A 54-year-old male was admitted to the hospital with complaints of edema, abdominal pain, decreased urine output, and absence of urine. He had a history of diabetes and hypertension. Laboratory tests found increased creatinine, decreased eGFR, and abnormalities in other values indicating chronic kidney disease. He was diagnosed with chronic kidney disease and prescribed various medications to manage his condition, including amlodipine, atorvastatin, prazosin, pantoprazole, clonidine, torsemide, and calcium carbonate with vitamin D3. The patient received counseling on diet, lifestyle modifications, and monitoring of his condition and medications.

1. PRESENTED BY
OVIYA.J.P
PHARM D

2. A 54 year old male was admitted in XXX hospital . He had an complaints of edema , abdominal
pain ,decreased urine output ,absence of urine. Past medical history of DM and HTN for past 5
years . vitals were abnormal in blood pressure and temperature. lab investigation increased in
creatinine , eGFR – decreased, sodium level-decreased , total ALP- increased , protein total is
increased, albumin- decreased, serum globulin- decreased ,blood urea- increased. The patient
was diagnosed with CHRONICKIDNEYDISEASEand treated with

T.Amlo Amlodipine 10mg od

T.Atorva Atorvastatin 10mg od

T.Minipress XL Prazosin 5mg bid

T.Pan Pantoprazole 40mg od

T.Arkamin Clonidine 0.1mg bid

T.Dytor Torsemide 5mg od

T.Shelcal calcium carbonate+vitD3 500mg bid

Inj.human mixtard 15units

3. NAME Mr.X
AGE 54 YEARS
SEX MALE
IP. NO yyyy
HOSPITAL xxx
DATE OF ADMISSION 04.08.19

4. S - SUBJECTIVE
O- OBJECTIVE
A - ASSESSMENT
P - PLAN

6.  Edema
 Abdominal pain
 Decreased urine output
 Absence of urine
PAST MEDICAL HISTORY
K/C/O DM and HTN for past 5 years.

7. PAST MEDICATION HISTORY :
not on regular medications.
SOCIAL HISTORY:
Smoker :yes
Alcoholic :yes
Tobacco in any form : No
Known allergies : Nil
Marital status : Married

9. VITALS
Sl.
No
vitals 06.08.2019 07.08.2019 08.08.2019 09.08.2019
1. Blood Pressure
(mm/Hg)
140/90 130/80 130/100 150/100
2. Pulse Rate
(beats/min)
92 86 88 96
3. Respiratory
Rate
(breaths/min)
24 22 22 24
4. Temperature 99.60F 99.2 0F 99.20F 1000F

10. Sl.No Parameters Reference
value
Normal
1. Creatinine 7.1 0.7-1.2 mg/dL
2. GFR 8 >60 ml/min/1.73 m2
3. Sodium 111 133-145 mEq/L
4. Potassium 4.5 3.3-5.1 mEq/L
5. Bilirubin total 0.44 Upto 1 mg/dL
6. Total cholesterol 122 Upto 200 mg/dL
7. Total ALP 237 Upto 129 units/L

11. Sl.No Parameters Reference
value
Normal
8. RBS 134 75-125 mg/dL
9. Protein total 5.8 6.4-8.3 g/dL
10. Albumin 1.7 3.4-5.2 g/dL
11. Serum globulin 4.1 1.5-3.5 g/dL
12. SGPT 59 Upto 40U/L
13. Prothrombin time 21 11-16 sec
14. hemoglobin 9.6 13-17.5 g/dL
15. Total WBC 6100 4000-11300
cells/mm3

12. Sl.No Parameters Reference
value
Normal
16. Total RBC 5.1 4.5-6 million cells/mm3
18. Blood urea 153 10-50 mg/dL
19. Uric acid 9.4 Upto 7 mg/dL
20. calcium 6.1 8.5-10.5 mg/dL
21. phosphorus 7.4 2.7-4.5 mg/dL
22. serum chloride 84 98-106 mEq/L
23. Plasma bicarbonate 8.8 21-26 mmol/L

14. CHRONICKIDNEY DISEASE
SPECIFIC TESTS : urine examination
blood test.
USG ABDOMEN -paired renal cortical echoes, mild ascites. .

