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.....Case presentation on tuberculosis Amna butool .....

  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
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