This presentation highlights an actual conversation between a patient hospitalized to be treated for organophosphate poisoning, and a PharmD student. the PharmD student interviews patient to obtain complete history. this presentation will be very helpful to PharmD students and give them a practical example of interviewing patients giving them an outline and a general idea about conducting patient interviews to obtain history

1. PATIENT HISTORY
REVIEW
A CASE STUDY
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2. PATIENT HISTORY REVIEW
RT, a 34 year old male, is a patient at GHATI (Aurangabad) who is being
treated for organophosphate poisoning. He was brought to the hospital with
chief complaints of vomiting, dizziness and abdominal cramps. Upon arriving
his body was washed and he was given gastric lavage. He was given inj. Emeset
& atropine I.V. 40 mg continuous infusion. He was also given PAM
(pralidoxime) in 0.9% NS.
Following is a conversation between Mr. RT and a Pharm D. student.
name of the patient has been changed for maintaining confidentiality.
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3. THE PRESCRIPTION
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4. THE PRESCRIPTION
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5. OBTAINING PATIENT
HISTORY
THE CONVERSATION
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6. Hello, I am XY, a Pharm D. student and you must be Mr.
RT ?
Would you be comfortable to answer a few questions ?
How are you feeling now Mr. RT?
Yes, absolutely.
I am feeling quite well sir.
Hello sir. Yes my name is RT.
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7. Could you please give me the name and contact number
of that doctor so that I can talk to him and confirm your
initial treatment ?
I don’t have it with me at the moment, but I will surely
give it to you tomorrow.
(XY questions RT’s brother)
Can you recall the treatment he was given at the clinic ?
The doctor gave him some tablets. I don’t know which.
But his condition did not improve. In fact he started
vomiting severely. So I had to bring RT here.
Your files say that you have been brought here because of
pesticide poisoning. Is that correct ?
Yes, it is correct. I was in my farm, spraying pesticides on
the crops. While returning home I felt dizziness and I
started vomiting. My brother took me to a clinic near by.
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8. Thank you. Now, RT can you tell me something about
your treatment at this hospital?
When I was brought here, they washed my body. They then
inserted a tube through my nose and from it passed a purple
solution into my stomach. They also removed contents from
my stomach.
What happened next?
I am glad to know that you are feeling better now. Let me
brief you with your treatment.
Then they gave me saline. And now I am feeling good.
Sure. Please go ahead.
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9. You were then given atropine mixed in the saline solution.
Atropine is an antidote for pesticides. You are also being
given PAM. This too us an antidote.
Ok
I think when you came here, you first given an injection.
It was to stop your vomiting.
Yes, that’s right. I forgot to tell you about it.
The purple solution given to you was potassium
permanganate. It was given to clean your stomach of all
the toxins.
Ok.
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10. Well, your condition seems quite stable now. I think you
would be ready to be discharged by tomorrow. Still let me
confirm with your physician.
Ok. Thank you, sir.
That is because you have a dry mouth. It is a side effect
of atropine. Don’t worry, it will go away once we stop
atropine and you are discharged.
When would I get discharged?
Do you have anything else that you wish to tell me?
Yes. I feel very dry and want to drink water even though
I am not thirsty.
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11. I hope I have answered your questions and made you
understand your treatment well, haven’t I ?
Yes sir, thank you very much.
Have a good day Mr. RT. Get well soon
Thank you.
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12. COUNSELLING THE PATIENT
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13. POINTS FOR COUNSELLING
• ATROPINE – this is given as an antidote to pesticide poisoning. It will cause
dry mouth and dilated pupils which may cause blurred vision. Do not worry,
they will go away once we stop your treatment.
• PAM (pralidoxime) – this is also an antidote.
• Inj. Emeset – this is a brand name for ondansetron. Ondansetron is given to
you to prevent your vomiting. You might feel mild headache. If it is severe,
kindly report your physician. There are minor chances that you may still feel
nauseous. Report your physician if it happens.
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14. POINTS FOR COUNSELLING
• You were given gastric lavage with potassium permanganate to remove any
poison present in your stomach
• Your body was washed to remove any pesticide present on your skin.
Pesticides can be absorbed into the body from skin. To prevent this, it is
necessary to wash body thoroughly. I advise you to discard your clothes that
you were wearing while spraying pesticides. Also, from next time remember
to cover your face and body properly before spraying pesticides.
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15. POINTS FOR COUNSELLING
• Pesticides can be stored in body fat and can release slowly for a few days.
This might lead to poisoning again. After proper treatment, there are very
rare chances of such incidence to happen, but still if you feel any dizziness,
drowsiness, nausea, vomiting, headache, tremors or blurred vision then
immediately come to hospital along with your case papers.
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16. PHARMACOLOGY OF DRUGS
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17. ATROPINE
• MOA - Atropine antagonizes Ach by competing with it and other muscarinic agonists for a
common binding site on the muscarinic receptor.
• OTHER INDICATIONS - Possibly effective for treatment of irritable bowel syndrome and
acute enterocolitis. Also may be useful as adjunctive therapy for duodenal ulcer.
• ADRs - Blurred vision; mydriasis; photophobia; cycloplegia; increased IOP; atropine fever
and atropine flush; inhibition of secretions
• INTERACTIONS - Anticholinergic agents: Additive anticholingeric effects. Haloperidol:
Worsened schizophrenic symptoms; decreased haloperidol concentrations. Phenothiazines:
Decreased antipsychotic effects and increased anticholinergic effects may occur.
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18. PRALIDOXIME
• MOA – PAM is a choline-esterase rescuer. It binds to choline-esterase
inhibitors and frees the enzyme choline-esterase
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19. ONDANSETRON
• MOA - Selective serotonin (5-HT3) receptor antagonist that inhibits serotonin
receptors in chemoreceptor trigger zone.
• OTHER INDICATIONS – for pre-operative and post-operative nausea/vomiting;
emetogenic chemotherapy; general nausea and vomiting; motion sickness
• INTERACTIONS - Rifamycins (eg, rifampin): Plasma levels of ondansetron may be
reduced, decreasing the antiemetic effect. Parkinsonism: contraindicated to be used
with apomorphine.
• ADRs – tachycardia; headache; seizures; rash.
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20. Thank you
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