case STUDIES

CASE ONE:

JH, a 27-year-old elementaryschool teacher, approachesthe pharmacycounter. She asks the pharmacistto refill her prenatalvitamin prescription. Whilethe pharmacist is filling theprescription, JH and the pharmacistdiscuss how her pregnancyis progressing.

JH is thrilled that she has not experienced any problemsduring 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 chickenpoxyesterday. The student?s mother had sent him to school,believing that the rash covering her child could not be chickenpoxbecause he had been vaccinated. The school nurseinsisted that the child had chickenpox and sent him home,but JH already had been exposed.

JH asks the pharmacist whether there is anything she cando to reduce her risk of developing chickenpox. Are any preventivemeasures available for JH?

CASE TWO:

JM, a student currentlyenrolled in his last year ofpharmacy school, is seeingpatients with a medical internat the family practiceclinic, when the attendingphysician asks them to treatthe woman in ExaminationRoom 3. When they enter theroom, the patient explains that she has been experiencingsevere dizziness for 3 days. The dizziness has been accompaniedby nausea and vomiting. She says that it is worsewhen she changes position.

Her symptoms have been so severe that she needs herhusband to support her during the short walk to the bathroom.The intern asks the patient whether she has recentlyhad an upper respiratory infection. The patient confirms thatshe is just getting over a cold. During the examination, JMnotices that the patient?s eyes make involuntary rapidmovements from side to side when the intern asks her tofollow his fingers with her eyes.

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

The intern informs the patient that the severe symptomsshould last only a few days, with all symptoms resolvingcompletely within 4 to 6 weeks. Although there is no immediatecure for labyrinthitis, the intern does vaguely rememberthat some medications are useful for symptomaticcontrol. He asks JM to assist him in remembering whatmedications 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 thosewho are receiving steroid therapy?the Centers for Disease Control and Prevention recommends prophylaxis with varicella zoster immune globulin ata 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 developschickenpox, acyclovir 800 mg 5 times a day should be initiated within 24 hours of start of rash.

CASE TWO:

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

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