PHARM-D final Internship Report Presentation Under the Guidance of DR.R.Goutham Chakra If Anyone need this they can contact me via dr.m.bharathkumar@gmail.com

1. Internship Annual Report Presentation
2021 - 2022
Presented by:
METI. Bharath Kumar
16DK1T0014
Pharm.D
Internship
Preceptor:
Dr. R. Goutham chakra, Pharm-D,
Associate Professor,
Department of Pharmacy practice
JUNE-2022
1
SAASTRA COLLEGE OF PHARMACEUTICAL EDUCATION AND RESEARCH
Near Varigonda Jwalamukhi Temple, Muttukur Road, Kakupalli,
Nellore - 524 311 Andhra Pradesh, India.
(Approved by PCI & AICTE New Delhi, Permanently Affiliated to JNTUA Anantapur, MoU with KIIMS Hospital, Nellore)

2. CONTENTS
S.NO PARTICULARS SLIDE NO.
1. Clinical Postings during the Internship (June 2021-June 2022) 3
2. Summary sheet of activities 4
3. Most Informative Patient Data Profile 5-10
4.
Most Informative Drug Intervention/Drug Interaction
11-13
5.
Most Informative Patient Counseling
14
6.
Most Informative Adverse Drug Reaction
15-16
7.
Most Informative Medication Error
17
8.
Most Informative Query
18-19
9.
Most Informative Journal Club Activity
20-28
2

3. Clinical postings during the Internship
3
S.NO DEPARTMENT MONTH DURATION
1. PSYCHIATRY June-July 2 Months
2. GENERAL SURGERY August 1 Month
3. PAEDIATRICS September-October 2 Months
4. GENERAL SURGERY November 1 Month
5. GENERAL MEDICINE December-January 2 Months
6. GENERAL MEDICINE February-March 2 Months
7. GENERAL MEDICINE April-June 2 Months

4. 4
Department Month From To
ACTIVITIES PERFORMED
Patient
data
profile
form
Queries Leaflets
Case
presentations
Journal club
presentations
PSYCHIATRY
June-July 15-06-2021 31-07-2021 10 5 0 0 1
GENERAL
SURGERY August 01-08-2021 31-08-2021 5 2 0 1 2
PAEDIATRICS
September-
October
01-09-2021 31-10-2021 25 5 2 2 0
GENERAL
SURGERY November 01-11-2021 30-11-2021 8 3 1 2 1
GENERAL
MEDICINE
December-
January
01-12-2021 31-01-2022 46 4 3 3 3
GENERAL
MEDICINE
February-
March
01-02-2022 31-03-2022 19 5 3 2 3
GENERAL
MEDICINE April-June 01-04-2022 14-06-2022 7 6 1 2 2
SUMMARY SHEET OF ACTIVITIES

5. CASE PROFILE OF ACUTE
INFECTIOUS HEPATITIS
Most Informative Patient Data Profile
5

6. SUBJECTIVE INFORMATION
• A 10 years female patient admitted in the paediatrics
department unit-II with the chief complaints of fever,
vomiting's since 5 days, abdominal pain and sclera turns
yellow since 2 days.
• PAST HISTORY : No history of similar complaints in past.
ON ADMISSION:
• WEIGHT : 26 kgs.
• BP:100/60 mm of Hg.
• PR:92/min.
• RR:24/min.
6

7. OBJECTIVE INFORMATION
History and physical examination:
• History: In history there is no risk factors.
• Physical examination: Abdominal tenderness +, yellowish discoloration of
eyes and skin.
• Anti –hepatitis A virus Ig M :9.5
Reference range : Negative : < 0.80
Equivocal : 0.80-1.20
Positive : > 1.20
• Liver Function Test :
AST/SGOT :54 (8 to 48 u/l)
ALT/SGPT: 65 ( 7 to 55 u/l)
ALP: 142 ( 40 to 129 u/l)
Total Bilirubin: 2.5 ( 0.1 to 1.2 mg/dl)
Indirect Bilirubin: 1.5 ( 0.2 to 0.8 mg/dl)
Direct Bilirubin:1 ( < 0.3 mg/dl)
Based on subjective and objective information the case is confirmed as
“Acute Infectious Hepatitis”.
7

