This was my last presentation in academics (Pharm.D Internship as Clinical Pharmacist Intern). It consists of the summary of cases analyzed, ADR reported, and drug-drug interactions noted during my internship at Government Cuddalore Medical College Hospital (RMMCH).

1. INTERNSHIP REPORT
PHARM.D. (6 YEARS) PROGRAMME
INTERNSHIP AT GOVERNMENT CUDDALORE
MEDICAL COLLEGE HOSPITAL (RMMCH)
2021-2022
Submitted by
NAME : CHATHREIAN S R
ENROLL NO: 1661090022
REG. NO : I16060004

2. PERIOD OF POSTING
SL.NO WARD
POSTING PERIOD
FROM TO
1. MEDICINE 04.08.2021 05.02.2022
2.
O&G 07.02.2022 06.04.2022
3.
SURGERY
07.04.2022 06.06.2022
4 PAEDIATRICS 07.06.2022 06.08.2022

3. MEDICINE: (UNIT – 2)
ACTIVITIES IN THE HOSPITAL :
 No. of cases analyzed - 60
 No. of ADR reported - 06
 Intervention done - 06
 Drug information provided - 12
 No. of patient counselled - 10
Every Tuesday attended OP and Casualty - Studied the prescription pattern of drugs.
Service provided:
• Patient counselling
• Prescription analysis
• Appropriate drug and dose

4. WARD DESCRIPTION OF THE ADR
SUSPECTED
DRUG DIAGNOSIS
WHO’S CASUALTY
ASSESSMENT
MEDICINE Pt developed paralytic ileus after a first dose. The
drug was stopped and reaction was abated
C. Loperamide AGE with some
dehydration
Probable
MEDICINE
Pt developed hypersensitivity reaction– skin
rashes in hands & legs after a first dose. The drug
stopped and reaction was abated.
C. Doxycycline Typhoid fever Probable
MEDICINE
Pt developed hypersensitivity reaction after a
first dose _ skin rashes. the drug stopped and the
reaction was abated.
Inj. Ranitidine Abdominal pain / T2 DM Probable
MEDICINE On the 3rd of therapy Pt developed in to
hypotension(90/50mmhg).
The reaction abated after the dose was reduced.
Inj. Furosemide
40mg + T. Sildanafil
10mg
CHF / Pulmonary
hypertension
Probable
REPORTED ADVERSE DRUG REACTIONS

5. MEDICINE 10.8.2021 TEDIZOLD PHOSPHATE Dr. A. NANJIL KUMARAN
Assit.Professor
Drug information handbook by Patric
M.Malone
MEDICINE 18.8.2021 GLYBURIDE Dr. A. NANJIL KUMARAN
Assit.Professor
IBM – MICROMEDEX
MEDICINE 4.9.2021 IBUPROFEN Dr. A. NANJIL KUMARAN
Assit.Professor
IBM - MICROMEDEX
MEDICINE 17.9.2021 ATENOLOL Dr. A. NANJIL KUMARAN
Assit.Professor
IBM – MICROMEDEX
MEDICINE 9.10.2021 HALOPERIDOL Dr. A. NANJIL KUMARAN
Assit.Professor
IBM – MICROMEDEX
MEDICINE 27.10.2021 SPIRONOLACTONE Dr. A. NANJIL KUMARAN
Assit.Professor
IBM – MICROMEDEX
MEDICINE 3.11.2021 DOXYCYCLINE Dr. A. NANJIL KUMARAN
Assit.Professor
IBM – MICROMEDEX
MEDICINE 19.11.2021 ISOSORBIDE DINITRATE Dr. A. NANJIL KUMARAN
Assit.Professor
IBM – MICROMEDEX
MEDICINE 12.12.2021 TENECTEPLASE Dr. A. NANJIL KUMARAN
Assit.Professor
IBM – MICROMEDEX
MEDICINE 18.12.2021 FLUCONAZOLE Dr. A. NANJIL KUMARAN
Assit.Professor
IBM – MICROMEDEX
MEDICINE 5.1.2022 ATORVASTATIN Dr. A. NANJIL KUMARAN
Assist.Professor
IBM – MICROMEDEX
MEDICINE 29.1.2022 FUROSEMIDE Dr. A. NANJIL KUMARAN IBM – MICROMEDEX
DRUG INFORMATION QUERIES

