Here are the key points I gathered from analyzing the prescription: - The patient is a 78-year-old male diagnosed with stage 4 lung cancer with liver and bone metastases, along with comorbidities including hypertension, COPD, and prostate cancer. - Initial medications for cough and shortness of breath like NAC, montelukast-levocetrizine, prednisone, and doxofylline provided incomplete relief, leading to hospital admission. - In the hospital, antibiotics like piperacillin-tazobactam were added for possible infection, along with steroids, bronchodilators, heart medications, and chemotherapy with gemcitabine once cancer was confirmed.

1. Clinical Pharmacy Semester 10th
Cancer
Cancer refers to any one of a large number of diseases characterized by the
development of abnormal cells that divide uncontrollably and have the
ability to infiltrate and destroy normal bodytissue. Cancer often has the
ability to spread throughout your body.
Cancer is the second-leading cause of death in the world. But survival rates
are improving for many types of cancer, thanks to improvements in cancer
screening, treatment and prevention
Causes
Cancer is caused by changes (mutations) to the DNA within cells. The DNA
inside a cell is packaged into a large number of individual genes, each of
which contains a set of instructions telling the cell what functions to
perform, as well as how to grow and divide. Errors in the instructions can
cause the cell to stop its normal function and may allow a cell to become
cancerous
Symptoms
Signs and symptoms caused by cancer will vary depending on what part of
the body is affected.

2. Clinical Pharmacy Semester 10th
Some general signs and symptoms associated with, but not specific to,
cancer, include:
 Fatigue
 Lump or area of thickening that can be felt under the skin
 Weight changes, including unintended loss or gain
 Skin changes, such as yellowing, darkening or redness of the skin, sores
that won't heal, or changes to existing moles
 Changes in bowel or bladder habits
 Persistent cough or trouble breathing
 Difficulty swallowing
 Hoarseness
 Persistent indigestion or discomfort after eating
 Persistent, unexplained muscle or joint pain
 Persistent, unexplained fevers or night sweats
 Unexplained bleeding or bruising
.

3. Clinical Pharmacy Semester 10th
Student Name: Amina Tariq Date: 4/26/2021
Patient Demographics:
Name: XYZ Age: 78 years Gender: M Ht/Wt: -----
Chief Complaint:
Shortness of breath, Findings of pulmonary mass on CXR, productive cough with whitish
sputum occasionally blood streaked, pleuritic chest pain,
Past Medical History;
Hypertension, pulmonary TB, COPD, Prostatic Adenocarcinoma, anemia of chronic diseases
Diagnosis:
Lung Cancer (squamous cell lung cancer stage 4 (liver, bone metastasis))
VITAL SIGNS
SIGNS 1 2 Comment
BP 120/80
mmHg
Normal
Temp 37.8 C Normal
RR 26 cpm High
PR 81 bpm Normal
RIPHAH INTERNATIONAL UNIVERSITY
Riphah Institute of Pharmaceutical Sciences
PHARMACOTHERAPY REVIEW (Patient Case)

4. Clinical Pharmacy Semester 10th
LAB TEST INTERPRETATION
Lab Tests value Normal range INTERPRETATION
RBC 3.2 4.0-5.5*10^6/ul Low
Hb 12.3 11.5-16.0g/dl Low
HCT 37.9 36-46% Normal
Platelet 411 150-450 *10^3/ul Normal
WBCS 21.94 4-11.0*10^3/ul High
MCH Normal 27-32pg
MCV Normal 76-96fl
K+ 3.73
Na 137.3
Creatinine
1.08
CrCl=65ml/min
BUN 15.41
Total protein 59g/L Low
LDH 624 High
Albumin 3.7
Urinalysis Normal
Sputum GS
Gram + cocci in
singly
glucose

