CASE PRESENTATION

Pharmacotherapeutics-2

presented by
Harish.K

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Chronic kidney disease

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 SUBJECTIVE EVIDENCE
PATIENT’S PROFILE:

NAME: XY D.O.A: 30/12/2019

AGE:67 years old IP.NO:F36367 (3)
MARITAL STATUS: Married Weight/Height:Not taken

REASON FOR ADMISSION: Fever, Urinary pain

 CHIEF SYMPTOMS: Vomitting/ chest pain / leg swelling / No flow on left
hand AV fistula

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PAST MEDICAL HISTORY:
1.CKD – 1 Year
2.HTN – 1 Year
PAST MEDICATION HISTORY:

PREVIOUS SURGERY:
AV fistula at hand done on 14/3/2019.

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OBJECTIVE EVIDENCE
• On admission patient was conscious, oriented and febrile.
Vitals Observed value
Temperature 99.2℉
Respiratory rate 20 breaths/min
Blood pressure 170/90mmhg
SpO2 94%

Pulse rate 70 b/m

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Vitals on hospitalisation:
Date 28/01/2020 29/01/2020

Time 2PM 6PM 10PM 6AM 10AM 2PM 6PM 10PM

Temperature (℉) 98.0 98.4 98.0 98.0 97.0 98.0 97.8 98.2

Heart rate 70 70 62 56 62 60 58 54
(beats/min)

Blood pressure 160/80 160/70 150/70 110/10 140/80 100/80 150/90 150/90
(mmhg) 0

SpO2(%) 93% 93% 94% 96% 97% 96% 96% 96%

Respiratory 20 20 20 20 20 20 20 20
rate(breaths/min)

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Contd…,,
Date 30/01/2020 14/12/2019
Time 6AM 10AM 2PM 10PM 6AM 10AM

Temperature (℉) 97.8℉ 98.4℉ 97.0℉ 97.4℉ 98.2℉ 98.4℉

Heart rate (beats/min) 54 56 60 62 95 95

Blood pressure 150/80 150/80 140/80 140/90 130/90 110/60

(mmhg)

SpO2(%) 96% 97% 96% 96% 95% 95%

Respiratory 20 20 20 20 20 20
rate(breaths/min)

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Lab investigation tests:

Lab tests Observed value

Hb (mg/dl) 6.4
Total count(cells/cu.mm) 9800
P (%) 74
L (%) 21
DC E (%) 02
B (%) 00
M (%) 03
Total RBC(million cells/cu.m) 2.05
PCV (%) 19.1
MCV (%) 93.2
MCH(g/dL) 31.4

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 Lab tests Lab tests
Observed Z Observed
value value
Date 28/01/2020 Date 29/01/2020
urea 135 T.Protien 6.7
FBS 100 Albumin 3.6
RBS 86 Uric acid 1.82
Sodium 136 HIV -VE
Potassium 6.6 HbsAg -ve
RDW 15.8 Calcium 7.5
creatinine 10.5 Iron 51
Phophorous 3.9
PTT 30/29 SEC
CONTROL
INR Pt value 13
Control 12 sec
INR 1.22
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DIAGNOSTIC TEST:
Blood culture test (positive)
 Urine culture test (negative)
 chest X - ray taken
 ECG taken
 CT scan

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ASSESSMENT:
BLOOD CULTURE TEST:
The impression shows the presence of GRAM NEGATIVE
BACTERIA (i.e) E.Coli is present.
CT SCAN REPORT:
The impression shows that the EPIPLOIC APPENDIGITIS
that means inflammation in the stomach by the accumulation of fat.
DIAGNOSIS:
With the patient complaints & blood culture test and symptoms, the
patient was diagnosed to have LOWER RESPIRATORY TRACT
INFECTIONS.

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Goals of treatment:
• Reduce the symptoms.
• Improve quality of life
• Remove or reduce the risk factors.
• Reduce the stomach ache.
• Reduce the breathing difficulty.

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STAT:
DRUG DOSE TIME

Inj. Pantocid 40 mg 6.30 pm

Inj. Emeset 8mg 6.30 pm

Inj. Avil 1cc 8.00pm

Neb . levolin 1 resp 7.30 pm

Neb. Foracort 1 resp 7.30 pm

Inj. Piptaz 0.1ml 10.30 pm

Inj. Piptaz 4.5gm 10.45 pm

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PLAN
Treatment chart:
Drug name Generic name Dose FREQ TIME 11/12 12/12 13/12 14/12

Tab. Elitroxin levothyroxine 12.5mg OD 6 AM    

Tab. Astor Atorvastatin 20mg H.S 9PM   DOSE CHANGES

TO 80 mg

Tab. Astor Atorvastatin 80mg H.S 9PM - -  

Tab. Cordarone Amiodarone 100mg od 9PM -   STOPPE

D

Tab. Esomac D Esomeprazole 20mg OD 6 AM - -  

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Contd….
Drug name Generic name Dose FREQ TIME 11/12 12/12 13/12 14/12

Tab. Prazopress prazosin 5mg HS 9PM -   

XR

Tab. Cilacar Cilnidipine 20mg OD 9AM -   

Tab. Silodol Silodosin 4mg HS 9PM   - -

Inj. Human Insulin 15 units BD 8AM    

mixtard 8PM    

Cap. pregaba Pregabalin 75mg HS 9PM - -  -

Tab. Dolo Acetaminophen 500mg SOS 8AM -  stopped

2PM  -
8PM - -
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Contd..,
Drug Generic name Dose FREQ TIME 11/12 12/12 13/12 14/12
name

Inj . Piptaz Piperacillin/ 2.25gm TID 6AM  Frequency changed

tazobactam 2PM 
10PM 

QID 6AM   
2PM   
6PM   
10PM   

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Pharmacist intervention:
 Hb level is low and RDW is high that indicates patients is in anemic
condition. Here no drug is prescribed for anemia.
 we can prescribe FOLIC ACID orally 1 mg once daily or
RIBOFLAVIN 5mg can be given in orally.

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PATIENT COUNSELLING:
BASED ON DRUG PROFILE BASED ON DISEASE
PROFILE
1. Levothyroxine drug should be 1.The seriousness of the disease.
taken half an hour before a 2. In emergency condition
breakfast. immediately contact the hospital.
2. Silodosin should taken only
with food.

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Based on lifestyle & Home remedies:
 Change the clothes if once used.
 Use the own utensils.
 Keep bathroom & surroundings clean
 Avoid contact with the sick person
 Avoid pollutants area such as chemical fumes or industry visits
 Quit smoking.

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THANK YOU
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