Side Effects

Case Study
James is a 24 year-old male that presents to the in-window of pharmacy requesting immediate attention by a pharmacist. He states that he has a job interview in two hours but he has been having diarrhea every 30 minutes since lunchtime. He is frantic; stating he can’t miss the interview and is concerned he may have to cancel his interview if his diarrhea persists. Upon further questioning you learn he has no blood, dark coloration, or mucus present in his loose stool. He does not have a fever. RA hasn’t done anything, yet, to relieve his symptoms. James has suffered from diarrhea in the past but he has just let it “run its course.”

Current medications: none

Using the QuEST method, quickly and accurately assess James:

1. Using the SCHOLAR-MAC method, classify the pertinent information illustrated in this case

Symptoms	Loose stools
Characteristics	No blood, dark coloration, or mucus in stool. Fever not present.
History	Has not tried anything, but needs a fast acting agent
Onset	After lunch this afternoon
Location	Abdomen
Aggravating factors	Eating lunch
Remitting factors	none
Medications	None
ALL	NKDA
Comorbidities	None

Using the QuEST method, establish if this patient is an appropriate self care candidate. Provide a rationale:

• No severe symptoms
• No symptoms that persist or return repeatedly without an identifiable cause
• Not self-treating to avoid medical care

If this patient is a self care candidate, suggest appropriate strategies (QuEST) for James. Include supportive measures with your recommendations:

• This patient has to be alert and symptom-free in two hours:
• • Loperamide (Imodium®) can cause sedation and DIZZINESS.
  • Bismuth subsalicylate is fast acting and has no effect on alertness.
• An appropriate alternative treatment would be to suggest bismuth subsalicylate (Pepto-Bismol®) tablets
• · General care measures:
  • Drink plenty of clear fluids to help prevent dehydration caused by diarrhea.
  • After diarrhea subsides, avoid alcoholic beverages and spicy foods for two additional days.

If recommending self care, talk with James regarding 2-3 counseling points (QuEST)

1. Take 2 tablets now, and then take an additional 2 tablets every one-half to one hour as needed if symptoms persist.
2. Do not exceed 8 doses (16 tablets) in 24 hours.
3. Pepto-Bismol may cause temporary and harmless darkening of the tongue or stool.

When can the patient expect relief from symptoms?

• RA should have relief from symptoms within one hour. If symptoms persist after one hour, he should take 2 more tablets.
• When should James seek his primary care provider?
  • James should consult his provider if diarrhea CONTINUES for more than 2 days.
  • If his symptoms are accompanied fever; hearing loss; nausea; RINGING IN THE EARS; severe constipation; vomiting he should seek his provider

Positive(Normal) Health Benefits/ Medical Uses

Some positive side effects of Pepto-Bismol includes the treatment of upset stomach, heart burn and nausea. Pepto can help stall the making of the bacteria that causes diarrhea, and prevents traveler's diarrhea. With a doctors help and supervision you can use this product to treat stomach ulcers caused by certain bacteria, Helicobacter Pylori. But this should never be used to self- treat ulcers!

A normal side effect of Pepto Bismol would the discoloration of the tongue. This is becaue the active ingredient in Pepto Bismol is Bismuth.When a small amount of Bismuth combines with trace amounts of sulfur in human saliva, a substance is formed. Usually this happens to people who don't practice good dental hygeine.  However, the reaction is harmless and temporary.

Physical, Psychological, and Emotional Side Effects of Pepto Bismol

Even though Pepto Bismol is over the counter, many people react very differently to this drug. Most of these side effects are physical and require immediate medical attention. There are little known emotional and social side effects but still require immediate medical attention.

• Physical Effects: Continuous constipation/constipation, dizziness, drowsiness, faster breathing, Headache(w/sweat), muscle spasms, increased nausea and/or vomitting, ringing in the ears, black tongue and stool, vision problems
• Emotional Effects: Anxiety, confusion, mental depression
• Social Effects: Slurred speech

-Post by Marian Hong and Edward Blanco