6. DIAGNOSIS PHARMACOTHERAPY
PROBLEM
IMPACT OF PROBLEM INTERVENTION
SUGGESTED
CONGESTIVE
HEART FAILURE/
SHTN
Aspirin + Heparin
Clopidogrel + Heparin Either increases effects of the other.
Advised to use with
caution or monitor
closely.
Aspirin + Metoprolol
Both increases serum potassium.
CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
WITH COMPLETE LEFT
BUNDLE BRANCH BLOCK
Hydrocortisone + Atorvastatin Hydrocortisone decreases the level
of atorvastatin.
Advised to use with
caution or monitor
closely.
Hydrocortisone + clopidogrel Hydrocotisone increases the level of
clopidogrel
RIGHT SIDED PLEURAL
EFFUSION
Dextromethorphan+ Tramadol Both ↑ses Serotonin levels
Advised to use with
caution or monitor
closely.
OSTEOARTHRITIS B/L KNEE
WITH SHTN AND T2DM Aceclofenac+Prednisolone
Aceclofenac+Glimepiride
Increase the risk of GI ulceration
A risk of hypoglycemia
Advised to use with
caution or monitor
closely.
INTERVENTION CASES

7. OTHER ACTIVITIES
ASSIGNMENTS:
1. Fibrinolytics
2. Antifibrinolytics
COVID:
1. Covid death data entry
2. Control room duty

8. O & G (UNIT – IV)
ACTIVITIES IN THE HOSPITAL
 No. of cases analyzed - 20
 No. of ADR monitored - 03
 Intervention done - 03
 Drug information provided - 04
 No. of patient counselled - 10
Service provided :
Ward round participation
Patient counseling
Prescription analyzed
Appropriate drug and dose

9. OG 16.2.2022 METHYL DOPA
Dr. P. Rajalakshmi
Professor IBM – MICROMEDEX
OG 24.2.2022 ESTRADIOL
Dr. P. Rajalakshmi
Professor IBM – MICROMEDEX
OG 3.3.2022 OXYTOCIN
Dr. P. Rajalakshmi
Professor IBM – MICROMEDEX
OG 21.3.2022 LABETALOL
Dr. P. Rajalakshmi
Professor IBM – MICROMEDEX
DRUG INFORMATION QUERIES

10. WARD DESCRIPTION OF THE ADR
SUSPECTED
DRUG DIAGNOSIS
WHO’S CASUALTY
ASSESSMENT
OG After administering Inj. Triamcinolone acetonide
patient developed bradycardia. Inj. Atropine
0.5mg used to manage and drug was withdrawn.
Inj. Triamcinolone
Acetonide
Intra articular
inflammation /
Fibroid uterus
Probable
OG
After administering T. Levothyroxine 100mcg on
the 5th day patient developed chest pain and
palpitation and patient became normal after the
drug dose was reduced into 25mcg.
T. Levothyroxine Hypothyroidism Probable
OG
Pt developed hypoglycemia (58mg/dl) on 3rd day
of therapy. Dose reduced and inj. 25% dextrose
infusion given and then reaction was abated.
Inj. Regular Insulin
Inj. NPH
Uterine prolapse / 2nd
grade CA – uterus &
uncontrolled T2DM
Probable
REPORTED ADVERSE DRUG REACTIONS

11. DIAGNOSIS PHARMACO
-THERAPY PROBLEM
IMPACT OF PROBLEM INTERVENTION
SUGGESTED
DYSMENORRHOEA Ferrous sulphate with doxycycline Ferrous sulphate decreases the level of
doxycycline by inhibition of GI
absorption
Use with caution and
monitor closely S.
Potassium level.
MICROCYTIC
HYPOCHROMIC ANAEMIA Omeprazole + Ferrous sulfate
Concurrent use of iron and omeprazole
may result in reduced non-heme iron
bioavailability
Advised to Discontinue
ciprofloxacin or give
ciprofloxacin before 2
hour or after 6 hour of
taking ferrous sulphate.
RIGHT OVARIAN CYST
WITH TYPE II DM Glimepiride + Doxycycline
Concurrent use may result in increased
blood glucose lowering effect and
increased risk of hypoglycaemia
Advised to use with
caution and monitor
closely.

12. SURGERY(UNIT-2)
ACTIVITIES IN THE HOSPITAL
 No. of cases analyzed - 20
 No. of ADR monitored - 03
 Intervention done - 05
 Drug information provided - 04
 No. of patient counselled - 06
Attended OP and Casualty on every Tuesday and Friday – Studied the prescription pattern of the drugs
Service provided:
 Ward round participation
 Patient counseling
 Prescription analyzed
 Appropriate drug and dose
Oral presentation:
1. Antibiotics classification based on WHO – AWaRe group

