case study

1. CASE PRESENTATION ON
COMMUNITY ACQUIRED PNEUMONIA
SUBMITTED BY : ADNA NELSON K
III PHARMD
DEPARTMENT OF CLINICAL PRACTICE,
MALLIGE COLLEGE OF PHARMACY,SILVEPURA,BANGALORE-90

2. COMMUNITY ACQUIRED PNEUMONIA
• Pneumonia is defined as the inflammation of the lungs parenchymal cell so it will
mainly affects alveoli of lungs.
• It is characterized by alveoli filled by mixture of inflammatory exudate, bacteria, and
WBC
• Community-acquired pneumonia (CAP) is infectious pneumonia in a person who has
not recently been hospitalized.
• CAP is the most common type of pneumonia. The most common causes of CAP vary
depending on a person's age, but they include Streptococcus pneumoniae, viruses,
the atypical bacteria, and Haemophilus influenzae.
• Overall, Streptococcus pneumoniae is the most common cause of community-
acquired pneumonia worldwide.

3. SIGN AND SYMPTOMS
• Fever
• Chills
• Dyspnea
• Productive cough
• Hemoptysis
• Bluish lips

4. DEMOGRAPHIC DETAILS
• Patient name : ABC
• Age : 88 years
• Sex : male
• Date of admission : 29-8-017
• Date of discharge : 2-9-2017

5. SUBJECTIVE EVIDENCE
COMPLAINTS ON ADMISSION
• c/o cough along with expectoration yellowish sputum
since 5 days
• c/o fever since 2 days
• c/o shortness of breath

6. PAST MEDICAL HISTORY
• Diabetes mellitus since 10 years
• Ischemic heart disease
PAST MEDICATION HISTORY
BRAND NAME GENERIC NAME DOSE FREQUENCY TIME
T.Metpure metoprolol 12.5mg 1-0-1 After food
T.Ecospirin aspirin 75mg 0-0-1 After food
T.Novostat CV Rosuvastatin and
clopidogrel
10/75 mg 0-0-1 After food
T.Flavedon MR trimetazidine 35mg 1-0-0 After food
T.lasilactone Furosemide and
spirinolactone
20/50 mg ½-0-0 After food

7. SOCIAL HISTORY
• Appetite : normal
• Sleep : normal
• Bowel and bladder : normal
• Diet : mixed

8. GENERAL PHYSICAL EXAMINATION
• B.P : 130/80 mm hg
• RR : 20 cycles per min
• Temp : 100F
SYSTEMIC EXAMINATION
• CVS : S1 S2 (+)
• CNS : CONCIOUS, ORIENTED
• RS : B/L NVBS
• PELVIC ABDOMEN : SOFT
• GCS : 15

9. PROVISIONAL DIAGNOSIS
•LOWER TRACT INFECTION

10. OBJECTIVE EVIDENCE
INVESTIGATION
ESR – 30
CHEST X-RAY
• LEFT POSTERIOR MEDIASTINAL MASS AS REFIBRED
( THICKENED)
FINAL DIAGNOSIS
• From subjective and objective evidence it is confirmed
that patient is suffering from left lower lobe community
acquired pneumonia with sepsis

11. GOALS OF THERAPY
• To reduce the sign and symptom of the disease
• To prevent the further complication of the disease
• To cure the infection
ASSESSMENT

12. MEDICATION TREATMENT CHART
DATE BRAND NAME GENERIC NAME INDICATION DOSE
(MG)
ROUTE FREQUENCY TIME END
TIME
29-8-017 T.METPURE XL METOPROLOL HTN 12.5 PO 1-0-1 AF 2-9-017
29-8-017 T.ECOSPIRIN ASPIRIN IHD 75 PO 0-0-1 AF 2-9-017
29-8-017 T.NOVOSTAT CV RUSOVASTATIN
AND CLOPIDOGREL
DYSLIPIDEMIA 10/75 PO 0-0-1 AF 2-9-017
29-8-017 T. FLAVEDON MR TRIMETAZIDINE IHD 35 PO 1-0-0 AF 2-9-017
29-8-017 T.LASILACTONE FUROSEMIDE AND
SPIRONOLACTONE
HTN 20/50 PO ½-0-0 AF 2-9-017
29-8-017 INJ.PANTODAC PANTAPRAZOLE PPI 40 IV 1-0-1 BF 2-9-017
29-8-017 INJ.ZOSTUM CEFEPERAZONE ANTIBIOTIC 1OOO IV 1-0-1 2-9-017
29-8-017 INJ.PARACETAMOL ACETAMINOPHEN ANTIPYRETIC 1000 IV STAT AND SOS 2-9-017
29-8-017 T.CRIXAN CLAROTHROMYCIN ANTIBIOTIC 500 PO 0-0-1 AF 2-9-017
29-8-017 C.ANTIFLU OSELTAMIVIR ANTI VIRAL 75 PO 1-0-1 AF 2-9-017
30-8-017 T.SPOROLAC LACTIC ACID BACILLUS ANTI-
DIARRHEAL
PO 1-1-1 AF 2-9-017

13. PROGRESS CHART
PARAMETERS DAY1 DAY2 DAY3 DAY4
BP (MM HG) 130/70 130/80 130/70 120/70
PULSE (BPM) 107 98 98 86
RR ( CPM) 22 22 20 19
SPO2 (% @room temp) 95% 97% 98% 96%

14. PLANNING
DISCHARGE MEDICATION
BRAND NAME GENERIC NAME DOSE FREQUENCY TIME DAYS
T.Metpure metoprolol 12.5mg 1-0-1 After food Continue
T.Ecospirin aspirin 75mg 0-0-1 After food Continue
T.Novostat CV Rosuvastatin and
clopidogrel
10/75 mg 0-0-1 After food Continue
T.Flavedon MR trimetazidine 35mg 1-0-0 After food 5 days
CAP.SPOROLAC LACTOBACILLUS 20/50 mg ½-0-0 After food 5 days
CAP.ANTIFLU OSELTAMIVIR 75MG 1-0-1 After food 5 days
t.CRIXIAN CLAROTHROMYCI
N
500mg 0-0-1 After food 5 days
T.PANTODAC PANTAPRAZOLE 40MG 1-0-1 Before food 5 days

15. PHARMACIST INTERVENTION
• DRUG INTERACTION
MODERATE
• CLARITHROMYCIN + CLOPIDOGREL
Clarithromycin will reduce the bio activation of clopidogrel
• METOPROLOL+ ASPIRIN
Both will increase serum potassium level
• CLOPIDOGREL + OSELTAMIVIR
Clopidogrel decreases the level of oseltamivir

16. MONITORING PARAMETERS
• METOPROLOL : nausea , constipation , fatigue, dizziness
• ASPIRIN : Abdominal upset, GI bleeding
• TRIMETAZIDINE : nausea, skin rashes, palpitation, hypotension
• Rusovastation and clopidogrel : stiffness, fatigue
• PANTAPRAZOLE : headache , fever , constipation or diarrhea,
• CEFEPERAZONE : diarrhea, anemia, hypersensitivity reaction
• ACETAMINOPHEN : GI irritation , hepatotoxicity
• CLARITHROMYCIN : diarrhea, nausea , headache
• OSELTAMVIR : nose bleeding, fever , body pain

17. COUNSELLING POINTS
• Use of mask in the public place
• Should not smoke
• Drink more fluids
• Wash hands frequently
• Do some aerobic exercises
• If you get hypotension or diarrhea consult with your physician
• Take low salt
• Take pantoprazole 30 min before food