Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure typically does not cause symptoms. please comment thank u....

1. PRESENTED BY:
MARTIN SHAJI
PHARM D
CASE STUDY ON COPD
With HTN

2. DEMOGRAPHIC DETAILS:
Patient Name : XXXXX
Age / gender : 65 Y Male
Admission number : 37631
Department : MM –II
Date of admission : 20-9-2018
Dare of discharge : 27-9-2018
Provisional Diagnosis: COPD ?

3. SOAP NOTES
SUBJECTIVE EVALUATION :
 A 65 years male patient was admitted in a male
medical ward –II with
 Chief complaints of dizziness , breathlessness (
grade 2) since 4 days , body pains since 1 week ,
cough with sputum since 10 days .
Past medical & medication history shows not a
known diabetic , hypertensive.
Allergic history shows nill
 Personal history shows ,Occupationally he is an
coolie , patient was an known smoker from past 15
years & had disturbed sleep and mixed diet ,
appetite is reduced , bowel and bladder habits are
normal.
 Family history was irrelevant

4. OBJECTIVE EVALUATION :
ON PHYSICAL EXAMINATION patient was conscious and
coherent
ON GENERAL EXAMINATION :
B.P : 130/90 mm of Hg
Temp : 99.4◦ F
R.R : 32 cycles /min
ON SYSTEMIC EXAMINATION :
CVS : S1S12 +
R.S : Decreased air entry
CNS : conscious
P/A : soft
ON LABORATORY INVESTIGATION :
Hb : 12.5 gms / dl ( normal value : 13-17 gms / dl )
RBS : 104 mgs / dl ( normal value : 80-140 mgs / dl )
UREA : 34 mgs /dl ( normal value :7-18 mg /dl )
SERUM CREATININE : 1.2 mg / dl ( normal value : 0.6-1.4 mg /dl )

5. X – ray :
x-ray results shows white colour in some parts of
lungs , which shows damage of alpha antitrypsin
enzyme which majorly protects the alveoli walls and
accumulation of WBC .
*Smoking is one of the main reason which damages
this alpha antitrypsin .

6. ASSESMENT :
Based on the subjective ( chief complaints)
and objective evaluation(Increased R.R & B.P & on X-
ray report) the patient was diagnosed as
“ Chronic Obstructive Pulmonary Disease with
Hypertension ’’
 Cause : smoking
 Condition: Moderate
 Not a drug induced
 Can manage with medications

7. PLANNING :
DAY 1
Patient was conscious and coherent
c/o of breathlessness , cough with sputum , body pains , dizziness
CVS – S1S2 +
CNS – Conscious
P/A : soft
B.P – 190 /100 mm Hg
Rx
Inj.ceftriaxone - 1gm IV BD
T . Paracetamol – 500 mg oral TID
T . Deriphylline - 110 mg oral OD
T. Amlodipine - 10 mg oral OD
Nebulisation with Duolin – 6th hourly
DAY 2
Patient was conscious and coherent ,no fresh complaints was
observed
Continue the same treatment as DAY 1
DAY 3 :
Patient was conscious and coherent

8. c/o of right sided lateral chest pain non radiating , cough
B.P – 140/100 mmHg
RS – decreased air entry
Rx
Inj.Pantop - 40 mg OD
Inj . Ceftriaxone - 1 gm IV BD
T.Amlodipine – 10mg OD
Inj . Diclofenac – 75mg IM OD
Inj . Decadron - 10 mg BID
Nebulisation with duolin – 6th hourly
IV fluids – 1 Bottle normal saline for 4 hours
DAY 4
Patient had complaints of right sided pleural effusion and body
pains
B.P -140/100 mmHg
Rx
continue the same treatment as given on DAY 3

9. DAY 5
Patient had no fresh complaints ,but there is slight rise in the
blood pressure.
B.P – 160/100 mmHg
Rx
Continue the same treatment as given on day 4
DAY 6
Patient had complaint of cough
R.S – Decreased air entry
B.P -170/100 mm Hg
Rx
Continue the same treatment as given on day 5
DAY 7
No fresh complaints was observed
R.S –BLAE
B.P – 160/100mm Hg
Rx
Continue the same treatment as given on day6

10. DAY 8 :
patient was able to breath
R.S – BLAE
CVS – S1S2 heard
B.P – 160/100 mmHg
Rx
Duolin was stopped
Patient was discharged with
T. Ceftixime – 200mg p.o BD x 5 days
T.pantop - 40 mg p.o OD x 1 month
T. Amlodipine - 10 mg p.o OD x 1 month
T.Salbutamol - 2 mg p.o OD x 1month
Review : After 1 month

