ADR case scenario WITH VARIOUS EXAMPLES

GOOD DESCRIPTION

1. PH 3.4 Recognize and report an ADR

2. Case Scenario 1 6 yr old male child (named EA) with body weight 17 Kg admitted with history of fever, swollen neck, abdominal pain, joint pain and reddened tongue and diagnosed as a case of Kawasaki disease. His lab investigation data: Hb: 10.0 gm% ,TC: 10900/c.mm Platelets: 2.87 lakhs/c.mm PCV: 33.5% MCV: 78.8 fl. T reatment was started on 23 rd June 2023 with Inj.Intravenous Immunoglobulin ( IvIg ) ( Mfg by: Reliance life sciences, batch no: ID05G21020 , Mfg date: Sep 2022, Expiry date: Aug 2025 )

3. Dose - 2g/kg/day IV OD . The patient developed itching all over the body and rashes on 23rd June 2023 following the injection. D rug was withdrawn on 24 th June 2023 and the reaction was managed with Inj.Chlopheniramine IV and Inj.Dexamethasone IV . He recovered from the reaction on 24th June 2023. The suspected drug was again given to the patient on 27 th June 2023 and itching all over the body recurred the same day . The drug was stopped and appropriate trt given Case Scenario 1 contd..

4. Case Scenario 2 Mrs.SD, a female patient ,40 yrs of age with body weight of 53 kg was diagnosed to be positive for HIV . Her lab investigation data was Sr.Urea : 26 mg/dl Sr.Creatinine : 0.8 mg/dl Total bilirubin: 0.4 mg/dl Direct bilirubin: 0.3 mg/dl CD4 count: 789 cells Patient was treated with a fixed dose combination of T.Tenofovir 300mg+Lamivudine 300mg+Dolutegravir 50mg OD from 3 rd November 2023 .

5. Case Scenario 2 contd.. She developed rashes with itching on 11 th November 2023 . ART regimen was stopped and the reaction was managed with Inj.Dexamethasone 8mg IV BD, Inj.Chlorpheniramine maleate 2cc IV BD and Liquid Paraffin for external application . Patient recovered from reaction on 25th November 2023. The reaction recurred following re-administration of the ART regimen on 2 nd December 2023. The regime was switched over to T.Abacavir -Lamivudine and T.Dolutegravir . Mfg by: Mylan labs, Batch no: E16JQ23012, Mfg date: Jan 2023, Expiry date: Dec 2025

6. Case scenario 3 ABC, a male patient ,48 yrs old with body weight of 72 Kg was hospitalized with chest pain and was diagnosed as coronary artery disease/inferior wall Myocardial Infarction. He was a known hypertensive. He was admitted in CCU in our hospital and was treated with following drugs on 16 th Mar 2024 Inj.Streptokinase 1.5 million units IV bolus T.Aspirin 150mg OD T.Clopidogrel 75mg OD T.Amlodipine 2.5mg BD Patient developed hypotension on 16 th Mar 2024 following administration of Inj.Streptokinase . Blood pressure dropped to 88/52 mmHg The drug was stopped on the same day.

7. Case scenario 3 contd..   IV fluid-Normal saline was given to correct hypotension The patient recovered on 16 th Mar 2024. Streptokinase Mfg by: Gland Pharma Ltd., Batch No: LSTKB2094, Mfg date: 07/2023, Expiry date: 06/2026

8. Case scenario 4 48 yrs old male Patient named SH with body weight 49 Kg came to hospital with complaints of abdominal pain for past 1 month. He was a known case of colon cancer with metastasis for which surgery was done. The patient was suggested CECT scan –Abdomen. On 4 th Jan 2024 he was given Inj. Iohexol 60mg IV for scan. The patient developed vomiting immediately following Inj.Iohexol . Drug was stopped. The reaction was managed with Inj.Ondansetron 8mg IV and the patient recovered . ( Mfg by: Unique pharmaceutical laboratories, batch no: IOD23086, Mfg date: 05/2022, expiry date: 04/2026 )  

9. A 53 yr old male patient named NS with body weight of 66 Kg a known case of hypertension / type 2 diabetes mellitus was newly diagnosed to have rheumatoid arthritis. His lab investigation data was Random blood sugar: 206 mg/dl Rheumatoid factor: + ve CRP: >6 Treatment was started on 17 th October 2023 T.Prednisolone 5mg BD T.Calcium 300mg BD Cap.Vitamin D3 60000 units once a week.   Case scenario 5

10. Case scenario 5 contd … The patient developed nausea and retrosternal discomfort on 21st October 2023. Inj.Ondansetron 4mg IV and Inj.Ranitidine 50mg IM BD were given All other medications were continued and the patient recovered on 23 rd October 2023. Prednisolone Mfg by: Macleods , batch no: GPF22177A, Mfg date: 08/2022, 07/2026