it includes a case of tuberculosis

1. CASE PRESENTATION
ON TUBERCULOSIS
AMNA BUTOOL
PHARM D IV YEAR
18Z21T0001

2. DEMOGRAPHIC DETAILS:-
Name: XXX
Age : 58 yr
Sex : Female

3. Reason for admission :-
• Cough since 1 month
• Shortness of breath since 15 days
• Fever,loss of ppetite
• Headache,body pains,night sweats,wt loss

4. •Vital signs:-
• Temp: 100°F
• BP : 160/80 mmHg
• PR : 125b/m
• RR : 24b/m
• CVS : S1S2+
• RS : Bilateral wheezing

5. PMHx : Hypertension, DM
PMHx:T.TELMA -20mg OD,
T.GLYCOMET-500mg BD.
FMHx : Nothing significant
SHx:Mixed diet

6. •Provisional diagnosis :-
• Pneumonia?
• Tuberculosis?

7. •ADVICE:-
• Complete blood picture
• Bio-chemistry,sputum test
• Liver function test and CHEST X -RAY

8. Complete blood picture:
Test Result Normal
Heamoglobin 10.2gm% 12-16gm%
T.WBC count 17,000cells/cmm 4000-1100cells/cmm
Neutrophils 82% 45-75%
Lymphocytes 14% 20-45%
Eosinophils 2% 1-6%
Monocytes 2% 1-9%
Basinophils 0% 0-1%
ESR 38mm/hr Male:-0-22mm/hr

9. Bio chemistry:
Test Result Normal value
RBS 205 mg /dl Up to 160 mg /dl
B.urea 24 mg/dl 10-50mg/dl
Sr . creatinine 1.0 mg /dl 0.5-1.5 mg/dl

10. Liver Function test:
Test Result Normal value
AST (SGOT) 35 IU/L 5-40IU/L
ALT (SGPT) 50 IU/L 7-50 IU/L
Total protein 4.5g/dl 3.5-5.5 g/dl
Albumin 4g/dl 3.4-5.4g/dl

11. Chest x -ray
• Patchy area of consolidation in right upper lobe
.sputum test :positive

12. Subjective evidence
• Cough since 1 month
• Shortness of breath
• Fever
• Headache
• Body pains
• Night sweating • Weight loss
• Loss of apetite

13. Objective evidence:
:-
• Temp : 100°F
• Neutrophils : 82%
• T.WBC : 17,000
• RBS : 205 mg/dl
• ESR : 38 mm/hr

14. •Final diagnosis :
• Based on the subjective and objective evidence
the final diagnosis made to be TUBERCULOSIS.

15. ASSESSMENT OF CURRENT THERAPY:
Brand name Generic name Dose Frequency RAO
Inj. Oflamac Olfoxacin 200mg BD IV
Neb.
Duolin&bdecor
t
Ipratropium
bromide
Levosalbutam
ol
Budensonide
20mcg
150mcg
100mcg
TID Neb
Tab.forecox Rifambacin
Isoniazid
Pyrazinamide
Ethambutol
225mg
100mg
750mg
400mg
OD P/O
Tab.pantop Pantaprazole 40mg OD P/O
Tab. Glyomet
Tab. Stamlo
Metformin
Amlodipin
500mg
5mg
B
D
O
D
P/O
P/O

16. CURRENT THERAPY
•Inj.oflamac (oflaxacin)
• Dose : 200mg ,BD, IV
• MOA : It involves inhibition of bacterial topoisomerase IV
and DNA gyrase synthesis.
•.Indication : It is used to treat bacterial
• Infection.
••ADR'S : headache, nausea,diarrhea, lightheadness,skin
itching.

17. •Neb. Duolin&Budecort
•(ipratropiumbromide+levosalbuta mol+Budensonide)
• Category : Corticosteroid
• Dose : 150 mcg,TID,Neb
• MOA : It acts by inhibit the synthesis of Inflammatory cells.
••Indication : It is used to treat Shortness of breath.
•ADR'S : Abdominal pain ,shaking of hands or feets
,cough,sneezing,fever, Pain &swelling in joint.

