A CASE PRESENTATION ON GERD ( GASTROESOPHAGEAL REFLUX DISEASE)

A CASE PRESENTATION ON GERD

1. PHARMACOTHERAPEUTICS-III CASE PRESENTATION NANDHA COLLEGE OF PHARMACY RAJNANDINI SINGHA IV P harm D

2. CASE STUDY ON GERD

3. SUBJECTIVE A 60 year old Male patient was admitted in Perundarai medical college hospital on 25/1/2018 with the complaints of abdominal discomfort for 10 days .

4. HISTORY OF PRESENT ILLNESS H/O Abdominal discomfort H/O Difficulty in breathing H/O skin allergy H/O cough with expectoration

5. PAST HISTORY K/C bronchial asthma before 3 days

6. PERSONAL HISTORY Diet: Mixed.

7. GENERAL EXAMINATION Patient conscious, oriented BP :160/70 mmHg PR :79 bpm

8. SYSTEMIC EXAMINATION CVS – S 1 S 2 Heard RS - B/L AE+,B/L WHEEZ+ CNS – NFND P/A - Soft

9. OBJECTIVE INVESTIGATION CHART NAME OF INVESTIGATION OBSERVED VALUE NORMAL VALUE WBC 14.0 x10 9 /L 4.5-10.5 ×10 9 /L RBC 4.26x10 12 /L 3.8-5.9 × 10 12 /L HAEMOGLOBIN 10.5g/dl 12-14g/dl PLATELETS 173.0  10 9 /L 130-400 10 9 /L L/M/G 2.5/1.5/11.0 10 9 /L MCV 92.9 FL 80-100FL HCT 40.2% 35-50% MCH 27.6pg 27- 34pg

10. MCHC 29.7g/dl 32-36g/dl ESR 32mm/hr 0-20mm/hr BIOCHEMISTRY RBS 67 mg/dl Up to 140 mg/dl BLOOD UREA 30 mg/dl 10-40 mg/dl SERUM CREATININE 1.0mg/dl 0.6-1.3 mg/dl SERUM PHOSPHATE 3.5 mg/dl 2.5-4.5 mg/dl URINE ANALYSIS COLOUR PALE YELLOW REACTION Acidic ALBUMIN NIL

11. PROGRESS CHART DATE TEMP (°F) B.P P.R R.R 25/1/18 98.4 110/80 80 20 26/1/18 98.4 110/80 75 22 27/1/18 98.8 100/80 84 20 28/1/18 98.6 140/60 82 20 29/1/18 98.4 110/80 78 22 30/1/18 99 140/80 82 20 31/1/18 98.5 120/80 80 20 1/1/18 98.7 140/80 85 22 2/1/18 98.4 120/80 82 22

12. OTHER INVESTIGATION X-RAY –Increased BVM (bronchovascular marking)

13. ASSESMENT FINAL DIAGNOSIS: Bronchial Asthma GERD ( Gastroesophageal reflux disease)

14. DRUG CHART DRUG GENERIC NAME DOSE ROUTE FREQ 3 4 5 6 7 Inj.genta Gentamycin 1mg IV 1-0-1 √ √ √ √ √ INJ .RANTAC Ranitidine 2ml IM 1-0-0 √ √ √ √ √ T.CPM Chlorphenaramine 10mg PO 1-0-1 √ √ √ √ √ T. Dolo Paracetamol 650mg PO 1-1-1 √ √ √ √ √ Inj. Deri Theophylline+Etophylline 2ml IV 1-0-1 √ √ √ √ √ T.celin Vitamin C 40mg PO 1-0-0 √ √ √ √ √ SYRUP. Rantac ranitidine 15mg PO 1-0-1 √ √ √ √ √ Liquid paraffin Liquid paraffin 10ml topical 0-0-1 √ √ √ √ √

15. DRUG GENERIC NAME DOSE ROUTE FREQ 3 4 5 6 7 BVM OINTMENT Betamethasone valarate 0.1% 1-1-1 topical √ √ √ √ √ SYRUP. REXCOF Dextromethophan and chlorpheniramine maleate 100ml 1-0-1 PO √ √ SALBUTAMOL NEB SUBUTAMOL 1-1-1 NASAL √ √ √ √ √

16. DISCHARGE SUMMARY The patient was discharged on 7/02/18 DISCHARGE ADVICE T.PARACETAMOL(1-1-1) 650mg T.CPM(1-0-1)10mg SYRUP.RANTAC(1-1-1)10ml T.CELIN(VITAMIN C) (1-0-0)500mg Liquid paraffin(1-0-1) BVM OINTMENT(1-0-1)

17. PLAN

18. PATIENT COUNSELLING : DRUG RELATED DISEASE RELATED LIFE STYLE MODIFICATION Take SYRUP Rantac before 30mins of food LIQUIID PARAFFIN and BVM OINTMENT should be apply on dry skin. Advice the patient not to skip meals. Avoid stress and NSAIDS Elevate the head on the bed. COPD: On coughing mouth should be closed. Avoid dust, allergen, alcohol, smoking. Avoid choclate, coffee, soda, alcoholic drinks. Avoid Citrus fruits and juices of tomato. Advice the patient to eat boil food for 2-3 weeks. Green vegetables should be taken to regenerate the lining of stomach.

19. S.NO ASSESMENT PLAN 1. Chlorpheniramine + food Alcohol can increase the CNS Side effect such as drowsiness, dizziness . . MANAGEMENT: To avoid consumption of alcohol , hazardous activities require complete alterness ,mental alertness. Syrup Ranitidine should administered 30mins before food. 3. T.CPM AND SYRUP .Rexcof Side effect - sleepiness Do not prescribe in the morning

20. MONITORING PARAMTER: pH Monitoring for GERD Increased acid exposure time .

21. PHARMACIST INTERVENTION: Antacid should be recommended in the prescription. Suggesting to Reduce the adminstration of PARACETAMOL to reduce toxicity. Proton pump inhibitor is recommended to be add in the prescription.

22. THANK YOU