- A 70-year-old man presented with breathlessness and was diagnosed with type 2 diabetes mellitus, chronic obstructive pulmonary disease, and hypertension. - He was treated with various medications including insulin, antibiotics, bronchodilators, corticosteroids, and antihypertensives based on his conditions and symptoms. - His treatment plan was adjusted over several days based on his blood sugar, pulse, and temperature readings.

1. CASE PRESENTATION:
DMT2, COPD & HTN
PRESENTED BY : TANUSHKA
DEPARTMENT OF PHARMACY PRACTICE
PharmD : 2nd year

2. SUMMARY
• A.J a 70 –year old man with no known drug allergy (NKDA) was
hospitalized with chief complaint of breathlessness and asymptomatic
during 2 days .He had been a K/C/O Diabetes mellitus type 2 and bronchial
asthma for since 2 years for which he was being treated with metformin
500 mg and combination of Levocetirizine and Montelukast Sodium. A.J.
has severe respiratory distress and presence of Bilateral wheezing sounds
and crepts. Laboratory tests were conducted and the report are as follows:
• RBS- 616 mg/dl
• Blood Urea- 42mg/dl
• Sr. Creatinine- 0.8mg/dl
• Hb-12.5 g/dl
• TLC- 8.4*103/l
• Albumin- 3.5g/dl
• Globulin- 3.2g/dl

3. SUBJECTIVE
• AGE- 70 years
• SEX- Male
• C/C: Breathlessness since 2 days
• MEDICAL HISTORY- K/C/O DM T2, BA since 2 years
• N/K/D/A
• MEDICATION HISTORY- Oral Metformin 500mg,
Comb. Of levocitrizen and Montelukast sodium
for the above stated period
• SOCIAL HISTORY-Reformed smoker

4. OBJECTIVE
• Physical examination
Respiratory - rate -16 breaths/min, B/L crepts and wheezing present
Laboratory investigation
RBS- 616 mg/dl
Blood Urea- 42mg/dl
Hb- 12.5 g/dl
TLC- 8.4*103/l
Albumin- 3.5
Globulin- 3.2
ALT- 50 IU/L
AST- 61 IU/L
ALP- 110IU/L
Sodium- 134 mg/dl
Potassium- 3.9 mg/dl
Chloride- 90 mg/dl
Calcium- 8.5 mg/dl
Platelets- 301*103 /ul
Monocyte- 10.3%
Neutrophils- 85%
Lymphocyte 15%
FINAL DIAGNOSIS: DMT2, COPD & HTN

5. TREATMENT PLAN-17/1/15 (ON ADMISSION) RBS-616 mg/dl
BRAND NAME GENERIC NAME DOSE ROUTE FREQUENCY
INJ.LASIX FUROSEMIDE 20 mg I.V BD
Neb.DUOLIN
BUDECORT
LEVOSALBUTAMOL AND
IPRATROPIUM
BROMIDE
BUDESONIDE
2.5 ml
0.5mg
NASAL BD
INJ.DERIPHYLLIN ETOPHYLLINE
THEOPHYLLINE
84.7 mg
25.3 mg
I.V TDS
INJ.AUGMENTIN AMOXYCILLIN
POTASSIUM
CLAVULANATE
1.2 g I.V TDS
INJ.PANTOP PANTOPRAZOLE 40 mg I.V OD
Inj
HYDROCORTISONE
HYDROCORTISONE 100mg I.V STAT

6. TREATMENT PLAN -18/1/15 (RBS- 685mg/dl)
BRAND NAME GENERIC NAME DOSE ROUTE FREQUENCY
INJ. LUPINSULIN INSULIN 40IU SC BD
INJ.LASIX FUROSEMIDE 20 mg I.V BD
Neb . DUOLIN
BUDECORT
LEVOSALBUTAMOL AND
IPRATROPIUM
BROMIDE
BUDESONIDE
2.5 ml
0.5mg
NASAL BD
INJ.DERIPHYLLIN ETOPHYLLINE
THEOPHYLLINE
84.7 mg
25.3 mg
I.V TDS
INJ.AUGMENTIN AMOXYCILLIN
POTASSIUM
CLAVULANATE
1.2 g I.V TDS
INJ.PANTOP PANTOPRAZOLE 40 mg I.V OD
TAB.AMLOVAS AMLODIPINE 5 mg oral OD
Tab. DIAPRIDE GLIMEPRIDE 1 mg ORAL BD

