Clerkship Review presentation

7/25/2019 Clerkship Review presentation

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CLERKSHIP REVIEW-I

By :-Avinash

Pharm.D 5thyr

Roll no-1414907


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GENERAL MEDICINE


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Contents

Drug Information Queries

Patient prole

Drug Interactions Patient counseling

Case presentation


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DRUG INFORMATION QUERIES

se of !opical Anest"esia

Lumpectom#

Mec"anical $al$e $s %ioprost"atic $al$e

Causes of Dia&etic Retinopat"#

!reatment of cellulitis


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PATIENT PROFILE

Acute gastroenteritis with Anemia Liver Abscesses Generalized weakness Chronic Kidney Disease with DM-II with !" with Anemia

Le#t leg in$ury Diabetes mellitus-II with y%ertension Insect bite C&'D with Atrial (ibrillation y%ertension with DM-II


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DRUG INTERACTIONS Case'(

) *+o,acin-*nansteron Case'/

) Aspirin-Insulin Case'0 )abe%razole*iron

Case'1

) Pantopra2ole-Rifa,imine Case'3

) !ramaol-P"en#lnep"rine) Metronia2ole-Diclofenac) Diclofenac-Ami4acin

Case'5) !elmisartan-6urosemie) Ceftria,one-6urosemie


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PATIENT COUNSELLING

A&out Life st#le moication

A&out Disease an Drugs

+ene#its o# the com%letion o# the !hera%y


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CASE PRESENTATIONON

Chroni Ki!ne" Dise#seWith Di#$etes %e&&it's

With H"(ertension

With Ane%i#


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De%o)r#(his

I'D "o-,./012,

Age - / yrs

3e4 5 (emale


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Re#sons *or A!%ission

c.o) Decreased #re6uency o# micturation since 7 days8

) 'ain in abdomen8

) 'al%itation since 7days8


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HOPI

'atient was a%%ro%riately well 7 days back whenshe develo%ed %ain in abdomen8

Loose stools #or which she took medication8 Decrease in #re6uency o# micturation8 Always sweating8


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P#st Me!i#& Histor" .&

) Diabetes mellitus since 7yr) y%ertension since 9yr

P#st Me!i#tion Histor" 'atient was on oral hy%oglycemic agents

) Met#ormin * glimi%ride * %ioglitazone) 'atient was on Antihy%ertensive drugs

) Amlong * hydrochlorthiazide


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Person#& Histor" Married

:egetarian

F#%i&" Histor"

"o .& similar com%laint / children; all normal

Soi#& Histor" "on smoker "on drinker


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PROVISIONAL DIAGNOSISDiabetes mellitus-II

y%ertensionAnemia


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L#$or#tor" Re(orts

He%#to&o)" DLC

) %olymor%hs 08>>-08>>?) Lym%hocytes ,1= 9>8>>-/>8>>?) @osino%hills >7 98>>->?

) Monocytes >9 98>>-,>8>>?) +aso%hils >> >8>>-,8>>?

b 281= ,98>>-,8>>g? @3) /2= >8>>-9>8>>mm.,sthr !LC ,97>> = />>>-,>>>>.mm )+3

) )andom blood sugar 97,80= 0>8>-,,>8>mg.dl


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Ren#& F'ntion Test +RFT,) Brea 2,8>/= ,8>>-/>8>>?) Creatinine >890 = >8/>-,8/>mg.dl) 3odium ,7< ,7-,/[email protected]) 'otassium 78,= 78>-8>>[email protected]) Chloride ,>, 1


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Lier F'ntion Test +LFT, +ilirubin !otal 98/> = >89> - ,8>>mg.dl +ilirubin Direct ,80>= >8,> 5 >87>mg.dl 3G&! /787>= 8>> 5 />8>>IB.L 3G'! 978,> 8>> 5 78>>IB.L Alkaline 'hos%hatase 9,08/= 8>> 5 ,,98>>IB.L

Li(i! Pro*i&e !otal Cholesterol ,8> 5 9>>8>mg.dl !riglyceride 1782 ,>mg.dl DL />8> 7>8> 5 0>8>>mg.dl LDL ,>8 5 ,1>8>mg.dl

:LDL ,/280< 8>> 5 78>>mg.dl


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Urine R.E

:olume 7>ml Color %ale yellow Brine albumin traces Brine sugar #asting nil )+Cs occasional 'B3 cells /-.'(= @%ithelial cells 7-/.'( Crystals nil Casts nil


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Wi!#&

3almonella !y%hi E&F ,/> 3almonella !y%hi EF ,/> 3almonella !y%hi EAF neg

3almonella !y%hi E+F neg


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FINAL DIAGNOSISChronic Kidney Disease