15. PLAN

16. BRAND NAME GENERIC NAME DOSE FREQ DATE
6/8 7/8 8/8 9/8
T.Amlo Amlodipine 10mg od    
T.Atorva Atorvastatin 10mg od    
T.Minipress XL Prazosin 5mg bid    
T.Pan Pantoprazole 40mg od    
T.Arkamin Clonidine 0.1mg bid  
T.Dytor Torsemide 5mg od  
T.Shelcal
Inj.human mixtard
30/70
Calcium
carbonate+Vit.D3
500mg
15 units
bid



17. DRUGS MECHANISM ADR USES
Amlodipine Increases myocardial oxygen
delivery.
Edema ,
pulmonary edema.
CCBs
Atorvastatin Inhibits rate limiting step in
cholesterol biosynthesis by
competitively inhibiting HMG coA
reductase.
Diarrhea
,arthralgia.
HMG CoA
reductase
inhibitors.
Pantoprazole PPI blocks the final step of acid
production.therefore reduce the
heart burn
Head ache ,
abdominal pain.
Proton pump
inhibitors.
Prazosin Alpha 1 blockers inhibits post
synaptic alpha adrenergic
receptors,causing arterial and
venous dilation and leads to
decrease in blood pressure.
Dizziness ,head
ache
Antihypertensives.
Clonidine Lowers bp by inhibiting
sympathetic vasomotor tone
Dry mouth, head
ache , fatigue.
Alpha 2 adrenergic
partial agonist,

18. DRUGS MECHANISM ADR USES
Torsemide It increased
excretion of water,
sodium ,chloride
and calcium
Excessive urination
Head ache.
Loop diuretics
Calcium carbonate Neutralise gastric
activity.
Anorexia ,
constipation
Antacids.
Inj.human mixtard Regulates glucose
metabolism
Nasopharyngitis.
Hypoglycemia.
Antidiabetics.

19. GENERAL GOALS:
 Decreased RBS, blood urea, creatinine, uric acid, serum globulin, SGPT, total ALP,
phosphorus, prothrombine time levels
 Increased total protein, albumin, calcium, serum sodium, serum chloride, plasma bicarbonate
levels
• Regular monitoring ALP and SGPT levels
• Monitoring of Serum sodium ,calcium , creatinine levels.
• Monitor uric acid level.
• Monitor albumin and plasma bicarbonate levels.
MONITORING PARAMETERS:

20. Drug – Drug Interaction
CLONIDINE+PRAZOSIN : either increases toxicity of other by pharmacodynamic synergism.
CALCIUM CARBONATE + AMLODIPINE : calcium carbonate decrease effects of amlodipine by
pharmacodynamic antagonism.
PRAZOSIN+AMLODIPINE : both increase antihypertensive channel blocking.
Minor interaction
CLONIDINE + INSULIN REGULAR HUMAN: Clonidine decrease effect of insulin regular human by
pharmacodynamic antagonism.
TORSEMIDE +CALCIUM CARBONATE : Torsemide decrease levels of calcium carbonate by increasing renal
clearence.

21. DRUG FOOD INTERACTION :
GRAPE FRUIT +ATORVASTATIN : grape fruit will increase the level or effect of atorvastatin by
affecting hepatic /intestinal enzyme CYP3A4 metabolism.
REMEDY: don’t eat grapefruit while taking medicines.
GRAPE FRUIT +AMLODIPINE : grape fruit will increase the level or effect of amlodipine by
affecting hepatic /intestinal enzyme CYP3A4 metabolism.
REMEDY : don’t eat grapefruit while taking medicines.

22. General counselling
PATIENT COUNSELLING :
Don’t take any medications including OTC medications without physician advice.
 Regular monitoring of blood sugar should be done.
 Diet with low protein, low phosphorous, sodium and potassium is suggested.
 Take care of the foot since, the patient is having DM.
 Diet restriction : 1, Reduce carbohydrate containing food.
2, Increase more fiber containing food.
 Monitor the blood pressure regularly.
 Reduce the exposure to sun, as the Furosemide potentiate Photo Hypersensitivity reaction
 Include calcium enriched food in diet.
 Alert doctor if adverse effects occur.

23.  Diet Based
 Should not be included
• Grape fruit while taking medicines.
Should be included
 White rice
 White bread and pasta
 Cooked rice and wheat cereals.
 Healthy vegetables.

24.  Life style modification or non medical treatment
Avoid public toilet.
Prevention of bacterial infection in urinary tract.
Drug Based
1. Abrupt discontinuation of Arkamin cause Rebound Hypertension.
2.Torsemide should be taken in morning or afternoon inorder to avoid nocturnal diuresis,
use sunscreen to avoid photosensitivity.
3. Pantoprazole should be taken 30 minutes before breakfast.
4. Donot take grape juice along with Atorvastatin and Amlodipine.

25. THANK YOU