8. PLAN OF TREATMENT
8
PROGNOSIS TREATMENT
Day 1
BP:100/60 mm of Hg
Temp : afebrile
PR:92/min
RR: 24/min
CVS: S1S2 + ve
RS : BAE +
Day 2
c/o: abd pain
No c/o : vomitings
Accepting oral feeds
O/E
Vitals stable
P/A: soft
Jaundice +
Rx
1.Inj.cefotaxime 1g IV BD
2.T.PCT 500 mg ¾ th PO TID
3.ORS
4.Syrup.hepamerz 2ml-2ml
5.Inj.ondansetron 2cc+3cc NS IV sos
6.IVF DNS 500 ml IV TID
Rx
1.Inj.cefotaxime 1g IV BD
2.T.PCT 500 mg ¾ th PO TID
3.ORS
4.Syrup.hepamerz 2ml-2ml
5.Inj.ondansetron 2cc+3cc NS IV sos
6.IVF DNS 250 ml IV TID

9. PLAN OF TREATMENT
9
PROGNOSIS TREATMENT
Day 3
c/o: abd pain
c/o : vomitings
Accepting oral feeds
O/E
Vitals stable
P/A: soft
Jaundice +
Day 4
c/o: abd pain
c/o : vomitings
Accepting oral feeds
O/E
Vitals stable
P/A: soft
Jaundice +
Rx
1.Inj.cefotaxime 1g IV BD
2.T.PCT 500 mg ¾ th PO TID
3.ORS
4.Syrup.hepamerz 2ml-2ml
5.Inj.ondansetron 2cc+3cc NS IV sos
6.IVF DNS 500 ml IV TID
Rx
1.Inj.cefotaxime 1g IV BD
2.T.PCT 500 mg ¾ th PO TID
3.ORS
4.Syrup.hepamerz 2ml-2ml
5.Inj.ondansetron 2cc+3cc NS IV sos
6.IVF DNS 500 ml IV TID
7.T.ursodeoxycholic acid 150 mg BD
8.Inj.Vit K 5mg IV STAT

10. DRUG CHART
10
S.NO DRUG NAME INDICATION DOSE ROUTE OF
ADMINISTRATI
ON
FREQUENCY
1. Cefotaxime Prevention of
infections
1 g IV BD
2. Pantoprazole Reduce acidity 40 mg IV OD
3. Syrup hepamerz Liver protectant 2 ml PO BD
4. Inj.Vitamin K Improve clotting
factors
5 mg IV OD
5. Udiliv
(ursodeoxycholic
acid)
Reduce
cholesterol in
blood
150 mg PO BD
6. Acetaminophen
(paracetamol)
Reduce fever 500 mg PO SOS
7. Ondansetron Reduce vomitings 2 cc IV BD

11. • Patient ID: 10708
• Age: 55 years
• Gender: Male
• Department: General medicine
• Ward: Male ward
• DOA: 04-03-2022
SOAP NOTES:
Subjective evidence:
A 55 years male patient admitted in the male medical ward
MM-8 with the chief complaints of sudden shortness of
breath since 2 days associated with orthopnea, swelling of
both lower limbs since 5 days.
Past medical history:
H/o: CKD on MHD since 1 week.
HTN + since 6 months on Rx.
11
Most Informative Drug Intervention/Interaction

12. Assessment: Based on subjective and past medical
history the case is diagnosed as chronic kidney
failure.
Plan of treatment:
1.CPAP: continuous positive airway pressure
2.Inj Lasix 60 mg IV BD.
3.Inj sodium bicarbonate 10 CC IV TID.
4.Inj calcium gluconate 10 CC IV TID.
5.T. Amlo 10 mg OD.
6.T.Arkamine 0.1 mg TID
7.T.Bc/ ca+2 OD
8.T. IFA OD
12

13. S .No Drug name Interacting drug Mechanism
1. Calcium gluconate Furosemide Furosemide decreases
levels of calcium
gluconate by increasing
renal clearance
DRUG - INTERACTIONS
13

14. PATIENT COUNSELLING FOR PULMONARY TUBERCULOSIS
14
Most Informative Patient Counselling
Patient ID: 12555
Age: 60 years
Gender: Male
Department: General medicine
Ward: MM-8
DOA: 14-03-2022
Diagnosis: Pulmonary tuberculosis
Counselling details:
1.Practice cough Etiquette.
2.Do not spit directly on the ground.
3.Wash hands frequently.
4.Avoid smoking, alcohol consumption.
5.Keep strong eat foods that provide good nutrition.
6.BCG vaccination to newborn babies.
7.Treat and care for all persons diagnosed with TB.
8.Do not spend long periods of time in enclosed room with anyone who has
active TB until that person has been treated and becomes non contagious.

