4

Docusate with senna (coloxyl + senna)

• Indication: Dual-action product. Docusate is a stool softener which will draw water into the stool and make it softer while senna is a laxative that stimulates the bowel to push the stool out
• Dosage and directions: 1-2 tablets before bed, up to 4 tablets daily if required.
• Adverse effects: Generally well tolerated. May get diarrhea or abdominal discomfort.
• Duration of treatment, time to recovery, when to refer: I will refer to you a doctor if constipation is still present after 2-3 days of treatment. Also, refer if you begin to vomit or there is blood in the stool.
• Lifestyle/self-care: Try to exercise 30 mins a day if possible, drink 2L of water a day, use a toilet stool so stool comes out easier.

I will give you a self care-card for constipation and a consumer medication information leaflet. Do you have any questions for me?

IF PATIENT DIDNT MIND RECTAL TREATMENT USE GLYCEROL SUPPOSITORIES FASTER ACTING 15-30 MINS

• Indication: This product will soften the stool and stimulate contraction in the area helping you pass the stool.
• Dosage and directions: Lie on your side, draw knees into your chest and insert suppository high into the rectum with a clean finger. The stool is usually ready to be passed within 30 minutes.
• Adverse effects: Medication can cause local irritation, otherwise it is well tolerated. As this product is expected to work quickly (within 30 minutes), you might want to plan the best time to use this product.
• Duration of treatment, time to recovery, when to refer: use the product once daily to help stools pass until it returns to normal. I will refer you if begin to vomit or thre is blood in the stool
• Lifstyle/self care: Healthy diet including 2 fruits and 5 vegetables a day, exercise, use toilet stool, drink 2L of water.