13. WARD DESCRIPTION OF THE ADR
SUSPECTED
DRUG DIAGNOSIS
WHO’S CASUALTY
ASSESSMENT
SURGERY
Inj. Doxorubicin on 6th day of therapy, pt.
developed some mouth lesions/ sores
Inj. Doxorubicin Breast Cancer Probable
SURGERY
Inj. Cyclo Phosphamide on 3rd cycle, pt.
developed hair loss vigorously.
Inj. Cyclo
Phosphomide Breast Cancer Probable
SURGERY
On 3rd of therapy pt developed hyperglycemia
and plasma acetone +ve. Treated with insulin
infusion and came to normal condition.
Inj. Methyl
Prednisolone Exacerbation of Sclerosis Probable
REPORTED ADVERSE DRUG REACTIONS

14. SURGERY 22.4.2022 MEROPENEM
Dr. ANWAR ALI
Professor IBM Micromedex
SURGERY 27.4.2022 ROPINIROLE
Dr. A. ANWAR ALI
Professor IBM Micromedex
SURGERY 5.5.2022 OCTREOTIDE
Dr. A. ANWAR ALI
Professor IBM Micromedex
SURGERY
25.5.2022
PACLITAXEL
Dr. A. ANWAR ALI
Professor IBM Micromedex

15. DIAGNOSIS PHARMACO
-THERAPY PROBLEM
IMPACT OF PROBLEM INTERVENTION
SUGGESTED
ACUTE PANCREATITIS
OCTREOTIDE +
ONDANSETRON Both increase the QTC interval
Advised to use with
caution and monitor
closely.
LIVER ABSCESS
METRONIDAZOLE +
ACETAMINOPHEN
Metro will increase the level or effect
of Acetaminophen by affecting hepatic
enzyme CYP2E1 metabolism.
Advised to use with
caution and monitor
closely.
RIGHT DIRECT INGUINAL
HERNIA
TRAMADOL +
[PROMETHAZINE +
PENTAZOCINE]
When concurrently administered both
increase the serotonin levels and also
increase the sedative effect. Potential
for dangerous interaction.
Use with caution and monitor
Advised to use with
caution and monitor
closely.

16. PEDIATRICS (UNIT – 1)
ACTIVITIES IN THE HOSPITAL
 No. of cases analyzed - 20
 No. of ADR monitored - 03
 Intervention done - 02
 Drug information provided - 04
 No. of patient counselled - 04
Attended OP on every Monday and Thursday –Studied the Prescription Pattern of the Drugs
Service provided:
Ward round participation
Patient counseling
Prescription analyzed
Appropriate drug and dose

17. WARD DESCRIPTION OF THE ADR
SUSPECTED
DRUG DIAGNOSIS
WHO’S CASUALTY
ASSESSMENT
PEDIATRICS
Pt developed Itching and red spots entire body
after the first dose of Inj. Ampiclox. drug
withdrawn and reaction abated.
Inj. Ampicillin +
Cloxacillin
Broncholitis Probable
PEDIATRICS
Pt developed feeling spinning after Inj.
Phenytoin infusion . its stopped and next day re
initiated and reaction not appeared.
Inj. Phenytoin
Infusion
Status epilepticus & neuro
degenerative disorder Probable
PEDIATRICS
Pt developed reddish rash on face and upper
body in 5th dose. Dose frequency changed and
the reaction abated.
Inj. Vancomycin Clostridium difficle
associated Diarrhoea Probable
REPORTED ADVERSE DRUG REACTIONS

18. PEDIATRICS 25.6.2022 CEFIDEROCOL
Dr. Ramamoorthy
Asst. professor IBM Micromedex
PEDIATRICS 30.6.2022 AMOXYCLAV
Dr. Ramamoorthy
Asst. professor IBM Micromedex
PEDIATRICS 15.7.2022 RISDIPLAM
Dr. Ramamoorthy
Asst. professor IBM Micromedex
PEDIATRICS 29.7.2022 BRIVARACETAM
Dr.Ramamoorthy
Asst. professor IBM Micromedex

19. DIAGNOSIS PHARMACO
-THERAPY PROBLEM
IMPACT OF PROBLEM INTERVENTION
SUGGESTED
ACUTE BACILLARY
DYSENTERY Zinc + Ciprofloxacin
Zinc decreases the level or effect
of Cipro by cation binding GI
tract
Recommended to
administer Cipro. 2 hr
before or 6 hrs after Zinc
UNPROVOKED
SEIZURE
Phenytoin + Carbamazepine
Phenytoin will decrease the level
or effect of Carbamazepine by
affecting hepatic enzyme
metabolism
Advised to use with
caution and monitor ECG
closely

20. OG – SALA
MEDICATIONN
ERROR
MEDICINE CASUALTY
- HEMOPTYSIS
FIRST LINE OF
THERAPY

21. PEDIATRICS –
KATHANDU BITE –
23 SCHOOL
STUDENTS
SURGERY OT -
APPENDICITIS
OP – DIABETIC
FOOT ULCER -
DRESSING