15. 15
Most Informative ADVERSE Drug reaction
Patient ID: 357635
Age: 33 years
Gender: Male
Department: Psychiatry
Ward: Male ward
DOA: 28-01-2022
Chief complaints: Talking to self, laughing to self, suspiciousness, decreased sleep
since 2 years.
SOAP NOTES: A 33 years male patient admitted in the psychiatry ward with the
above chief complaints.
Diagnosis: Schizophrenia
Treatment: Sodium valproate, olanzapine, diazepam, risperidone
Adverse drug reaction: Facial edema
Identification/Description: Patient was admitted in the psychiatry department and
treated with sodium valproate, olanzapine, diazepam, risperidone and experiencing
risperidone induced facial swelling. This can be managed by altering the other drug.
Conformation: By subjective evidence
Severity: Grade 1, Predictable ADR , preventable ADR.
Reported and filed ADR.

16. 16
Most Informative Medication Error
Patient ID: 49540
Age: 2 days
Gender: Male
Department : Pediatrics
Ward: SNCU
DOA:07/09/2021
Chief complaints: Fast breathing +, cry and activity poor, not accepting feeds, sucking -ve.
SOAP NOTES:
A 2 days male new born admitted in the SNCU with the chief complaints of fast breathing,
cry and activity poor, not accepting feeds and sucking negative.
Diagnosis: Neonatal sepsis.
Treatment: Cefotaxime and Amikacin.
Identification of medication Error: Identified E.coli which is resistant to cefotaxime. And
this cefotaxime is prescribed to the neonate.
Description of medication error and how it was rectified:
In the culture report the microorganisms was showing resistant to cefotaxime and it was
prescribed by the physician. By prescribing this drug there will be no effectiveness in
the management of sepsis. As the organism is gram negative, and it is sensitive towards
aminoglycosides the other antibiotics like amikacin and gentamycin are effective in
killing gram negative bacteria.

17. 17
Most Informative Query
QUERY:
URINARY TRACT INFECTIONS (UTIs) TREATMENT:
RESPONSE:
Treatment in patient who are seriously ill:
High grade fever, tachycardia and hypotension
1.Ceftazidine 1g IV Q8H or cefperazone with salbactum 1.2 g IV Q12H or
cefpirome 1-2 g IV Q12H +gentamicin/netilmicin/tobramycin 3-5 mg/kg/day IV
OD / amikacin 15 mg/kg/day IV OD or ofloxacin 400 mg IV Q12 H or
2. Piperacillin 12-16 g/day IV in 4 divided doses + gentamicin
/netilmicin/tobramycin 3-5 mg/kg/day IV OD / amikacin 15 mg/kg/day IV OD or
3. Carbencillin 2 g IV infusion over 30 minutes Q6H +ciprofloxacin 400 mg IV
Q12 H or
4.Ciprofloxacin 400mg IV Q12 H + gentamicin /netilmicin/tobramycin 3-5
mg/kg/day IV OD or amikacin 15 mg/kg/day IV OD

18. Milder UTI are treated with:
• Ciprofloxacin 500mg PO Q12H or
• Ofloxacin 200 mg PO Q12H or
• Cotrimoxazole DS PO Q12H
• REFERENCE: SudhaVidyasagar, Raviraj Acharya. Manipal
Medical Manual: medical emergencies, treatment of serious
infections, basic approach to patient care.4th edition. New
Delhi; CSB publishers and distributors;2000.
18

19. • TITLE: Evaluation of Restricted Antibiotics Utilization in a Tertiary
Care Teaching Hospital.
• JOURNAL : Indian Journal of Pharmacy Practice.
• ARTICLE TYPE : Research article.
• AUTHORS : Shiv Kumar, Ashish Kumar
• PUBLISHED ON : Jul-Sep, 2021
• VOLUME:14
• ISSUE: 3
• ETHICAL APPROVAL : The study was conducted after the approval
from Institutional Ethics Committee of Navodaya Medical College
Hospital and Research Centre, Raichur.
19
JOURNAL ACTIVITY
CITATION

20. METHODS AND MATERIALS:
• SOURCE OF DATA: A well designed patient data entry form was
developed and used for this study. The following information like patient
demographic details (Name, age, gender, reason for hospitalization,
duration of illness, smoking history, treatment chart etc.) and culture
report, sensitivity test for antibiotics were included.
• STUDY DESIGN: A prospective observational study.
• STUDY PERIOD: 6 months.
• SAMPLE SIZE: 350 patients.
INCLUSION CRITERIA:
• The patients admitted as inpatient in various department of NMCH during
study period and patient who are prescribed with at least one restricted
antibiotic were included in this study.
EXCLUSION CRITERIA:
• The pregnant, lactating women and outpatients were excluded from this
study.
20

