- The patient, a 35-year-old male, presented with abdominal pain and vomiting for 2 days. On examination, he had tenderness in the right lower abdomen. - Laboratory tests and imaging confirmed a diagnosis of appendicitis. He received IV antibiotics and underwent a laparoscopic appendectomy. - The clinical pharmacist reviewed the patient's medications and provided recommendations to avoid potential drug interactions and maximize treatment of appendicitis.

1. Department of Pharmacy Practice at BBH, Bengaluru
CASE PRESENTATION ONCASE PRESENTATION ON
APPENDICITISAPPENDICITIS
IP NO.AA143064
Presented To:
MR.BALAKESHAVA RAMAIH
DPT.OF PHARMACY PRACTICE
KCP
Presented By: Saroj Poudel
3rd year Pharm.D

2. PATIENT DEMOGRAPHIC DETAILSPATIENT DEMOGRAPHIC DETAILS
AGE:35 years SEX: MALE HT/CM: 160cm
WEIGHT/Kg: 65kg
DOA: 22-11-14 WARD: w-5 (K1)
MEDICATION HISTORY:
MEDICAL HISTORY: No H/O present surgeries
No known Co. morbilics
FAMILY HISTORY:
SOCIAL HISTORY:
ALLERGIES: NO Allergies

3. SUBJECTIVE EVIDENCESUBJECTIVE EVIDENCE
CC: C/O pain over right part of abdomen – 2 days
HPI: C/O pain over right part of abdomen – 2 days, initially started around ambilical .
Gradually progressed to right lower part of abdomen.
H/O vomiting 5-6 episodes- 2 days.
No H/O fever, no trauma, no trauma, no urinary difficulty.

4. OBJECTIVE EVIDENCEOBJECTIVE EVIDENCE
VITAL SIGNS: Pt. Concious , co-operative.
Nutrition: Moderate
BP:120/80mmHg
Pulse:90/min
RR: 16/min
No Lymphadenopathy,pallor,clubbing,cyanosis,icterus,edema
RS: NVBS.
CVS: NAD
CNS: NAD
Abdominal system: Tenders present in R & F, Afebrile

5. OBJECTIVE EVIDENCEOBJECTIVE EVIDENCE
LAB REPORTS:
Day Parameter Result Remark
Hb: 15.7
TC/DC:
Plts:
12900
3.10 lakhs
Blood Sugar RBS: 115mg/dl
Creatinine 1.17
Urine Negative
Sodium 138
Potassium 3.9
CONTD….

6. OBJECTIVE EVIDENCEOBJECTIVE EVIDENCE
MEDICATIONS:
DAY &
TIME
NAME OF MEDICATION
(GENERIC NAME)
DOSE ROUTE TIME INDICATION
22-11-14
1:20 pm
Inj.AMPICILLIN 500mg IV 6-1 semisynthetic penicillin
(beta-lactam antibiotic)
Inj.GENTAMYCIN 160mg IV(OD) 6pm aminoglycoside
antibiotic which acts by
inhibiting microbial
protein synthesis
Inj.METRONIDAZOLE 500mg IV(Q8H) 9-3-9 nitroimidazole antibiotic
Inj.OMEPRAZOLE 40gm IV(Q12H) 7-7 Proton Pump Inhibitor
Inj.PARACETAMOL 1gm IV(Q8H) 9-3-9 analgesic
7pm DICLOFENAC 75mg IV(Q12H) 9-9 NSAID
23-11-14
8am
Cap.OMEPRAZOLE 20mg P/O 7-7 Proton Pump Inhibitor
Tab.PARACETAMOL 1mg P/O 9-3-9 analgesic
Cap.OMEPRAZOLE 20mg P/O 10 days Proton Pump Inhibitor
CONTD….

7. OBJECTIVE EVIDENCEOBJECTIVE EVIDENCE
MEDICATIONS:
DAY &
TIME
NAME OF MEDICATION
(GENERIC NAME)
DOSE ROUTE TIME INDICATION
Tab.CAMADOL P/O 1-1-1 Pain relief
Tab.CIPRO-T2 P/O 5 days antibacterial a
antidiarrheal
agents
22-11-14 DNS/DNS @ 100ml/hr
DC IVR once Pt. taken orally
well
23-11-14 D/C IVR
22-11-14
7pm
Inj.PETHAIDINE
Inj.PHENARGAN
50mg
25mg
Q6H 4 times pain
CONTD….

8. PROGRESS CHARTPROGRESS CHART
PHYSICIAN/NURSE NOTES:
DAY 1: 22-11-14
IMP: Appendicitis
Posted for Lap. Appendectomy
N/O till further order
Informed counsel
Inform to OT & Anesthetic
CBC,RBC,Na+,K+
drugs and fluid in respective chests
Shift to OT on call
Charge for male biopsy.
DAY 2: 23-11-14
Nutritional Assessment Done

9. PHARMACEUTICALPHARMACEUTICAL
CARE PLANCARE PLAN

10. ASSESSMENTASSESSMENT
DIAGNOSIS LIST: Appendicitis .
PLAN OF CARE: Laparoscopic
Appendectomy

11. ASSESSMENTASSESSMENT
REFERENCES: www.webmd.com
www.everydayhealth.com
DISEASE EVALUATE CURRENT
THERAPY FOR PROBLEM
EVALUATE NEED FOR THERAPY
Appendicitis Inj.METRONIDAZOLE Metronidazole may produce a local
antioxidant and anti-inflammatory effect
on inflamed tissue by affecting neutrophil
function.
Inj.AMPICILLIN is a penicillin antibiotic. It works by killing
sensitive bacteria by interfering with
formation of the bacteria's cell wall while
it is growing.
Inj.GENTAMYCIN aminoglycoside antibiotics. It works by
stopping the growth of bacteria.
CONTD….

12. PLANNINGPLANNING
DISEASE GOALS FOR TREATMENT OF PROBLEM GOALS ACHIEVED (Y/N)
Appendicitis Surgery (conventional or laparoscopic)
is indicated if appendicitis is diagnosed
and should be performed as soon as
possible to decrease risk of perforation.
Administer antibiotics and IV fluids until
surgery is performed.
Analgesic agents can be given after
diagnosis is made. These are not given
before a suspected case of appendicitis
to determine whether the patient has a
ruptured appendix or not.
Yes Achieved
Yes Achieved
Yes Achieved

13. CLINICAL PHARMACIST INTERVENTIONCLINICAL PHARMACIST INTERVENTION
DRUG SPECIFIC:
Concurrent use of AMPICILLIN and OMEPRAZOLE may result in reduced
ampicillin bioavailability.
Concurrent use of DICLOFENAC and METRONIDAZOLE may result in
increased exposure of diclofenac.
Concurrent use of AMINOGLYCOSIDES and PENICILLINS may result in loss
of aminoglycoside efficacy

14. PATIENT EDUCATIONPATIENT EDUCATION
DISEASE SPECIFIC: 1.stop smoking and try to get your weight down if you are
overweight.
2.Check the hospital's advice about taking the pill or hormone
replacement therapy (HRT)
DRUG SPECIFIC: 1. If you forget to take a dose, do not worry, just take your next
dose when it is due. Do not take two doses together to make up
for a forgotten dose.
2 .Try to keep your regular appointments with your doctor. This is
so your doctor can check on your progress.
DIET SPECIFIC: 1. An all-fruit diet for 2 or 3 days, with three meals a day of fresh
juicy fruits at five-hourly intervals.
2. Fruit and milk diet for further 3 days. In this regimen, milk
may be added to each fruit meal.