This is a case presentation on pulmonary tuberculosis in SOAP format especially for pharm d students.

1. CASE PRESENTATION ON PULMONARY
TUBERCULOSIS
DONE BY:
ASHIMA JOSEPH
IV PHARM.D

2. CASE ABSTRACT:
A 50 Year old male was admitted in Karpagam hospital on 21/2/2020
His chief complaints were cough, poor appetite, excessive joint pain for 1
week, chest pain for 1 month, weight loss, evening rise in temperature, and
breathlessness.
On physical examination he was found to be afebrile, conscious and
oriented. On laboratory examination his hemoglobin, total count, lymphocytes,
MCH, MCV, MCHC and RBC levels was found to be decreased. He had a past
medical history of tuberculosis and he discontinued the medications. Finally on
laboratory and specific investigation the patient was diagnosed as
PULMONARY TUBERCULOSIS.

3. • He was treated with following medication
ATT-CAT- II (8MONTHS)
T.Dolo

4. PATIENT DETAILS
NAME Mrs. X
AGE 50 YEARS
SEX MALE
IP.NO K18061268
DATE OF ADMISSION 21/2/20

5. SUBJECTIVE

6. Reasons for admission
Cough
poor appetite
excessive joint pain for 1 week
chest pain for 1 month
weight loss
evening rise in temperature
breathlessness

7. Social History:
Smoker -yes
Alcoholic-yes
Marital status-Married
Allergies-Nil
Past medical history- TUBERCULOSIS
Past medication history-ATT CAT-I DISCONTINUED

8. OBJECTIVE

9. VITALS:
COMPONENTS OBSERVATION NORMAL VALUES
BLOOD PRESSURE 120/80 mm Hg 120/80 mm Hg
RESPIRATORY RATE 16 breaths/min 12-20 breaths/min
PULSE 100 beats/min 60-100 beats/min
TEMPARATURE 98.4 °F 98.4 °F

10. On Examination:
Afebrile
Conscious
Oriented

11. LABORATORY INVESTIGATIONS:
COMPONENTS FINDINGS NORMAL VALUES
HAEMOGLOBIN 7.1 gm/dl 14-18 gm/dl
TOTAL COUNT 11,800 cells/cu.mm 4,000-11,000 cells/cu.mm
PLATELETS 4,30,000 1.5 to 4.5 lakh/cumm
MONOCYTES 1.8% 2-10%
TOTAL RBC 3.39
millions/cumm
4.7-6.1 millions/cumm
MCH 21.1 Pg/cell 27-33 Pg/cell
MCHC 28.3 gm/dl 33-36 gm/dl
LYMPHOCYTES 14.6% 20-40%
MCV 74 fl 80-96 fl
RBS 118.4 mg/dl 70-140 mg/dl

12. SPECIFIC TEST:
• Sputum culture and sensitivity test (+ve).
• Chest X-ray.

13. ASSESSMENT

14. CAUSES:
Tuberculosis is caused by bacteria (Mycobacterium tuberculosis) that spread from person to
person through microscopic droplets released into the air.
This can happen when someone with the untreated active form of tuberculosis coughs, speaks,
sneezes, spits, laughs or sings.
RISK FACTORS:
Low body weight
Babies and young children, whose immune systems have not matured
People with chronic conditions such as diabetes or kidney disease
People with HIV/AIDS
Organ transplant recipients
Cancer patients undergoing chemotherapy
People receiving certain specialized treatments for autoimmune disorders

15. DIAGNOSIS
PULMONARY TUBERCULOSIS

16. PLAN

17. BRAND NAME GENERIC NAME GIVEN
ROUTE
GIVEN DOSE FREQUENCY
ATT-CAT- II
(8MONTHS)
Isoniazid(H)
Rifampicin(R)
Pyrazinamide(Z)
Ethambutol(E)
Streptomycin(S)
Oral
Oral
Oral
Oral
IM
2 Months –
R150,H75,E275,Z400,S750
1 month-R150,H75,E275,Z400
5 Months- R150, H75,E275
TID
T.Dolo Paracetamol Oral 650mg SOS
DRUG CHART