Diabetes mellitus-IIy%ertension and

Anemia


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D#"-/

&.@- calm; conscious and oriented - drowsy but res%onding to verbalcommand

'.A) so#t)

non-tender) non-distended C:3- 3,; 39 normal "o murmur

+' 5 ,9>.2> mmg ') 5 2>.min )) 5 9>.min !em% 5 128


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D#"-0

&.@- calm; conscious and oriented '.A) so#t) non-tender) non-distended

C:3- 3,; 39 normal "o murmur )4

) !ab !orsemide 9>mg +D

+' 5 ,,>.0> mmg ') 5 0


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D#"-1



) !ab Cyra-D &D) In$ Insulin 2hrly) &mit In$ 'antodac

+' 5 ,,>.0> mmg ') 5 2/.min )) 5 9>.min !em% 5 12H( (+3 5 ,27mg.dl


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D#"-2


C:3- 3,; 39 normal "o murmur C.&

) $oint %ain) "o stool %ass due to lack o# diet

+' 5 ,/>.2> mmg ') 5 29.min )) 5 7>.min !em% 5 128


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D#"-3 &.@- calm; conscious and oriented '.A

) so#t) non-tender) non-distended

C:3- 3,; 39 normal "o murmur 3M'!&MA!ICALL +@!!@)

+' 5 ,7>.2>

mmg ') 5 2>.min )) 5 9>.min !em% 5 12H(

(+3 5 9


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) 3y% A%tivate 9ts# !D3

+' 5 ,/>.0> mmg ') 5 2>.min )) 5 9>.min !em% 5 12H( (+3 5 7


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) Decreased a%%etite) (ever last night

)4) !ab 'CM mg 3!A!

+' 5 ,,>.2> mmg ') 5 02.min )) 5 92.min !em% 5 11H( (+3 5 9


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) Consti%ation since ,> days )4

) 3y% 'iclin Jsugar #ree7ts# 3!A! 3

+' 5 ,7>.2> mmg ') 5 29.min )) 5 99.min !em% 5 128


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) %ain in legs) )educed sensation

)4) 'regabalin 0mg 3

+' 5 ,,>.2> mmg ') 5 02.min )) 5 99.min !em% 5 128


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Me!iines Presri$e!

DaysMedicines

,.2

9,.2

99.2

97.2

9/.2

9.2

I:("3 9:ac

3to

%In$InsulinJ)acc tosliding

scale


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Cont!89

DaysMedicines

,

.2

9,

.2

99

.2

97

.2

9/

.2

9

.2

In$@mset2mgI:

3&3

!abDolomg3!A!

!abCyra-D &D

!ab)ami%ril98mg

&D


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SOAP


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S'$:etie Ei!ene

Decreased #re6uency o# micturation 'ain in abdomen 'al%itation


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O$:etie Ei!ene

@levated Brea Decreased 'otassium Decreased Creatinine @levated +ilirubin

@levated 3G&! @levated Alkaline 'hos%hatase @levated )andom blood sugar Decreased b @levated @3) @levated !LC B3G 5 e%atomegaly with #atty liver


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Assess%ent

'atient admitted with c.o o# decreased #re6uency o# micturation; %ain inabdomen; %al%itation since 7 days

(rom lab investigation; abnormal levels o# Brea; Creatinine; 'otassium;)andom blood sugar; b; !LC; @3); 3G'!; 3G&!; +ilirubin were#ound8

(inally the %atient was diagnosed with Chronic Kidney Disorderassociated with diabetes; hy%ertension and anemia8

'atient was treated with re6uired medications and su%%ortivemedications8 Condition #ound to be im%roving and the %atient #inally gotdischarge8


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Ph#r%#e'ti#& C#re Pn

Go#&s o* Ther#(" )elieving %ain in abdomen )elieve %al%itation "ormalize #re6uency o# micturation )elieve consti%ation !reatment o# kidney disorder

Go#&s Ahiee! 3ym%toms were relieved by thday


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Pro$&e%s I!enti*ie! Interactions #ound between

) )abe%razole and iron )abe%razole decreases the e##ect o# iron byincreasing gastric %8

) )ami%ril and !orsemide %codynamic synergism8 )isk o# acutehy%otension ; renal insu##iciency8


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P#tient Co'nse&&in)

Adhere to the medication8 @4ercise at least 7> minutes a day8 )educe salt u%take8 3odium u%take should not e4ceed 97>>

mg %er day8 Increase %otassium rich #ood8 Consume diet rich in #ruits; vegetables and low #at dairy

%roducts while reducing total and saturated #at intake8


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!"an4'8ou..9

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