21. RESULTS
21

22. 22

23. 23

24. 24

25. DISCUSSION
• A total of 350 patients prescribed with restricted
antibiotics admitted as inpatients in various wards of
the hospital were included for the study.
• Table 1 table represents the total distribution of male
and female in restricted antibiotics therapy. Total 350
patients were admitted in which 189 male (54%) and
female 161 (54%) were found. it is lesser than
supportive data of Varghese et al. 11 Table 2 shows
the distribution of antimicrobial use among various
age group. pediatric group were given 43 restricted
antimicrobials, our study also concluded that
antimicrobials were found to be given more in adult
group between 17-60 years (n=255, 73%) which is
almost similar Of the data of Varghese et al.
25

26. • Table 3 represents total restricted antibiotics prescribed and
administered through various routes are: PO 32 (9.14%), IV 318
(90.85%).
• Table 4 shows the extent of prescriptions of major class of
restricted antimicrobial drugs. A total of 350 restricted
antimicrobials were given, of which amikacin antibiotic constitute
29.42% (n=103) of the total antimicrobials prescribed followed by
82 (23.42%) of ciprofloxacin, Piperacilin + tazobactam 21.42%
(n=75), cefuroxime 21.41% (n= 74), meropenem 10 (2.86%), and
linezolid 6(1.61%) were prescribed.
• Table 5 illustrates the restricted antibiotics usage patterns.
• Table 8 illustrates details of concomitant drugs prescribed along
with restricted antibiotics.
• Non-restricted antibiotics 149 (16.97%), Proton Pump Inhibitors
125 (14.23%), Anti-hypertensive 94 (10.70%), H2 Receptor
Blocker 95(10.82%), Antipyretics 58 (6.60%), NSAIDS 42
(4.78%), Anti Hyperlipidaemic 41 (4.66%), Antiasthmatic 40
(4.55%), Cardiovascular drugs 36 (4.10%), Calcium 103 (11.73%),
Trypsin- chemo trypsin 95 (10.82%).
26

27. CONCLUSION
• The study concludes that, the restricted antibiotics were
mostly prescribed as empirical therapy in the study
population.
• Over use of restricted antibiotics is a special factor for
antibiotic resistance.
• Establishment of drug formularies in hospitals and the
involvement of the clinical pharmacist in order to ensure
rational antibiotic therapy may improve the quality of
patient care and reduce the cost of therapy.
• The most common interventions were found to be need of
rapid laboratory testing, guidelines generation for
restriction of drugs, need to review prescription by the
clinical pharmacist.
27

28. REFERENCES
1. Mayers L, Douglas S, et al. Antimicrobial Drug Resistance. Springer International
Publication. 2009;1(2):978-4.
2. Ola S, etal. Antibiotics and Antibiotic resistance. Wiley Publication. 2011;1(3):978-2.
3. Medilineplus US. National Library of Medicine, Rockville Pike, Bethesda, U.S. Department
of Health and Human Services National Institutes of Health. 2019.
4. Laxminarayan R, Chaudhury RR. Antibiotic Resistance in India: Drivers and Opportunities
for Action. PLoS Med. 2016;13(3):1-7.
5. Aslam B, Wang W, Arshad MI, Khurshid M, Muzammil S, Rasool MH, et al. Antibiotic
resistance: A rundown of a global crisis. Infect Drug Resist. 2018;11:1645-58.
6. Gould IM. A review of the role of antibiotic policies in the control of antibiotic resistance,
J.Antimicrobi. Chemother.April 1999; 43(4):459–65.
7. Leung E, Weil DE , Raviglione M , Nakatani H. WHO policy package to combat
antimicrobial resistance. Bulletin of the World Health Organization. 2011;89:390- 92.
8. Gruson D, Hilbert G, Vargas F, Valentino R, Bebear C, et al. Rotation and restricted use of
antibiotics in a medical intensive care unit. Am J Respir Crit Care Med. 2000;162(3):1-18.
9. Bhullar SH, Shaikh FAR, Deepak R, Poddutoor PK, Chirla D. Antimicrobial Justification
form for Restricting Antibiotic Use in a Pediatric Intensive Care Unit. Indian Pediatrics.
2016;53(4):304-6.
10. Restricted antibiotic list. www.elmmb.nhs.uk/specialist-formulary/secondarycare-guidelines-
for-management-of-infections-in-adults/restricted-antibiotic-list, east Lancashire health economy
medicines management board.
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