Pharmacy case #1

[bananaface]

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We haven't done any of these for awhile, so I am going to start posting a series.

Case 1:
Mom brings in 6 y/o girl and a prescription for the child for Bactrim Suspension. The child is standing awkwardly and looks very uncomfortable.

a) What is the probable Dx?

b) What items should you cover in the counseling session?

c) What additional recommendations, if any, do you make?

You can ask questions about the scenario if there is information you would like to have that is not provided.

 

[Glycerin]

a) UTI?

 

[AngryRPh]

Tell the mom to make sure that the kid drinks plenty of water. SMZ/TMP unlikely to cause crystalization issues, but just to be safe...

 

[Caverject]

Are we doing your homework for you? 🙄 😉

 

[haphu3b]

is there such thing as a ds suspension? i believe ds comes in tablets only... suspension is 40/200

 

[bananaface]

a) UTI?

Yes.

 

[bananaface]

Tell the mom to make sure that the kid drinks plenty of water. SMZ/TMP unlikely to cause crystalization issues, but just to be safe...

Ok. There is one more relevant reason that I can think of why she should have adequate water intake.

But, the patient may be unwilling to drink much because it hurts when she pees. The antibiotic isn't going to kick in for a few days. Can we recommend something for the pain in the meantime?

(anyone who wants to may respond)

 

[bananaface]

Are we doing your homework for you? 🙄 😉

No. My class doesn't begin until September 28th. 😛

I will be sure to remember this next time you want a journal article pulled.

 

[bananaface]

is there such thing as a ds suspension? i believe ds comes in tablets only... suspension is 40/200

I edited. I was being a dork. 😀

 

[AngryRPh]

Ok. There is one more relevant reason that I can think of why she should have adequate water intake.

But, the patient may be unwilling to drink much because it hurts when she pees. The antibiotic isn't going to kick in for a few days. Can we recommend something for the pain in the meantime?

(anyone who wants to may respond)

I suppose you could give the kid tylenol and Pyridium...with the usual precaustions about neon-orange pee and not wearing contacts. On second thought, I'm not sure if Pyridium ihas an indication for children, and she is kind of young to swallow pills....Maybe compounding a Pyridium PO liquid????

 

[TotalKayOs]

counciling....sun screen
for her pain in the meantime.....?

 

[twester]

Yes.

I guessed UTI, too. There's hope for me as a pharmacist yet.

Would a pharmacist examine toilet habits, ie. wiping backward and not forward? Also, is there a possibility of sexual abuse? (Although how one would address that is beyond me. Maybe leave it alone unless there's a prior history of UTI.)

Just a guess.

Troy

 

[bananaface]

I suppose you could give the kid tylenol and Pyridium...with the usual precaustions about neon-orange pee and not wearing contacts. On second thought, I'm not sure if Pyridium ihas an indication for children, and she is kind of young to swallow pills....Maybe compounding a Pyridium PO liquid????

Her mom is pretty sure she could swallow an M&M whole, so she could get a small tablet down.

Does anyone know if phenazopyridine (aka Pyridium, Azo, Uristat, etc) would be safe for this 6 year old child? If so, what dose would you recommend? She weighs about 60 pounds. OTC tablets come in 95 mg doses.

 

[bananaface]

counciling....sun screen
for her pain in the meantime.....?

Sun screen is a good recommendation. It is August, after all. 😀

 

[bananaface]

I guessed UTI, too. There's hope for me as a pharmacist yet.

Would a pharmacist examine toilet habits, ie. wiping backward and not forward? Also, is there a possibility of sexual abuse? (Although how one would address that is beyond me. Maybe leave it alone unless there's a prior history of UTI.)

Just a guess.

Troy

You could certainly mention to the parent that some kids may end up with UTIs if they wipe from back to front. This may or may not be the reason the child has the UTI, but it is at least something for the parent can investigate at home and fix if problematic.

For this case, we are going to assume that abuse is not an issue, since we have no good reason to suspect otherwise. The physician, having just had the opportunity for an exam, would be in the best position to evaluate the possibility of abuse. If for some reason we believed there were abuse, we would contact CPS, rather than discussing it with a parent during counseling. Sometimes, though, you will be told that a patient was assaulted, in which case you can explain that the infection is likely a result of the incident. (I have only had to do this for an adult patient.)

 

[meg]

Cranberry juice!

 

[lisi]

I suppose you could give the kid tylenol and Pyridium...with the usual precaustions about neon-orange pee and not wearing contacts. On second thought, I'm not sure if Pyridium ihas an indication for children, and she is kind of young to swallow pills....Maybe compounding a Pyridium PO liquid????

You can give 12mg/kg/day in three divided doses to kids 6-12. Compounding it into a liquid wouldn't be a good idea. It's slightly soluble in water and causes GI irritation. Plus, I don't know if there's any stability data regarding pyridium in solution or in suspension. Once you compound any liquid formulation, it's going to increase the rate of chemical reactions, plus make it subject to hydrolysis. So there's no guarantee that you'll be able to accurately dose the kid once you've got it into the liquid, since you have no idea about potential degradation reactions or their rates.