copd exacbation with consolidation , with diabetescase presentation lalit jagtap
TRANSCRIPT
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Presented by: Mr. Jagtap Lalit R.Department of Clinical Pharmacy
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COPD EXACBATION WITH
CONSOLIDATION , WITH DIABETES
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Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD), also known as chronic obstructive lung disease (COLD), and chronic obstructive airway disease (COAD), among others, is a type of obstructive lung disease characterized by chronically poor airflow. It typically worsens over time. The main symptoms include shortness of breath, cough, and sputum production. Most people with chronic bronchitis have COPD.
In absence of concomitant presence of emphysema, the underlying condition may be classified as chronic bronchitis alone, and the exacerbations are then termed "acute exacerbations of chronic bronchitis" (AECB), and shares many characteristics with that of acute exacerbation of COPD. As COPD progresses, exacerbations tend to become more frequent, the average being about three episodes per year.
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Name : Mrs. A.B.C.Address : THALNER , DIST.- DHULE. Age : 68 year Sex : FemaleWeight : “73” kgInpatient no : 1755Hospital name : Indira Gandhi Memorial Hospital, ShirpurD.O.A : 19/01/2014D.O.D : 26/01/2014Consultant name : Dr. Pitambar Dighore
PROFORMA
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FAMILY HISTORY: Nil
SOCIAL HISTORY: Non alcoholic, Non Smoker, Non Vegetarian .
OCCUPATION: Farmer
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COPD with exacerbation.
DIAGNOSIS
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ASSOCIATED DISEASE:- None
PAST MEDICATION HISTORY:- Nil
PAST MEDICAL HISTORY:- Nil
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Cough from last one week Chest tightness from last one night Wheezing from last one day Breathlessness from last one day Burning sensation from last one day for 2 hours Dysponea Restlessness from last one day
PRESENT COMPLAINTS
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DATE 20/09 21/09 22/09 23/09
G.C
Fair
Fair
Fair
Fair
PULSE per min.
83 91 85 80
P/A Soft Soft Soft Soft
B.P. (mmHg) 110/65 130/80 115/72 120/75
ON EXAMINATION
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Hemogram :- Normal value
Hemoglobin 9.25gm % 14-16 gm %
Leukocyte count >250 cell/mm3 250 cell/mm3
LABORATORY ANALYSIS
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LUNGS VOLUMES AND FLOW RATE MEASUREMENT:
Forced expiratory volume (FEV1) was decrease Forced vital capacity (FVC) was decrease FEV1/FVC ratio was also decrease
Spirometer
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ECG REPORT: The report was found to be normal range.
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DIAGNOSIS
Chronic Obstructive Pulmonary Disease:-
Physical examination
Chest X-ray.
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MEDICATION
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MEDICATION DETAIL’S
Srno Medication
Dose mg
Std Dose mg
Frequency Route Date
1. Nebulizer with Duolin (Ipratropium bromide)
0.20 - 1
1-5 6 hrly inh 20-23
2. Nebulizer withBudecort (Budesonide)
0.10 -0.20
0.20 -0.40
8 hrly inh. 20-23
3. Inj Oframax forte (Ceftriaxone sod.)
1500 4000 12 hrly iv 20-23
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Srno
Medication Dose
mg
Std Dose mg
Frequency Route Date
4. Inj Efcorlin (Hydrocortisone)
100 400 8 hrly iv 20-21
5. Tab Omnacortil (Prednisolone)
20-20-10
05- 60 8 hrly oral 21-22
6. Syp Grillinctus BM (Bromhexine +Terbutaline)
10 ml 30 ml 12 hrly oral 20-23
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POST MEDICATION
Tab Omnacortil 20-20-10 mg thrice in a day for three days
Nebulizer with Duolin 4 times in a day for 5 days
Nebulizer with Budecort thrice in a day for 5 days
Inj Oframax fort 1.5 g daily for 7days
Syp Grillinctus BM 2 t.s.f. for a week
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Ceftriaxone with corticosteroids:-
Effect:– Antibiotics increased pharmacological action of corticosteroids such as carbohydrate, fat, protein, calcium metabolism, water excretion, inflammatory, immunologic and allergic responses.
DRUG INTERACTION1
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DISCUSSION2
Prescription outcome:-
The diagnosis data analysis shows that haemoglobin was found to be decreased level.
The physician should be prescribed some blood forming agent such as haematinics to the patient only orally/ as possible as blood transfusion.
Ex – Iron and its preparations:-
1) Tb Fersolate 200 mg oral 2) Syp Imferon 10 ml oral
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PATIENT COUNSELING
Smoking should be stopped (or go for nicotine replacement therapy)
Eat the iron rich food and blood forming foods.
Available oxygen therapy for emergency acute exacerbation.
Tell the patient not to use inhaler more than six times per day.
Instruct the patient how to use the nasal sprays.
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Instruct patient the technique for use of Nebulizer.
Nebulizer
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Peak flow meter
Instruct patient the technique for use of Peak flow meter.
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Some drugs may cause dizziness so use with caution while driving or performing other task requiring mental alertness
Patient should notify physician if conditions like dizziness, palpitation, nausea, cough, weight loss, swelling in feet and ankles, and sign of infection
Maintain hygienic condition
If any type of side effect occur by drug therapy consult physician immediately
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REFERENCES
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1. Ivan H. Stockley “Drug Interactions”; third edition, Bluckwell Scientific Publication.
2. www.drugdigest.com
3. IDR, Nov 2006, Page No: 192,273,206.
4. Herfindal T. E. et al, 2006, “Text book of therapeutics” 8th
edition, Lippincott Williams & wilkins, Page No:1348,51.
5. Dipiro J.J. Pharmacotheraphy: “A pathologic approach”, 6th edition 2001, MacGrow Hill publication, Page
No: 947
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7. Satosakar R.S. et al, 2006, “Pharmacology and p’cotherapeutics”,19th edition, popular prakashan New Delhi.
8 www.wikipedia.org
9. Drug and dosage, a quick glance by mankind pharmaceuticals.
10. www.netdoctor.com
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11. www.emedicine.net
12. Tripathi K.D, 2004 “ Essential of medical pharmacology”, 5th edition, Jaypee Publication.
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Thanking
You…