2. Presentation outline
Patient Demography
Patient presentation
Physical Examination
Investigations and Lab parameters
Pharmaceutical care plan
Monitoring parameters
Discharge counseling
References
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3. Patient Demography
• Name-M.T
• Age- 35 years
• Sex- M
• MRN-171316
• Ward-medical
• Bed No-25
• Admission date-30/08/2015
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4. Patient Presentation
• Chief Compliant
Light headedness and one episode of syncope 02 hours
duration.
History of Patient Illness
This a 35 years old male patient presented with light
headedness and one episode of syncope for 02 hours
duration. Associated to this he has also history of loss of
appetite, lightheadness, and weight loss. He is also known
Crohn’s disease(CD) patient follow-medications are
prednisolone 40mg p.o/day, methotrexate 15mg/weekly.
He has also unilateral leg swelling and mild abdominal pain.
Otherwise no history of cough, orthopnea, PND, and
vomiting
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5. Physical Examination
• G/A: ASL
• V/S: BP 87/60,PR-104, RR-20, T-35oc, spo2-90% off
• HEENT: pink conjunctiva, no icteric sclera
• LGS: no LAP
• Chest: clear and good air entry
• CVS: S1 & S2 well heard, no murmur & gallop
• Abd: no sign of fluid collection , no Organomeglly
mild abdominal tenderness
GUS: no CVAT
MSS: G-1 unilateral petting edema
CNS: COTPP
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6. Cont....
Drug allergy: NKDA
FH: his elder brother is a known Crohn's disease
patient
SH: He does not smoke, but occasionally drink
Alcohol
Past medication
prednisolone 40mg p.o/day
methotrexate 15mg/weekly
folic acid 5mg p.o/d
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7. Investigations & Lab. parameters
OFT and SE
RBS
CBC
Coagulation profiles
Imaging
ESR
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15. Supplement Start date Stop date Indication
Folic acid 5mg
p.o/day
01/09/2015 - Megaloblastic
anemia and For
prevention
anemia induced
by methotrexate
Cyanocobalami
n 1mg IM/day
01/09/2015 - Megaloblastic
anemia
High protein
diet
01/09/2015 - Hypoalbuminemia
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16. Drug Therapy Problems
Drug related
need
DTP Recommend
ation
/Intervention
Reason Monitorin
g
parameter
s
Safety dose
too high
Decrease the
dose of
methotrexate
into 15mg/wk
Proton pump
inhibitors such
omeprazole to
increase the
plasma
concentrations
of
methotrexate
OFT,SE
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17. Goal of Therapy
DVT
• Prevent further clot formation and embolization
• Relieve symptoms
• Prevent recurrence of DVT
• Decrease the risk of other complications
• Improve patient quality of life
Pancytopenia Secondary to Megaloblastic anemia
• To address the underlying cause
• Correcting nutritional deficiencies
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18. Cont....
CD
• Resolution of attendant complications (e.g.,
fistulas and abscesses)
• Maintaining adequate nutritional status
• Relieving intestinal inflammation, dysfunction,
and the development of cancer
• Alleviation of systemic manifestations (e.g.,
arthritis)
• Reducing the need for surgery or chronic
corticosteroid use
• Minimize side effects and long-term adverse
effects
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19. Pharmacotherapeutic Care plan
Subjective
• Light headedness
• one episode of syncope
• mild abdominal pain
Objective
Recent Hgb level 8.2 g/dL
• V/S: BP- 87/60, T-35 c
• Abd: mild abdominal tenderness
• MSS: Grade I unilateral petting edema
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23. Discharge Counseling
• Take the medications appropriately (type,
dose, frequency, timing and duration)
• Consult HCP before the initiation and
discontinuation of any medication
• Reduced or limit high vitamin k contain food
like, Spinach, Mustard greens, Soybean oil, etc.
• Avoid environmental trigger factors like
smoking, stress and depression.
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24. References
1. Brian K.Alldredge, Robin L. Corelli, Micheal E.
Ernest, B.Joseph Guglielmo, sPamala A. Jacobson,
Wayne A. Kradjan, Bradly R. Williams, Applied
Therapeutics The Clinical Use Of Drugs, New York,
Wolters Kluwer, 2013, 10th edition.
2. Marie A. Chisholm-Burns, Barbara G. Wells, Terry
L. Schwinghammer, Patrick M. Malone, Jill M.
Kolesar, John C., Joseph T. Dipiro,
Pharmacotherapy principles and practice, New
York;Mc Graw Hill, 2008, 2nd edition
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