LRTI 1.pptx

A Case of Lower Respiratory Tract Infection

1. Case Presentation on Lower R espiratory Tract I nfection Name : Syeda Khadija Tazeen Roll No. : 18111T0004 Pharm.D : 5 th year

2. PATIENT DEMOGRAPHIC PROFILE:- Age : 59 Gender : Male IP no. : 996663 Dept. : Pulmonology Unit : II

3. Reasons For Admission : Cough with expectoration Fever ∵ 2days low grade more during night time SOB at exertion ∵ 3days Swelling in both lower limbs Medical History Anemia Congestive heart failure , Chronic liver disease with ascites .

4. DAY 1 B.P - 160/100 mmHg P.R - 79 bpm Temp - 101F Spo2 - 90 % C/O - fever, SOB ADV - CBP ,LFT

5. Brand name Generic name Dose Frequency Route Augmentin Amoxicillin 1.2g BD IV Tab. lasilactone Spirinolactone+ Furosemide 20mg BD SC Inj. pan Pantaprazole 40mg OD IV Inj. zofer Ondansetron 4mg TID IV Inj. hydrocort Hydrocotisone 300mg TID IN Neb. duolin budecort Budesonide suspension 8 TH HRLY Oral Syp. A scoril Levosalbutamol+ ambroxol + guanaifenesin 6ml TID Oral Tab. montek Levocetrizine + montelukast 100ml OD Oral Tab. orofer Ferrous ascorbate OD Oral Tab. sporolac Lactic acid bacillus 500mg TID Oral DAY 1

6. DAY 2 B.P - 150/60 mmHg P.R – 115 bpm Temp - afebrile SpO 2 - 92% C/O - SOB MEDICATION - C.S.T (DAY 1)

7. T.WBC 9800 Neutrophile 68% lymphocyte 28% esinophiles 2% basophliles 3% monocytes 2% ESR 20mm/h Hb 8.7 ALT (0-35) 49 AST(0-35) 47 ALP(30-120) 106 bilirubin T (0.1-1mg/dl) 1.8 bilirubin D (0-0.2 0.8 albumin :globulin 3:1 HEMATOLOGY LIVER FUNCTION TEST

8. DAY - 3 B.P -140/80mmhg P.R - 103bpm Temperature - Afebrile Spo2 - 96% MEDICATION : C.S.T as DAY-1 DAY - 4 B.P - 140/80mmhg P.R- 103bpm Temperature- Afebrile Spo2- 96% MEDICATION:- C.S.T as DAY-1

9. DAY - 5 B.P - 130/60mmhg P.R - 86bpm Temperature - Afebrile Spo2 - 96% C/O - Throat pain while swallowing MEDICATION - C.S.T as DAY-1 DAY - 6 B.P - 130/80 mmhg P.R - 90bpm Temperature- Afebrile Spo2 - 95% MEDICATION - C.S.T as DAY1 + TAB . AZITHROMYCIN

10. DICHARGE MEDICATION Brand name Generic name Dose Frequency Route Augumentin Amoxicillin 1.2g BD IV Tab lasilactone Spirinolactone+ furosemide 20mg BD SC Inj pan Pantaprazole 40mg OD IV Inj Hydrocort Hydrocotisone 300mg TID IN Neb Duolin Budecort Budesonide suspension 8 TH HRLY ORAL Aap Ascort Levosalbutamol+ambroxol+ guanaifenesin 6ml TID ORAL Tab.Azithromycin Azithromycin 500mg OD ORAL Tab orofer OD ORAL

11. SOAP FORMAT SUBJECTIVE DATA:- A male patient aged 59yrs was admitted to hospital with the Complaints of fever since 2 days low grade; fever is increasing more during night time SOB at exertion , cough with expectoration ; white colour sputum Medical history :- CHF ,anemia, CLD with ascites Medication history :- Patient forgot to bring the medications and do not remember the name of medications OBJECTIVE DATA:- B.P - 150/100mmhg CNS - NAD P.R - 82bpm P/S - Soft, Hepatomegaly Spo2 - 95% R/S - BAE+ CVS - S1S2 + B/L - Crepts + Temperature - Afebrile B/L - wheeze +

12. LABORATORY DATA HEMATOLOGY LIVER FUNCTION TEST T.WBC 9800 Neutrophile 68% lymphocyte 28% esinophiles 2% basophliles 3% monocytes 2% ESR 20mm/h Hb 8.7 ALT (0-35) 49 AST(0-35) 47 ALP(30-120) 106 bilirubin T (0.1-1mg/dl) 1.8 bilirubin D (0-0.2 0.8 albumin :globulin 3:1

13. OTHER TESTS : ECHO Cardio graphic and colour Doppler test EF -60% U/S scanning ASSESSTMENT: Based on the signs & symptoms, laboratory data , patient history, and other investigations the patient was assessed to have “ LOWER RESPIRATORY TRACT INFECTION - PNEUMONIA ’ ’

