case study

1. CASE PRESENTATION
ON
CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
Submitted by:
MUHAMMED ADNAN
Pharm.D 2nd year

2. • Age: 60 yrs Sex: male
• Doa:19.1.11 Dod:21.1.11
• Complaints on admission: c/o
breathlessness since 1 yr, aggravated
since 3 days
• c/o cough with expectoration since 1
month, aggravated since 2 days, loss of
appetite
• Social history: Mixed diet
• Medical history : None
• Family history: nothing
2/19/2024 2

3. 2/19/2024 3
Problem list:- Chronic Obstructive Pulmonary Disease
• Subjective evidence:-
–H/O Breathlessness since 3 days
–H/O Cough with expectoration since 2 days
–H/O Chest pain since 2 days
 Objective evidence:-
 Known Smoker more than 25 years
 X-ray left basal krepts
 Lab Values:
 Urea:- 53mg% Sodium:- 129.5mmol/L
 S.Cr:- 2.5mg% Potassium:- 5.15mmol/L
 Assessment:- From subjective and objective evidences it is
confirmed that patient is suffering from COPD

4. • Indication for therapy
– To prevent disease progression
– To relieve from symptoms and to increase exercise
tolerance
– Prevent and treat exacerbations
Goals:
• Patient Specific:
– To relieve from shortness of breath and cough
• Disease Specific:
o To prevent disease progression, and to relieve from
symptoms
2/19/2024 4

5. • Assessment of previous therapy: Nil
• Assessment of current therapy:-
– Oxygen inhalation 3L/min
– Levosalbutamol (1.25mg )+ Ipratropium bromide
(500mcg) (Nebulization) q4h
– Budesonide 0.5mg (Nebulization) tid
– Hydrocortisone 100mg IV tid
– Theophylline (35mg) PO BD
– Ceftriaxone inj 1gm IV BD & from day 2 tid
– Ranitidine inj 25mg BD
2/19/2024 5

6. • Day 1 treatment:-
– Oxygen inhalation 3L/min
– Levosalbutamol (1.25mg )+ Ipratropium bromide
(500mcg) (Nebulization) q4h
– Budesonide 0.5mg (Nebulization) tid
– Hydrocortisone 100mg IV tid
– Etofylline (115mg ) +Theophylline (35mg) PO BD
– Ceftriaxone inj 1gm IV BD
– Ranitidine inj 25mg BD
• Day 2 and Day 3 treatment is same as of day 1
2/19/2024 6

7. Drug dose route freq Day 1 2 3
Oxygen inhalation 3L/min Inhal
ation
+ + +
Levosalbutamol +
Ipratropium bromide
1.25m
g+500
mcg
Nebu
lizati
on
Ever
y 4th
hourl
y
+ + +
Budesonide 0.5 mg Nebu
lizati
on
T.I.D + + +
Hydrocortisone 100mg I.V T.I.D + + +
Theophylline +
Etofylline
35+11
5mg
P.o B.I.D + + +
Ceftriaxone 1gm I.V B.I.D + + +
Ranitidine 25mg I.V B.I.D + + +

8. Progress chart
• Day1: B.p- 160/80 mm hg pr-120 bpm
c/o breathlessness & cough
• Day2: B.p-164/100 pr- 82bpm c/o cough
• Day3: B.p- 164/90 pr-90 bpm rbs-375
mg% no fresh complaints

9. Discharge medication
• Tab Deriphylline retard 1-0-1
• Tab Rantac 150 mg 1-0-0
• Cap Becosules 1-0-1
• Duolin respules 1-0-1
• Syp Tuspel plus (terbutaline,
bromohexine, ammonium chloride,
menthol) 2tsp 2-2-2
2/19/2024 9

10. Clinical Pharmacist Intervention
Adverse drug reaction:
• Theophylline & Etofylline : headache,
constipation, dizziness, rash, tremors, palpitation
• Ranitidine : headache, constipation
• Ceftriaxone: fever, rash, blood dyscrasias,
leucopenia, neutropenia.

11. • Patient Counseling:
– Mainly smoking cessation should be advised
– Some breathing exercise should be taught
– Psychological support should be given along
with health education
– Should be advised to avoid dust and
allergens
– Medication adherence should be explained
since it is an long term therapy
2/19/2024 11

12. 2/19/2024 12