2. My patient was a 35 year old female from
female ward of general medicine department.
I.P NO. : 51979
D.O.A : 26.11.15
3. SUBJECTIVE
REASON FOR ADMISSION : c/o abdominal discomfort,
joint pains. Vomiting past one month.
PAST MEDICAL HISTORY : Patient is steroid
dependent(can’t survive without these tablets)
not k/c/o DM,HTN
PAST MEDICATION HISTORY : on regular medication
past 10 years. T. Dexamethasone 0.5mg
T.Phenyl butazone
4. KNOWN ALLERGIES : Nil
SMOKER : No
ALCOHOLIC : No
TOBACCO IN ANY FORM : No
MARITAL STATUS : Married
5. OBJECTIVE
LABORATORY INVESTIGATIONS:
Blood Pressure, Cell Blood Count, Renal Function Test.
GENERAL INVESTIGATION :
Patient is conscious, weak, afebrile, poorly built. She is
steroid dependent from past 10 years.
7. BLOOD COUNTS
CELLS NORMAL VALUE PATIENT VALUE
HEAMOGLOBIN
(g/dl)
M 12-16
F 11-14
10
TLC(cells/cumm) 5000-10000 9500
PLATELETS 1-3 lakh
POLYMORPHS 40-60 65
LYMPHOCYTES 20-30 27
BASOPHILS 0-1 00
EOSINOPHILS 1-4 04
MONOCYTES 1-2 04
8. RENAL FUNCTION TEST
Normal Value Patient Value
UREA(mg%) 15-45 61
URIC ACID(mg%) F 2-5
M 2-7
CREATININE(mg%) 0.6-1.4 2.6
9. ASSESSMENT
Patient was diagnosed with Arthritis, Polyarthritis.
Patient was steroid dependent from past 10 years.
Patient had vomiting since one month.
Patient has abnormal urea and creatinine value.
Urea - 61 mg%
Creatinine - 2.6 mg%
10. S.No TRADE NAME GENERIC
NAME
FREQU
ENCY
DAYS
01 Inj.Pantop IV
(40mg)
Pantoprazole
sodium
1-0-1 26/11/15 to 29/11/15
02 Inj.Emest (4mg) Ondansetron 1-1-1 26/11/15 to 29/11/15
03 T.Dolo(650mg) Paracetamol 1-1-1 26/11/15 to 27/11/15
04 T.Dexamethasone
(0.5mg)
Dexamethasone 1-0-1/2 26/11/15 to 29/11/15
05 T.TRP Tremadol +
Paracetamol
1-0-1 27/11/15 to 29/11/15
06 T.HCQ(200mg) Hydroxychloroqui
ne sulphate
1-0-0 27/11/15 to 29/11/15
TREATMENT PLAN
11. S.No. TRADE NAME GENERIC
NAME
FREQUE
NCY
DAYS
07 Pirox(40mg) Piroxicam 1-0-1 26/11/15
08 IVF 10NS Normal
saline
50ml/hr 26/11/15 to 29/11/15
12. DAY 1
• Patient had vomiting hence was very weak.
• Normal saline IVF was given to compensate
electrolyte loss.
• Renal function test report showed some
abnormalities in urea and serum creatinine
level.
• Inj.Pantop, Inj.Emeset, T. Dolo and
Dexamethasone, Normal saline, Piroxicam was
started.
• Blood pressure was normal.
13. DAY 2
• Patient now had less episodes of vomiting.
• Piroxicam was stopped.
• T.TRP, T.HCQ was started as she still had
complance of sever joint pain.
• All other medications were continued as per the
treatment chart.
• Blood pressure was recorded as normal.
14. DAY 3
• No episodes of vomiting was noticed.
• Emeset was continued to prevent vomiting due
to side effects of other drugs(dexamethasone,
tramadol, piroxicam)
• Patient started showing positive signs to the
treatment given.
• Medications continued as per the treatment
chart.
15. DAY 4
• Patient feels better.
• Medications continued as per the treatment
chart.
16. DRUG INTERRACTION
• HCQ-ONDANSETRON : MAJOR
Concurrent use of HCQ and QT prolonging
agents may result in increased risk of QT
prolongation.
• ONDANSETRON-TRP : MODERATE
Concurrent use of ondansetron and tramadol
may result in reduced efficacy of tramadol.
• Piroxicam, dexamethasone, tramadol, pantop,
hydroxychloroquine sulfate are contraindicative
in pregnant and lactating mothers.
17. PHARMACIST INTERVENSION
SUGGESSIONS TO PHYSICIAN:
• Emeset should not be given with HCQ and Tramadol.
• Drug duplication to be checked.
• Phenylbutazone has to be discontinued as it has major side
effect i.e kidney damage.(refer renal function test report)
SUGGESSIONS TO PATIENT:
• Inform physician in case of any side effects.
• Donot discontinue Dexamethasone until directed by a
physician as it has unpleasant withdrawal symptoms.
• Increase intake of calcium rich food.
• Take the medication properly as it will improve the quality
of life.
