Tuberculosis and Pneumonia case study || PWDT form for Pharmacist ...pharmacyteach

 

Tuberculosis and Pneumonia

Pharmacist Workup of Drug Therapy (PWDT)

Pharmacist’s Patient Database

 

A	PATIENT DESCRIPTION
Name:  Mohammad Sulman		Age:70
Reg. No: 33471-56-501		Gender:Male
DOA:25-12-2023		Weight:
Address:chak No: 42 b tehsil yazman		Height:

 

B	CHIEF COMPLAINT
Ø  Cough( 3-4 weeks) Ø  Fever Ø  Shortness of breath Ø  Chills

 

C	HISTORY OF PRESENT ILLNESS
Ø  Tuberculosis Ø  Pneumonia

 

D	PAST MEDICAL/MEDICATIONS HISTORY
Diseases		Onset	Resolve	Prescriptions
Ø  Tuberculosis Ø  Pneumonia		20 days		·         No Record

 

 

E	PAST SURGICAL HISTORY
NILL

 

F	FAMILY HISTORY
NILL

 

 

 

 

G	MEDICAL HISTORY INTERVIEW
HEART PROBLEMS			URINARY/REPRODUCTIVE
Chest pain (angina)			UTI
Past heart attack			Prostate problems
Heart failure			Hysterectomy
Irregular heart beat			Chronic yeast infections
Heart by-pass surgery			Kidney disease
Rheumatic fever			Dialysis
Other			Other
EYES AND ENT			MUSCLES AND BONES
Poor vision			Arthritis
Poor hearing			Gout
Glaucoma			Back pain
Sinus problems			Amputation
Bladder disorder			Joint replacement
Other			Other
GASTROINTESTINAL			NEUROLOGICAL
Heartburn			Headache
Ulcer			Seizures or epilepsy
Constipation			Parkinson’s disease
Diverticulitis			Dizziness
Liver disease		+ve	Past stroke
Gallbladder problems			Fainting
Pancreatitis			Depression
Upper GIT bleeding			Anxiety
			Other:
DO YOU HAVE			LUNG PROBLEMS
High blood pressure			Asthma
Low blood pressure			Emphysema
High cholesterol			Bronchitis
Diabetes			Other: T.B , Penumonia	+ve
Cancer			DO YOU HAVE/ USE
Anemia			Glasses
Bleeding disorder			Hearing aid
Hay fever			Other
Sleeping problems
Other
DO YOU HAVE A FAMILY HISTORY OF
High blood pressure
Heart disease
Diabetes
Other

 

 

H	MEDICATION GIVEN IN THE WARD
Date start	Date stop	Medication	Remarks
25-1-16		Inj. Ceftriaxone (1g)  BD  IV	Antibiotic
25-1-16		Inj. Omeprazole (40mg) IV  BD	Proton  pump inhibitor
25-1-16		Nebulizer Ventolin	Bronchodilator
25-1-16		IV. levofloxacin (5mg/ml)	Antibiotic
25-1-16		IV. Paracetamol (1g/100ml)	Antipyretic

 

 

 

LABORATORY TESTS

 

TESTS

RANGES

DATE-WISE RESULT

 

Hematological Tests

 

RBC

4.5-5.5/cmm

3.09/cmm

Hgb test

12-16g g/dl

9/dl

ESR

0-10mm/ hour

130

PCV / HCT

40-54%

27.4%

MCV

76-96 fl

67.8fl

MCH

27-32 g

20.1 pg

MCHC

Retic. Count

WBC/ TLC

4000-11000 mm3

28800mm3

Neutrophils

40-75%

79%

Lymphocytes

20-45%

10%

Monocytes

2-10%

04%

Eosinophils

1-6%

07%

Basophils

ANC

PLT

400000mm3

402000mm3

PT

14 sec

APPT

38

INR

0.9-1.2

 

 

Liver Function Tests

 

Bilirubin Total

<1.0mg/dl

0.9 mg/ml

Direct/Conj

ALT/ SGPT

<31U/L

95 U/L

AST/ SGOT

ALP

<279U/L

417 U/L

GGT

Albumin

Globulins

Total serum protein

Anti HCV

 

Renal Function Tests

 

BUN

10-50mg/dl

28 mg/dl

Scr

Clcr

Creatinine

0.6-1.1 mg/dl

0.6 mg/dl

Uric acid

2.4- 5.7 mg/ml

3.7 mg/ml

 

Electrolytes

 

Na

135-155mEq/L

138mEq/L

Cl

K

3.5-5.5mEq/L

4.5 mEq/L

HCO3/CO2

Ca

Mg

PO4

 

Blood Sugar& HbA1c

 

RBS

FBS

HbA1c

 

Other Tests

 

 

 

Chest X-Ray, ECG, U/S, CT-Scan, MRI, etc Findings

 

_________________________Abnormal___________________________________________

M	MICROBIOLOGY
serial	Source	Isolate	Sensitivity
1.	Sputum Culture	Active Tb	+ve
2.	Sputum Smear Grading	Active Tb	+1

 

 

 

N	DIAGONOSIS/MEDICAL PROBLEMS LIST

 

·         Tuberculosis

·         Pneumonia

O	DAILY PROGRESS REPORTS (DPRs)

 

