This document presents a case study of an 83-year-old female patient admitted to the ICU with complaints of severe body pain and inability to walk for the past 10-12 days. Her medical history includes recurrent UTIs, hypertension, hysterectomy and colon cancer. Laboratory tests revealed anemia and hyperkalemia. She was prescribed various medications to treat her conditions. The clinical pharmacist intervened regarding concurrent use of spironolactone and telmisartan due to risk of hyperkalemia and provided patient education.

1. Department of Pharmacy Practice at BBH, Bengaluru
CASECASE
PRESENTATION ONPRESENTATION ON
RECURRENT UTI,
HTN Presented By:
Sandesh Shrestha

2. PATIENT DEMOGRAPHIC DETAILSPATIENT DEMOGRAPHIC DETAILS
AGE: 83 years SEX: Female HT/CM: UTS WEIGHT/Kg: UTS
DOA: 11-06-15 DOD: WARD: ICU WING:
MEDICATION HISTORY:
• Not recorded
MEDICAL HISTORY:
• Recurrent UTI, HTN
• HYSTERECTOMY, Colon Cancer
FAMILY HISTORY:
• Not recorded
SOCIAL HISTORY:
• Not recorded
ALLERGIES: Not recorded

3. SUBJECTIVE EVIDENCESUBJECTIVE EVIDENCE
CC:
c/o severe body pain since last week, unable to walk since 10-12 days,
main right shoulder pain very severe
HPI:
83 years old female patient,
k/c/o HTN/UTI/Hysterectomy/Colon Cancer
Came with c/o Severe body pain since last week
Unable to walk since 10-12 days

4. OBJECTIVE EVIDENCEOBJECTIVE EVIDENCE
VITAL SIGNS:
• BP: 140/90mmhg
• Pulse: 88/min
• Resp rate: 15/min
• GCS: 15/15
• Resp System: NVBS +
• Abdominal system: soft, non tender
• CVS: S1S2 +

5. OBJECTIVE EVIDENCEOBJECTIVE EVIDENCE
LAB REPORTS:
Day Parameter Result Remark
1 Hb 11.5 g/dl Anemic
TC/DC 11000 cells/cu.mm Normal
Plts 439000/microliter Normal
Sodium 137 mEq/L Normal
Potassium 4.9 mEq/L Hyperkalaemia
Creatinine 0.59 mg/dl Low
Total protein 5.9 g/dl Normal
CONTD….

6. OBJECTIVE EVIDENCEOBJECTIVE EVIDENCE
MEDICATIONS:
DAY &
TIME
NAME OF MEDICATION
(GENERIC NAME)
DOSE ROUTE TIME INDICATION
11-06-15 Inj
PIPERACILLIN/TAZOBACTAM
4.5gm IV 2-10-6 Anti bacterial
Inj AMAIKACIN 450mg IV 10am Anti bacterial
Inj NITROFURANTOIN 50mg NG 9-9 UTI
T PANTOPRAZOLE 40mg IV 6am GI ulcers
Inj ENOXAPARIN 0.4ml SC 10am Prevent clot
T SPIRONOLACTONE 25mg NG 9am HTN
T TELMISARTAN 40mg NG 9am HTN
T CARVEDILOL 6.25mg NG 9am HTN
T MEXILETINE 5mg PO 9am Local
anesthetic
CONTD….

7. OBJECTIVE EVIDENCEOBJECTIVE EVIDENCE
MEDICATIONS:
DAY &
TIME
NAME OF MEDICATION
(GENERIC NAME)
DOSE ROUTE TIME INDICATION
11-06-15 Inj VITNEURIN 1amp IV 10am Anemia
T SHELCAL 500mg NG 9-9 Nutrient
supplement
Inj PARACETAMOL IV Analgesic
Syp KCL 10ml PO Supplement
Inj TEICOPLANIN 400mg IV Anti bacterial
CONTD….

8. PROGRESS CHARTPROGRESS CHART
PHYSICIAN/NURSE NOTES:
DAY 1
c/o pain in anterior neck
Cramps and tightness
Temp: 98.5
DAY 2

9. PHARMACEUTICALPHARMACEUTICAL
CARE PLANCARE PLAN

10. ASSESSMENTASSESSMENT
DIAGNOSIS LIST:
• POST HYSTERECTOMY
• RECURRENT UTI
• HTN
• COLON CANCER

11. ASSESSMENTASSESSMENT
REFERENCES: MICROMEDEX
DISEASE EVALUATE CURRENT THERAPY FOR
PROBLEM
EVALUATE NEED FOR
THERAPY
Post
Hysterectomy
Surgery performed for removal Correct
Recurrent UTI Tab NITRO FURANTION Prevent UTI
HTN Tab TELMISETRAN
T ALDACTONE
T CARDIVAS
HTN treatment
Colon Cancer Surgery Performed for removal
cancer cells from the colon
Prevention and treatment of
colon cancer
CONTD….

12. PLANNINGPLANNING
DISEASE GOALS FOR TREATMENT OF PROBLEM GOALS ACHIEVED (Y/N)
Hysterectomy •Remove all visible ovarian cancer
•Reduction of pain and symptoms
Yes
Recurrent UTI •To relieve symptoms, eliminate the
infection and prevent recurrence
•To prevent unlikely but serious
complications such as kidney damage
YES
HTN • In patient above 60 yrs or older initiate
therapy in those with systolic BP levels
at 150mmhg or greater or whose
diastolic BP levels are 90mmhg or higher
To some Extend
COLON
CANCER
•To remove the entire tumor and any
cancer cells that may have spread near
by cells
Yes

13. PLANNINGPLANNING
RECOMMENDATIONS:
REFERENCES: MICROMEDEX
DRUG
TREATMENT
MONITORING
PARAMETERS
FURTHER TESTS DRUGS TO BE
AVOIDED/WHY
SPIRONOLACTONE
and
TELMISARTAN
Potassium level Concurrent used
causes hyperkalemia
CONTD….

14. PLANNINGPLANNING
DISCHARGE MEDICATIONS:
DATE & TIME NAME OF MEDICATION
(GENERIC NAME)
DOSE ROUTE TIME INDICATION
CONTD….

15. CLINICAL PHARMACIST INTERVENTIONCLINICAL PHARMACIST INTERVENTION
DRUG SPECIFIC:
SPIRONOLACTONE and TELMISARTAN
Concurrent use of ANGIOTENSIN II RECEPTOR BLOCKERS and POTASSIUM-
SPARING DIURETICS may result in hyperkalemia.

16. PATIENT EDUCATIONPATIENT EDUCATION
DISEASE SPECIFIC:
Reduce the weight if obese
It is very common to have light vaginal bleeding which can last upto 6 weeks
DRUG SPECIFIC:
Avoid NITROFURANTOIN if allergic to it, severe kidney disease, a history of jaundice
Don’t take two dose together if missed any dose
Take PANTOPRAZOLE 30 minutes before food
Complete the drug therapy as prescribed by physician

17. PATIENT EDUCATIONPATIENT EDUCATION
DIET SPECIFIC:
Consume large volume of fluids
Avoid consumption of alcohol
Reduce consumption of sodium
Eat more fruits and vegetables