14. PLANNING: STANDARD TREATMENT PROTOCOL

15. TREATMENT GIVEN IN HOSPITAL Brand Name Generic Name Dose Frequency Route Augumentin Amoxicillin 1.2g Bd Iv Tab Lasilactone Spirinolactone+ Furosemide 20mg Bd Sc Inj Pan Pantaprazole 40mg Od Iv Inj Zofer Ondansetron 4mg Tid Iv Inj Hydrocort Hydrocotisone 300mg Tid In Neb Duolin Budecort Budesonide Suspension 8 th Hrly Oral Aap Ascort Levosalbutamol+ambroxol + Guanaifenesin 6ml Tid Oral Tab Montek Levocetrizine+montelukast 100ml Od Oral Tab Orofer Od Oral Tab Sporolac Lactic Acid Bacillus 500mg Tid Oral

16. PHARMACIST INTERVENTION : Drug-drug interaction was found with medication given Azithromycin +Ondensetron : Both increase QT interval. Avoid or use alternative drug ECG monitoring recommended with concomitant medication that prolong QT interval etc Spironolactone +Hydrocortisone : Spironolactone will increase the level or effect of hydrocortisone by Glycoprotein efflux transporter MINOR Hydrocortisone + Furosemide : Pharmacokinetic Synergism Risk Of Hypokalemia Hydrocortisone +Monletlukast : Hydrocortisone Decrease The effect of montelukast by affecting enzyme CYP3A4Metabolism

17. RATIONALITY OF PRESCRIBING : There should be a thorough assessment and training of knowledge of appropriate drugs or antibiotic therapy ; among the healthcare workers including type of antibiotic dosage and duration of treatment should be or to be recommended by national guidelines

18. PATIENT COUNSELLING : ABOUT THE DISEASE : P neumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia . ABOU T THE DRUGS : Inj . Augumentin dose 1.2 mg BD : Mechanism of action - Augmentum binds to penicillin binding protein With in the bacterial cell and inhibit bacterial cell wall synthesis ADR- diarrhea nausea vomiting meiosis and hypersensitivity reaction Monitoring parameters-monitor liver function test and renal function test cautiously use the drug Tab. Lasilactone dose 20 mgBD : Mechanism of action- lasilactone contains a short acting diuretic and a long acting aldosterone antagonist prevent the buildup of extra water in your body increase urine excretion ADR –feeling confusion lack of energy headache Monitoring parameters electrolyte monitoring renal function test monitoring

19. Inj . P an 40 mg OD MOA : it covalently bind to H +/K+ exchanging ATP ase in gastric parietal cells resulting in block age of GASTRIC ACID secretion ADR- head ache, abdominal pain , dyspepsia Monitoring parameters : Mg levels Inj. Zofer dose 4mg TID MOA - Ondensetron block the action of 5HT receptor present on vagal nerve and certain areas of the brain ADR – Headache, malaise, fatigue M.P - Monitor for decrease to bowel activity particularly inpatient with risk factor of GI obstruction Inj . Hydrocortisone MOA- It is a corticosteroid and acts as a corticosteroids receptor agonist; it decrease permeability to capillaries and causes decrease in exudates Adr – glaucoma, hyperlipidemia , osteoporosis M.P : Lipid profile and Calcium levels

20. Neb. Budecort 8 th hourly MOA : it suppress the inflammatory responses and decreases airways hyperesponsivness ; they bind to glucocorticoid on cytoplasm ADR : o ropharyngeal cardidias and dyphome Tab . A zithromycin 500mg OD MOA : it binds to 50S ribosome of bacteria and inhibit translation of mrna thus interfere protein synthesis of bacterial cell ADR : diarrhea nausea abdominal pain T. Sporolac TID MOA : sporolac is a combination of good bacteria and yeast it lowers the ph and produce lactic acid in the intestine thus help in absorption of micronutrients and regulation of gastrointestinal tract ADR : flatulence abdominal bloating Syrup A scoril dose TID It work by thinning and loosening mucus in the the airways clearing congestion and making breathing easier ADR : P alpitation muscle cramp muscle cramp epigastric pain M.P : Monitor liver function test and renal function test

21. Inj. Duolin 8 th hourly MOA : the combination of ipratropium bromide and levosalbutamol ipratropium bromide acts as anticholinergic and antagonise the action of the acetylcholine. Salbutamol acts as beta 2 agonist ADR : tachycardia ,tremors, dizziness M.P : heart rate Tab. Orofer MOA : ferrous ascorbate work as a source of iron folic acid work by helping your body produce and maintained new cells ADR : nausea, bitter taste. Diarrhea Avoid alcohol intake ABOUT LIFESTYLE MODIFICATION: Avoid smoking and excessive alcohol consumption Eat nutrient dense diet rich in unprocessed whole plant based food Exercise is though to activate immune cells, it helps to expel bacteria from the airways and reduce stress Regular hand washing is recommended as a strategy for avoiding respiratory infection.