7. TREATMENT PLAN -19/1/15 (RBS-272 mg/dl) pulse rate-82 beat/min
BRAND NAME GENERIC NAME DOSE ROUTE FREQUENCY
INJ.LASIX FUROSEMIDE 20 mg I.V BD
Neb . DUOLIN
BUDECORT
LEVOSALBUTAMOL AND
IPRATROPIUM
BROMIDE
BUDESONIDE
2.5 ml
0.5mg
NASAL BD
INJ.DERIPHYLLIN ETOPHYLLINE
THEOPHYLLINE
84.7 mg
25.3 mg
I.V TDS
INJ.AUGMENTIN AMOXYCILLIN
POTASSIUM
CLAVULANATE
1.2 g I.V TDS
INJ.PANTOP PANTOPRAZOLE 40 mg I.V OD
TAB.AMLOVAS AMLODIPINE 5 mg oral OD
Tab. DIAPRIDE GLIMIPRIDE 1 mg ORAL BD

8. TREATMENT PLAN-20/1/15(RBS-426 mg/dl) pulse rate -106 beat/min
Temperature – 100.4 F
BRAND NAME GENERIC NAME DOSE ROUTE FREQUENCY
Neb . DUOLIN
BUDECORT
LEVOSALBUTAMOL AND
IPRATROPIUM
BROMIDE
BUDESONIDE
2.5 ml
0.5mg
NASAL BD
INJ.DERIPHYLLIN ETOPHYLLINE
THEOPHYLLINE
84.7 mg
25.3 mg
I.V TDS
INJ.AUGMENTIN AMOXYCILLIN
POTASSIUM
CLAVULANATE
1.2 g I.V TDS
INJ.PANTOP PANTOPRAZOLE 40 mg I.V OD
Tab. DOLO PARACETAMOL 650mg ORAL SOS
Tab. DIAPRIDE GLIMIPRIDE 1 mg ORAL BD
TAB.AMLOVAS AMLODIPINE 5mg oral OD

9. TREATMENT PLAN-21/1/15 (RBS-315mg/dl) pulse rate -98/min
BRAND NAME GENERIC NAME DOSE ROUTE FREQUENCY
Neb . DUOLIN
BUDECORT
LEVOSALBUTAMOL AND
IPRATROPIUM
BROMIDE
BUDESONIDE
2.5 ml
0.5mg
NASAL BD
INJ.DERIPHYLLIN ETOPHYLLINE
THEOPHYLLINE
84.7 mg
25.3 mg
I.V TDS
INJ.AUGMENTIN AMOXYCILLIN
POTASSIUM
CLAVULANATE
1.2 g I.V TDS
INJ.PANTOP PANTOPRAZOLE 40 mg I.V OD
Tab. DIAPRIDE GLIMIPRIDE 1 mg ORAL BD
TAB.AMLOVAS AMLODIPINE 5mg oral OD

10. ASSESSMENT
• Patient with DM T2, treated indication.
• Nebulisation with duolin and budecort is rationale for treatment of COPD.
• Amoxicillin and potassium clavunalate is rationale for preventing Respiratory
dysfunction due to microbial growth.
• Hydrocortisone is rationale for anti-inflammatory effect.
• Glimepride and amlodipine are rationale for treating DM and HTN respectively.
• Spirometry not done to evaluate the severity of COPD.
• No significant drug interactions were found.

11. PLAN
• Hydrocortisone should be given with
prednisolone
• As per ADA –combination of metformin and
glipizide should be given
• Amlodipine was given because ARBs and ACE
inhibitor may induce dry cough