PRESENTED BY,

PARTH DHANANI

10 B P W 618

B.Pharm [ Hons.]

BATCH: E

FIRST ESTABLISH ED IN 1 999

FIRST CORPORATE H OSPITAL IN GU JARAT,

SU CCESSFU LLY REND ERING SERVICES FOR

LAST ELEVEN YEARS

M U LTISPECIALITY CL IN ICS IN ONE ROOF

IT H AS SERVED LARGE NU M BER OF

PATIENTS OF GU JARAT, RAJASTH AN AND

M AD YAPRAD ESH STATE AND PROVID ED

SU ITABLE PLATFORM FOR D OCTORS TO

WORK IN H ARM ONY

Orientation - Introduction to hospital Staff Exposure - In patient department Out patient department IN Patient Department - Introduction Prescription filling Prescription return Stock audit Time Motion studies Case Report Form

Out Patient Department Introduction Prescription fill

Billing

Vital statistics

Total employees:116 Number of Physician/surgeon:32 licensed Bed:60

Number of Admission:14250

• Attendance Policy• Dress Code• Posting• Narcotic Drugs Dispensing• List of Emergency Medication• Formulary• Dispensing Tips• Medication Error• Software Use for Billing

ICCU / CCUDialysis CentreLithotripsy CentreTrauma CentreChemotherapy Centrekidney Transplant UnitX-ray / SonographyPathology Laboratory Health Check-upClose MonitoringMedical StoreAmbulanceCafeteriaSTD / ISD / PCO

Surgical Oncology Department Medical Oncology Department Psychiatry Department Gynec-endoscopy and Gynec-oncology Department Orthopaedics Department Plastic Surgery Department Rheumatology Department Paediatrics & Paediatric Surgery Department Cardio Thoracic Surgery Department Pulmonology Department

PATIENT NAME: XYZ ROOM: I/9 AGE: 46 YEARS SEX: FEMALE WEIGHT: 69Kg HEIGHT: 5’6’’

DAY 1 DAY 2 DAY 3

Haemoglobin 14.7 12.6 ---

Total count 14,900 11,400 ---

Platelet count 2,33,000 2,46,000 2,37,000

RBS ↑se 425 (70-110) --- ---

Creatinine 0.8 (0.6-1.2) 0.52 ---

Urea 13.5 14.2 ---

Sodium 137 139.33 ---

Potassium ↓se 3.0 2.8 3.1

Calcium --- 8.3 ---

SGPT ↑se 125 (0 - 35) --- 80.76

Serum Amylase ↑se 2415(35-120) --- ---

Serum lipase ↑se 5580 (0-160) 1520 ---

Serum AlkPo4ase --- 71 (70-120) 124.99

DRUG GENERIC NAME DAY 1

DAY 2

DAY 3

Inj. Magnex forte (3g) IN 100ccNS i.v. 12 hrly

Cefoperazone+ salbectam

√ √ √

Inj. H.Actrapid acc S/C 6 hrly

Short acting insulin √ √ √

Inj. Pantodac (40mg) i.v. OD

Pantoprazole √ √ √

Inj. Emeset 1 @ i.v. 8 hrly

Ondansetron √ √ √

Inj. Contramol 1@(50mg) in 100ccNS i.v. 8 hrly

Tramadol √ √ √

Inj. 150 ml RL 1@ at 200ml/hr

Ringer Lactate √ √ √

Inj. KCl 1@ in 1NS@ , 2@/day

Potassium √ √ √

Inj. Febrinil 1@ i.v. sos Paracetamol √ √ √

DRUGS INTERACTIONS MANAGEMENT

Ondansetron ↔ Tramadol

Concurrent use of 5-HT3 receptor antagonists may reduce the analgesic efficacy of tramadol. The proposed mechanism is antagonism of serotonin-mediated effects of tramadol at the spinal level.

No particular intervention is required. However, the possibility of a diminished therapeutic response to tramadol should be considered during concomitant therapy with 5-HT3 receptor antagonists.

Insul in ↔ lvp solution with potassium(KCl in NS)

Potassium repletion may partially or completely reverse glucose intolerance in some patients with liver cirrhosis. The effect of insulin may be potentiated, and the risk of hypoglycemia increased.

If coadministered, close monitoring of blood glucose level is required.

Diclofenac is widely used analgesic. But in this case ,tramadol is used as diclofenac being belonging to NSAIDs class, is nephrotoxic, which will further worsen the condition.

Food has to be administered by naso-jejunum route.

When patient begin to recover, he is first given clear water. If tolerated, then switched on to soft diet and finally, when patient begin to consume full diet, he is discharged from hospital.

Right now this patient is on soft diet.