5. Clinical Pharmacy Semester 10th
Rx
Before admission in hospital
NAC 600mg tablet 1 tab in ½ glass of water OD
Levocetrizine + montelukast
10/5 mg tab
1 tab ODHS
Prednisone 10mg tab 1tab BID x 7days
Levodropropizine syrup 10ml x TID
Doxofylline 200mg tab 1 tab BID
Symptoms were not relieved so patient was
admitted in hospital
 Piperacillin-Tazobactam 4.5gm
 Hydrocortisone 100mg
Salbutamol+Ipratropium
 Doxofylline 200mg tab BID
Levocetirizine+Montelukast 10/5mg
 Bisoprolol 5mg
 Telmisartan 40mg
 Atorvastatin 10mg
 IV q8
 IV q8
 nebulization q8
 1 tab BID
 1 tab ODHS
 ½ tab OD
 1tab OD
 1tab ODHS
After further evaluation during admission,
patient was diagnosed with lung cancer.
Systemic chemotherapy started(1st cycle)
 Gemcitabine 1600mg IV OD
 TPN Kabiven1400 Kcal x 24 hrs
 Piperacilin-Tazobactum4.5mg IV q8

6. 6
PRESCRIPTIONANALYSIS FORM
Dr. Name XYZ
Specialization MBBS, FCPS
Patient Name XYZ
Age 78 years
Weight 75kg
Diagnosis Lung Cancer
Other Details (If any) Patient came with severe SOB and cough, symptoms were not relieved with medication, after admission in hospital
medications were changed,after diagnosis of cancer chemotherapy was started
SuggestedCorrections in
Prescription (Missing Name,
Age, Wrong strength, dose,
frequency, etc..)
Duration of medication use should be mentioned
R IP HAH IN T E R NATION A L UN IVE R SITY
Riphah Institute of Pharmaceutical Sciences

7. 7
Rx Dosage
Form
Brand Generic Strength Class Frequen
cy
Durati
on
Instruction
s
1.TAB N-Acetyl Cystein (effervesce
nt tab)
Mucinac N Acetyl Cystein 600mg Mucolytic agent OD 1 tab in ½
glass of
water
2.Levocetrizine+
Montelukast
tab Montek LC Levocetrizine+
Montelukast
10/5mg Antihistamine+
leukotriene
receptor antagonist
ODHS 7days
3. Prednisone tab Deltasone Prednisone 10mg Corticosteroid BID 7days
4.Levodropropizine syrup Antux Levodropropizine 10ml Antitussive TID
5.Doxofylline tab Bronax Doxofylline 200mg Xanthine derivative BID
Piperacillin-Tazobactum inj Cadipip Piperacillin +
tazobactum
4.5mg Penicillin
antibiotics
q8
1. Hydrocortisone inj Hydrocortisone 100mg Corticosteroids q8
2. Salbutamol+ipratropi
um
inhalationa
l
Salbutamol+
ipratropium
Bronchodilator q8

8. 8
3. Bisoprolol Tab Zebeta Bisoprolol 5mg Beta blocker,beta1
selective
½ tab
OD
4. Telmisartan Tab Micardis Telmisartan 40mg Angiotensin II
receptor antagonist
1 x OD
5. Atorvastatin Tab Lipitor Atorvastatin 10mg statin 1 x
ODHS
6. Gemcitabine I/V infusion Gemzar Gemcitabine 1600mg Anticancer OD
7. Kabiven I/V infusion KABIVEN Amino acids,
electrolyts,lipids,de
xtrose
1400Kcal Nutritional
components
24hrs
8. Levocetrizine
+montelukast
Tab Montek LC Levocetrizine +
montelukast
10/5mg Antihistamine 1 x
ODHS
9. Doxyfylline Tab Bronax Doxyfylline 200mg Xanthine derivative BID

9. 9
DRUG INTERACTIONS ANALYSIS FORM
Software Drug Interactions Effects
Medscape Salbutamol and beta blocker( bisoprolol) Hypersensitivity
.