Pepto-Bismol

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Case Study

RA 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. RA has suffered from diarrhea in the past but he has just let it “run its course.”

PmHx: none
ALL: NKDA

Current medications: none

Using the QuEST method, quickly and accurately assess RA:

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 RA. 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 RA regarding 2-3 counseling points (QuEST)

Take 2 tablets now, and then take an additional 2 tablets every one-half to one hour as needed if symptoms persist.
Do not exceed 8 doses (16 tablets) in 24 hours.
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 RA seek his primary care provider?
- RA 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.

Miscellaneous

A Serious Start over 100 Years AGO Today, we think of how Pepto-Bismol soothes the digestive system after we've overindulged at a meal or eaten unfamiliar foods while traveling. But in its early days, Pepto-Bismol did more than comfort; it actually helped treat a very serious illness. The medicine we now call Pepto-Bismol was originally developed at the start of the 20th century, when high standards of hygiene and sanitation weren't as widespread as today. Looking to cure a frightening disease called "cholera infantum," which struck infants suddenly, causing severe diarrhea and vomiting and sometimes death, a doctor concocted a formula in his home that proved effective against these symptoms. The formula was made from pepsin, bismuth salicylate, zinc salts, salol, and oil of wintergreen, along with a colorant to make it pink, and he called it Mixture Cholera Infantum. (Researchers would later learn that cholera infantum was caused by a bacterial infection, treatable with antibiotics.)

Questions? Call 1-800-717-3786 or go to www.pepto-bismol.com