NAME: LM ROOM:111/1 AGE: 68 YEARS SEX: MALE WEIGHT: 64Kg HEIGHT: 5’9’’

DAY 1 DAY 2

Haemoglobin ↓se 12.1 12.9

Total count 5900 5568

ESR 05 (1–25mm/hr) ---

Platelet count 2,67,000 3,12,000

RBS ↑se 158.8 (70 – 110) 179.03

Creatinine 0.7 0.67

Urea 17 14

Sodium ↓se 125.3 135.9

Potassium 3.31 2.97

SGPT 16 (0 – 35 U/L) ---

pH ↓se 7.19 (7.38) ---

pCO2 38 (35-45) ---

pO2 ↓se 67 (80-100) ---

Bicarbonate ↓se 14 (21-30 Meq/L) 16.6

CPK MB ↑se 33.99 (0-7ng/L) 24.03

Troponon I ↑se 10.5 (0-0.4) 6.1

DRUG GENERIC NAME

DAY 1

DAY 2

DAY3

DAY4

DAY5

DAY6

Tab. Clavix (75mg) BD Clopidogrel √ √ √ √ √ √

Tab. Ecospin (150mg) OD Aspirin √ √ √ √ √ √

Inj. NTG 50mg in 50ml NS 1ml/hr

Nitroglycerin √ √ √ √ √ ---

Tab. Indur (30mg) 1-1-0 Isosrbide mononitrate

--- --- --- --- --- √

Tab. Betaloc 50mg BD Metoprolol √ √ √ √ √ √

Tab. Atorva (40mg) 1HS Atorvastatin √ √ √ √ √ √

Tab. Ramace (2.5mg) 1 OD Ramipril √ √ √ √ √ √

Inj. Lasix 2amp. i.v. BD Furosemide √ √ --- --- --- ---

Tab. Lasilactone (20+50) 1-1-0

Furosemide + Spironolactone

--- --- √ √ √ √

Inj. Clexane (0.6mg) s.c. BD Low Mol.Wt. Heparin

√ √ √ √ √ ---

Liq. Looz 10ml HS Lactulose √ √ √ √ √ √

DRUG GENERIC NAME

DAY 1

DAY 2

DAY3

DAY4

DAY5

DAY6

Tab. Alprex (0.5mg) 1 HS Alprazolam √ √ √ √ √ √

Inj. KCl 3amp. In 50ccNS 2ml/hr

Potassium supplement

--- √ √ √ √ √

Inj. Actrapid according to RBS

Short acting insulin √ √ √ √ √ √

DRUGS INTERACTIONS MANAGEMENT

Furosemide ↔ Metoprolol

Diuretics and beta-blockers may increase the risk of hyperglycemia and hypertriglyceridemia in patients with diabetes or latent diabetes.

Monitoring of serum potassium levels, blood pressure, and blood glucose is recommended during coadministration.

Metoprolol ↔ Insulin

Inhibition of catecholamine-mediated glycogenolysis and glucose mobilization in association with beta-blockade can potentiate insulin-induced hypoglycemia in diabetics and delay the recovery of normal blood glucose levels. Prolonged and severe hypoglycemia may occur.

Patient should be instructed about the need for regular monitoring of blood glucose levels and be aware that certain symptoms of hypoglycemia such as tremors and tachycardia may be masked.

Furosemide ↔ Ramipri l

Coadministration makes hypotension and hypovolemia more likely than does either drug alone. Some ACE inhibitors may attenuate the increase in the urinary excretion of sodium caused by some loop diuretics.

The possibility of first-dose hypotensive effects may be minimized by initiating therapy with small doses of the ACE inhibitor, or either discontinuing the diuretic temporarily or increasing the salt intake approximately one week prior to initiating an ACE inhibitor.

Heparin ↔ Nitroglycerin

Concurrent administration of heparin and intravenous nitroglycerin may lead to a decreased anticoagulant effect.

If coadministered, close evaluation of the coagulation status of the patient is required and heparin dose titrated as needed.

PATIENT NAME: PQR ROOM: I/3 AGE: 50 YEARS SEX: MALE WEIGHT: 77 Kg HEIGHT: 5’7’’

DAY 1 DAY 2 DAY 3 DAY 4

Haemoglobin 11.8 10.1 8 9

Total count 3360 7900 6100 5130

Platelet count 2,33,000 (1,30,000—4,00,000)

2,46,000 2,37,000 2,41,000

Creatinine 0.89 1.20 --- ---

Urea 13.5 14.2 --- ---

Sodium 137 139.33 --- ---

Potassium 4.7 3.68 3.75 ---

Calcium --- 8 --- ---

Chloride ↓se 4.37 (95-105) 4.89 --- ---

SGPT ↑se 118.9 113 63.65 ---

Serum Amylase ↑se 2415 --- --- ---

Serum lipase ↑se 5580 1520 --- ---

Serum AlkPo4ase --- 78 (30-120) 118.6 ---

• Soft tissue opacity in both lower zones of peritoneal cavity.

• Minimal right pleural effusionX-RAY

• Mildly enlarged liver, spleen & kidney

• Bowel: minimal dilation, excessive fluid filled

USG

• PERITONITISDIAGNOSIS

DRUG GENERIC NAME DAY 1

DAY 2

DAY 3

Inj. Magnex forte (1.5g) i.v. 8 hrly

Cefoperazone+ salbectam

√ √ √

Inj. Pantodac (40mg) 1@ i.v. OD

Pantoprazole √ √ √

Inj. Emeset 1 @ i.v. 8 hrly

Ondansetron √ √ √

Inj. Contramol 1@(50mg) in 100ccNS i.v. sos for pain

Tramadol √ √ √

DNS 500ml i.v. Dextrose √ --- ---

DNS/RL 1@ i.v. 150ml/hr

--- √ √

NS 120ml i.v. Chloride √ √ √

Inj. Febrinil 1@ i.v. sos Paracetamol √ √ √

Patient is initially given empirical therapy (cefoperazone + salbactam) to treat infection as culture test takes approximately 48–72 hours for indentification of organism. Subsequently definitive treatment is provided.

Drug interactions same as case-1 (pancreatitis)