18. DRUG PROFILE
DRUG CLASS MOA ADR
ATT-CAT- II
Isoniazid(H)
Rifampicin(R)
Pyrazinamide(Z)
Ethambutol(E)
Streptomycin(S)
Antituberculosis
drug
inhibition of mycolic acid synthesis
inhibits bacterial RNA synthesis by binding strongly to
the beta subunit of DNA-dependent RNA polymerase,
preventing attachment of the enzyme to DNA, and thus
blocking initiation of RNA transcription
inhibition of mycolic acid synthesis
inhibits the synthesis of metabolites, subsequently
impairing cell metabolism and cell multiplication
eventually leading to cell death
inhibit normal bacterial protein synthesis
Peripheral neuritis,
hepatotoxicity, anemia, GI
disturbances
Hepatotoxicity, fever,
chills, joint pain,GI
disturbances
Hepatotoxicity,
hyperuricemia, GI
disturbances skin rashes
Optic neuritis,
hyperuricemia, GI
disturbances, skin rashes
Ototoxicity,
nephrotoxicity,
neuromuscular blockade
Paracetamol Antipyretic and
analgesic
Inhibit release of prostaglandins in the CNS and by
inhibit endogenous pyrogens at the hypothalamic
thermoregulator center
Nephrotoxicity,
hepatotoxicity, skin rashes
and GI disturbances

19. PHARMACIST INTERVENTION

20. DRUG-DRUG INTERACTION
ISONIAZID -- ACETAMINOPHEN
Concurrent use of ACETAMINOPHEN and ISONIAZID may result in an increased risk of hepatotoxicity.
Mechanism-inhibition of CYP2E1-mediated metabolism of acetaminophen by isoniazid.
Acetaminophen use should be avoided or limited in patients taking isoniazid.
ISONIAZID-RIFAMPIN
Concurrent use of RIFAMPIN and ISONIAZID may result in hepatotoxicity.
Mechanism- increased isoniazid metabolism
For patients on concurrent isoniazid and rifampin, monitor liver function tests
PYRAZINAMIDE-RIFAMPIN
Concurrent use of PYRAZINAMIDE and RIFAMPIN may result in severe hepatic injury.
Patients should be monitored throughout the entire course of therapy since a majority of patients have onset of
symptoms of liver injury after the fourth week of therapy.

21. DRUG-FOOD INTERACTION
ACETAMINOPHEN-CABBAGE
Concurrent use of ACETAMINOPHEN and CABBAGE may result in decreased acetaminophen
effectiveness.
Cabbage may enhance the glucuronidation of acetaminophen to inactive metabolites.
RIFAMPIN-FOOD
Concurrent use of RIFAMPIN and FOOD may result in decreased rifampin concentrations.
Rifampin should be administered one hour before or two hours after a meal with a full glass of water.
ISONIAZID-FOOD
Concurrent use of ISONIAZID and FOOD may result in decreased isoniazid exposure.
Isoniazid should be administered on an empty stomach.

22. PATIENT COUNSELLING
• Educate the patient about the disease severity, the importance of adherence to therapy
and the complications of tuberculosis.
• Patient are advice to use tissues to cover when they cough and sneezes
• Tissues should be disposed appropriately and not left on outer space
• A surgical mask must worn by the patient whenever they leave the isolation room.
• Take medications properly.

23. PATIENT COUNSLLING-BASED ON DRUG
PROFILE
• Isoniazid should be administered on an empty stomach
• Rifampin should be administered one hour before or two hours after a meal with a
full glass of water.
• Rifampin stains body fluids such as urine, saliva, sweat, sputum, etc. orange red
which is harmless.

24. THANK YOU