A 34-year-old male patient presented with left renal calculi measuring 8mm according to a ultrasound scan. He reported pain in his loin for 10 days. His medical history included asthma. Physical exam findings were normal except for renal calculi seen on ultrasound. He was diagnosed with renal calculi and prescribed medications including ciprofloxacin, rabeprazole, drotaverine, ipratropium/albuterol, and budesonide to treat symptoms and prevent complications from the kidney stones.

1. CASE PRESENTATION
ON RENAL CALICULI
Presented by :
P.Vigneswari
III/VI pharm.d
Y17phdo821

2. BRIEF SUMMARY OF CASE
A 34 years male old patient was admitted in the hospital with chief
complaints of pain in loin for 10 days and USG scan shows left renal
calculi.And having k/c/o asthma. He has no past history and social
history

3. SUBJECTIVE DATA
A 34 years male old patient was admitted in the hospital with
chief complaints of pain in loin for 10 days and USG scan shows left
renal calculi.He has n/h/o of burning micturation, haematuria,SOB ,
fever ,chest pain and UTI . He is having k/c/o asthma .He has no past
history and social history.

4. OBJECTIVE DATA
Physical Examination :
Temp : 98.6%
P/ R :. 80/min
. B.P. :. 120/70 mm hg
. SPO2. :. 98%
Systemic Examination :
CVS. :. S1S2+
RSBAE : normal
P/A. :. Soft
. CNS. :. NAD

5. USG SCAN
• Impression : left renal calculi – 8mm

6. ASSESMENT
Based on the subjective data and objective data the final
diagnosis of the patient was found to be having RENAL CALCULI i.e
based on the USG scan report
DEFINITION : A small ,hard deposit that forms in the kidneys and
is often painful when passed . It is also called as Nephrolithiasis

7. ETIOLOGY
• The main cause for this patient is IDIOPATHIC
RISK FACTORS :

8. PATHOPYSIOLOGY

9. CLINICAL PRESENTATIONS

10. PLAN
1. Goals :
To decrease signs and symptoms by symptomatic therapy.
To prevent further complications.
To avoid disease progression
2. Standard treatment :
Pain relievers – ibuprofen, acetaminophen.
Drinking more water.
Medical therapy – alpha blockers.
Surgery – Nephrolithotomy
Parathyroid gland surgery

11. CURRENT DRUG CHART
S.NO BRAND
NAME
GENERIC
NAME
DOSE R.O.A FREQ CATEGOR
Y
USE
1. T.Cipox Ciproflaxa
cin
500 mg P/O BD Fluoroqui
nolone
To treat
bacterial
infection
2. Razo-d Rabeprazo
le
20mg P/O OD Proton
pump
inhibitor
Prophylac
tic drug
3. T.Drotikin
d
Drotaverie
n
80 mg P/O BD Anti
spasmodic
To treat
spasms
4. Neb.Duloi
n
Ipratropiu
m +
albuterol
20mg
+
100 mcg
P/N TID Anti
cholinergi
c + beta
agonist
To treat
asthma
5. Neb.Bude
cort
Budesonid
e
200 mcg P/N TID Corticoste
roid
To treat
asthma

12. DRUG NAME M.O.A ADRs M.O.P
Ciproflaxacin By inhibiting DNA gyrase
and inhibiting cell
division
Arthralgia,myalgia,and
pain pyelopnephritis
BP, HR, PFT, RFTs
Rabeprazole Suppress gastric acid by
inhibiting H+/K+ ATPase
Headache,rash,pruritis,
dizziness, fatigue, cough
Monitor Mg levels
Drotaverien Inhibition of
phsophodiesterase -1V,
correct cAMP
Vertigo, nausea, vomiting
and dry mouth
Monitor LFTs, RFT
Ipratropium + albuterol Albuterol : Relaxes
bronchus smooth muscle
Ipratropium : blocks
action of ach
Chest discomfort,edema ,
fatigue, heaache
PFTs ,BP, HR, serum
K+,glucose levels
Budesonide Depress the migration of
PMN, leukocytes and
prevent inflammation
Fatigue ,edema,chest
discomfort,nausea and
vomiting, rash
PFTs ,BP, HR

14. DRUG – DRUG INTERCATION
• MODERATE :
1. Ciprofloxacin and albuterol : Beta agonists can cause dose related
prolongation of QT interval and K+ loss.
Mng : Caution is recommended,prompt medical attention if they
experience any symptoms.
2. Ciproflaxacin and budesonide : Co administration with inhibitors
of CYP450 may increase the systemic bio availability of budesonide
. Mng : Dosing times should be avoided or separated

15. DRUG and FOOD INTERACTIONS
1. Ciproflaxacin : Do not take ciprofloxacin with dairy products such
as milk or yogurt, or with calcium-fortified foods e.G., cereal, juice
2. Budesonide : Avoid the regular consumption of large amounts of
grapefruits and grapefruit juice while taking budesonide. Grapefruit
can raise the levels of budesonide in your body and lead to increased
side effects.

16. PATIENT COUNSELING
• About disease : Kidney Stones or renal calculi are solid masses made
of crystal. Kidney stones usually orginate in our kidneys . They can
develop anywhere along urinary tract such as : kidney,ureters, bladder
and urethra

17. • About drugs :
1. Ciproflaxacin : Administer with or without food
2. Rabeprazole :. Take 30 min before meals to avoid GI distres.
• LIFE STYLE MODIFICATIONS