DPR (Date:  25     /  01   / 16           )	DPR (Date:    25     /  01   / 16)
Subjective/Objective	Assessment/Plan
B.P: 100/40 mmHg Pulse Rate: 98 Temp: 99 F0 R.R: 17/min	Inj. Ceftriaxone (1g)  BD  IV Inj. Omeprazole (40mg) IV  BD Neubulizer Ventolin IV Levofloxacin  (400mg) PO IV Paracetamol O2 Inhalation 2L/min
DPR (Date:      26     /  01   / 16)	DPR (Date:    26     /  01   / 16)
Subjective/Objective	Assessment/Plan
B.P: 110/70 mmHg Pulse rate: 87 Temp: 99Fo R.R: 17/min	Inj. Ceftriaxone (1g)  BD  IV Inj. Omeprazole (40mg) IV  BD Neubulizer Ventolin IV Levofloxacin (400mg) PO IV Paracetamol O2 Inhalation 2L/min

 

 

 

 

 

 

P	DRUG THERAPY ASSESSMENT/ IDENTIFYING DRUG RELATED PROBLEMS
Types of DRP	Assessment Questions	Actual	Potential	No	Comments
Indication	a. Are there drugs without a medical indication?   b. Is there any correlation between drug therapy and medical problems?   c. Are there any medications unidentified (not labeled or unknown)?	ü		ü              ü
Drug product selection	a. What is the comparative efficacy of the chosen medication(s)?   b. What is the relative safety of the chosen medication(s)?   c. Has the therapy been tailored to this individual patient?		ü   ü	ü
Drug regimen	a. Are the prescribed dose and dosing frequency appropriate with the usual therapeutic range and/or modified for patient factors?   b. Is PRN use appropriate for these medications?   c. Is the route/dosage form/mode of administration appropriate, considering efficacy, safety, convenience, patient limitations, and cost?   d. Are doses scheduled to maximize therapeutic effect and compliance and to minimize adverse drug effect, drug interactions and regimen complexity?   e. Is the length or course of therapy appropriate?	ü     ü   ü	ü
Therapeutic duplication	a.Are there any therapeutic duplications?   b. Additives, antagonistic, or synergistic effects?		ü ü
Drug allergy or intolerance	a.Is the patient allergic to or intolerant of any medicines (or chemically related medications) currently being taken?   b. Is the patient using any method to alert health care providers of the allergy/intolerance (or serious medical problems)?			ü     ü
Adverse drug events	a. Are there symptoms or medical problems that may be drug-induced?   b. What is the likelihood that the problem is drug related? Has it been reported?	ü   ü
Drug interactions	a. Are there drug-drug interactions?   b. Are these clinical significant?   c. Are any medications contraindicated (relatively or absolutely) given patient characteristics and current/past disease status?   d. Are there drug nutrient interactions? Are these clinically significant?   e. Are there drug laboratory interactions? Are these clinically significant?			ü ü   ü     ü
Failure to receive therapy	a. Has the patient failed to receive a medication due to system error or non-compliance?   b. Are these factors hindering the achievement of therapeutic efficacy?		ü   ü
Financial impact	a. Is the chosen medications(s) cost-effective?   b. Does the cost of drug therapy represent a financial hardship for the patient?		ü	ü
Patient knowledge of drug therapy	a. Does the patient understand the purpose of his/her medication(s), how to take it, and the potential side effects of therapy?   b. Would the patient benefit from education tools (e.g., written patient education sheets, wallet cards and reminder packaging)?		ü     ü

Q	PHARMACIST CARE PLAN MONITORING WORKSHEET
Types of DRP	Goals of Therapy	Therapeutic alternatives	Drug of choice	Monitoring parameters
Untreated indications	To achieve a desire therapeutic effect	Intensive Phase : Daily treatment with appropriate patient support, including DOT, for two months ·         Rifampicin ·         Pyrazinamide ·         Ethambutol   Continous Phase : Daily treatment with appropriate treatment support, including DOT, for four or six months   Ethambutol (E) and Isoniazid (H), 6 months. Or Rifampicin (R) and Isoniazid (H), 4 months.   A b-lactam (cefotaxime, ceftriaxone, or ampicillin) plus either azithromycin or a fluoroquinolone (level I evidence) (strong recommendation)   (For penicillin-allergic patients, a respiratory fluoroquinolone and aztreonam are recommended	ü  Rifampicin (R). ü  Isoniazid (H). ü  Pyrazinamide (Z) ü  Ethambutol (E) ü  Ampicillin. ü  Sulbactam. ü  Azithromycin ü  Fluoroquinolones	Visual Acuty and Color Vision measurements   Hepatic Enzymes and Uric acid measurement.   CBC count.   ECG monitoring   Renal creatinine Clearance monitoring..

R	IMPLIMENTATION OF THE PHARMACEUTICAL (PC) CARE PLAN
PC intervention on DRPs (Date, Drug, dosage regimen, Monitoring parameters)		Consultation to other health care professionals	Accepted (Y = Yes, N = No,    C = Accepted with changes)
26-12-23   MOXIFLOXACIN & AZITHROMYCIN (pneumonia moreover patient also suffers from TB)   PARAMETERS: ·         ECG MONITORING ·         CBC ·         RFT’S		Ward physician	ACCEPTED Y
Therapeutic Communications*		Professionals/ Patients	Comments/Outcomes

 

* Besides counselling, medication history taking, ADR report

   A METHOD FOR ESTIMATING THE PROBABILITY OF ADVERSE DRUG REACTION

(To assess the ADR, please answer the following questionnaire and calculate the patient score)

 

 

 

Reference values
If score is	then ADR is
≤ 0	Doubtful
1 to 4	Possible
5 to 8	Probable
≥ 9	Definite

 

 

 

 

S	PSYCHOMETRIC EVALUATION OF THE PATIENT

 

 

Comment:

Patient health is not improving due to untreated indications. The imaginable health state of the patient is 20 on the scale