11. S.NO DRUG Category DOSE ROA FREQU
ENCY
START AND END
DATE
1 Inj .ceftriaxone Antibiotic 1 gm IM BD DAY 1 – DAY 7
2 T.Paracetamol Antipyretic 500 mg Oral TID DAY 1- DAY 2
3 T.Deriphylline Bronchodilator 110 mg Oral BD DAY 1- DAY 2
4 Inj .Pantop PPI 40 mg IV OD DAY 3- DAY 7
5 T. Amlodipine Calcium
channel
blocker
10 mg Oral OD DAY 1 – DAY 7
6 Inj.Diclofenac NSAID 75 mg IM OD DAY 3 – DAY 7
7 Inj . Decodron Corticosteroid 10 mg IM BID DAY 3 – DAY 7
8 Nebulisation
with duolin
Bronchodilator - Nasal Every
6th
hourly
DAY 1 – DAY 7

12. PHARMACEUTICAL CARE ISSUES &
PHARMACIST INTERVENTION :
•Prescription was found to be irrational
As it contains drug-drug Interaction between Amlodipine and
Diclofenac
• Diclofenac reduces the action of Amlodipine , thus blood
pressure is not able to get in control in this case
• No intervention was done, as physician doesn’t prescribed
T.Diclofenac in discharge medications.

13. PATIENT COUNSCELLING :
REGARDING DISEASE:
 I have counseled the patient that COPD is the respiratory tract disease.
 I have said to the patient that it has symptoms like Long lasting cough with
sputum, shortness of breath , weight loss.
 I have counseled the patient that smoking is the main cause of this condition.
 I have said to the patient that this condition is managable with medications
& by avoiding smoking ,if left untreated it may lead to complication like
Respiratory system collapse , severe pulmonary infections etc.

14. REGARDING MEDICATION:
T.CEFIXIME :
 I have advised the patient to take T.Cefixime of 200 mg twice a day up to 5 days
,after intake of meal orally with glass full of water.
 I have said the patient that it is given to prevent infections , given as prophylactic.
 I have advised the patient to store it in a room temperature away from sunlight.
 I have advised the patient that this drug might cause side effects like nausea ,
vomiting , diarrhea , hypersensitivity , pseudolithiasis.
T. PANTOPRAZOLE:
 I have advised the patient to take T.Pantop of 40mg once a day in early morning
up to 1 month ,before intake of food orally with glass full of water.
 I have said the patient that it is given to treat GI irritation & Ulceration.
 I have advised the patient to store it in a cool temperature away from sunlight &
children.
 I have advised not to crush or break the tablet.
 I have advised the patient that this drug might cause side effects like flatulence,
diarrhea.

15.  T.Amlodipine :
 I have advised the patient to take T.Amlodipine of 10 mg orally once a day in
morning after intake of food up to 1 month.
 I have said the patient that it is given to manage blood pressure.
 I have said to patient to store it in room temperature.
 I have advised the patient that this drug may cause side effects like nausea,
somnolence , abdominal pain.
 T. Salbutamol:
 I have advised the patient to take T. Salbutamol of 2 mg once a day morning
up to 1 month ,after intake of meal orally with glass full of water but not with
Coffee or tea.
 I have said the patient that it is a given to treat breathlessness and to manage
COPD
 I have advised the patient to store it in a room temperature , away from excess
temperature& moisture.
 I have advised the patient that this drug might cause side effects like tremors
,headache,muscle cramps etc
I have advised the patient ,that in case of occurrence of any side effects with
regard to use of medications report to physician immediately
I have informed the patient , to come for review after 1 month.

16. LIFE STYLE MODIFICATIONS :
I have counselled the patient to
•Quit smoking and other irritants
•Maintain Good hygiene
•Use antibacterial soaps
•Do breathing exercises
•Reduce salty diet
•Avoid oily foods
•Do some physical exercises & yoga , meditation
•Take adequate amounts of vitamin A,C , E .
• Eat fresh fruits and vegetables
•Avoid aerosol products , Hair sprays , insecticides , paint sprays
etc..

17. DISCUSSION
CHRONIC
OBSTRUCTIVE
PULMONARY
DISEASE

18. CHRONIC OBSRUCTIVE PULMONARY DISEASE
majorly effects the lungs and respiratory tract
•It is majorly caused due to smoking and lung infections
•It includes chronic bronchitis and emphysema
•BRONCHITIS :
* The air ways that carry air to the lungs gets inflammated
and makes lot of mucus
•This can narrow the pathway ways , making it hard to
breath
•EMPHYSEMA :
* Air sacs are damaged and loose their stretch,so less air
gets in and out of the lungs which can make you feel
shortness of breath
CAUSES:
•Smoking
•Lung infections

20. SYMPTOMS:
* Long lasting cough with mucus
•Shortness of breath
•Wheezing
•Weight loss
DIAGNOSIS :
*Physical examination
•X-ray ( white colour )
•Pulmonary function tests
•TREATMENT :
•Oxygen therapy
•Bronchodilators
NON PHARMACOLOGICAL TREATMENT :
*Quit smoking
•Avoid aerosols, hair sprays, insecticides
•Maintain good hygiene.

22. THANKING YOU