18. •Tab.Forecox
•(Rifampicin+Isoniazide+pyrizinami de+Ethambutol)
• Category : Antibiotic -tuberculosis
• Dose : 1525 mg ,OD,P/O
• MOA : It is act by preventing the growth of
• Mycobacterium tuberculosis
••Indication : It is used to treat tuberculosis.
••ADR'S : Visual disturbance, hepatitis.

19. •Tab. Pantop (pantoprazole)
• Category : proton pump inhibitors
• Dose : 40mg , OD,P/O
• MOA : It acts by covalently bind to H+/k+ATP pump to inhibit gastric
Secretion.
•- Indiication : It is used to treat excess gatric acid.
• • ADR'S : head ache , runny nose, cough

20. •Tab.Glycomet (Metformin)
• Category : Anti -diabetic
• Dose : 500mg,BD,P/O
• MOA : It works by decreasing glucose
Production by the liver and increasing the insulin sensitivity to body tissue
•Indication : It is used to treat diabetis mellitus.
•ADR'S : Diarrhea,physical weakness,gas,low blood sugar, abdominal pain

21. •Tab.stamlo (Amlodipin )
• Category : Anti - hypertensive
• Dose : 5mg,OD, P/O
• MOA : It acts by inhibit the calcium ions entry into vascular
smooth muscle cells of cardiac cells which inhibit the contraction of
cardiac muscle.
• Indication : It is used to treat hypertension.
•ADR'S : swelling in hands or feets, dizziness,Drowsiness, flushing.

22. DAY 2
• O/E:C/C/C
• Temp:98F
• BP:130/90
• CVS:S1S2+
• C/O:NO FRESH COMPLAINTS
• MEDICATION CHART:CST

23. DAY -3:
• O/E:C/C/C
• Temp:98F
• BP:130/90
• CVS:S1S2+
• C/O:NO FRESH COMPLAINTS
• MEDICATION CHART:CST

24. •Planning:-
• General of therapy:-
• General goals:-
••To reduce the morbidity and mortality.
• To improve the patient quality of life.
•Patient specific goals :-
••To reduce the sign & symptoms.

25. •Monitoring parameters :-
• CBP,chestX-ray,sputum test, liver function test.
• Bi-chemistry.
• Toxicity monitoring parameter:•Tab.Forecox:-hepatitis (monitoring LFT)
• Tab. Pantop:- Nausea,vomiting (monitoring sr.
•Electrolytes)

26. •PATIENT EDUCATION :-
• You are suffering from a disease called aTuberculosis.
• Tuberculosis is the communicable disease whichspreads through the droplets
of the infected person, charactarized by the persistent cough , cough with
sputum,sudden weight loss,loss of appetite.Diabetes mellitus is the endocrine
disorder,which is charactarized by the hyperglycemia ,frequent urination
,excessive thirst,excessive hunger.
• Hypertension is the persistant elevation of arterial blood pressure.

27. •PHARMACIST INTERVENTION
• ☆Drug interactions :-
•Ofloxaxin+Metformin:concurrent use of
•FLUROQUINOLONES and ANTIDIABETIC AGENT may result in changes in blood
glucose and increased risk of hypoglycemia or hyperglycemia.
•Paracetamol+Isoniazid:concurrent use of ACETAMINOPHEN and ISONIAZID may
result in an increased risk of hepatotoxicity.

28. •Life style modification:-
• Maintain hygienic environment
• Cover your mouth while talking ,coughing, sneezing etc.
• Avoid spicy foods and drink boiled water.
• Fresh fruits and vegaetables should be included in diet.
• Avoid smoking &alcohol.
• Avoid sweets.
• Stay in well ventilated room and expose yourself to sunlight

29. THANK YOU