CASE PRESENTATION OF RVD WITH PULMONARY TB - PowerPoint Presentation

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CASE PRESENTATION OFRVD WITH PULMONARY TB

SCENARIO :

Here is a 17 yr old female patient presented with a complaints of fever and cough with expectoration and admitted in FMW for 8 days and she was diagnosed as RVD WITH PULMONARY TB.

CHIEF COMPLAINTS :

c/o fever since 4 days .

c/o cough with expectoration since 4 days .

PAST MEDICAL HISTORY : k/c/o RVD with pulmonary TB 8 months back ,she discontinued her treatment. H/o chicken pox -6 yrs back.

PAST MEDICATION HISTORY :

Nothing significant .

LAB INVESTIGATIONS :

CBC :

WBC : 11100 cumm -slightly increased which indicates presence of infection.

N – 82 % - increased which indicates systemic bacterial infection.

L – 15 % - decreased which indicates ,immunodeficiency or AIDS to attack TH4 cells .

ESR : 60 mm/hr –increased which indicates chronic infection.

MCH – 30.1 decreased the indicates hypochromia .PCV - 34.8 decreased , which indicates anaemia

overdehydration

or blood loss.

CD4 count – 340 cells/

ccmm

.

URINE EXAMINATION :

Epithelial cells : 8-10

hpf

increased, which indicates

infiltraton

of urine

VITAL SIGNS

:

BP : 110/70 mm/hg

PR :80 bpm

RR :22

TEMP : 37

OTHER INVESTIGATIONS : sputum test : NEGATIVE (mucoprulent )

chest x –ray reveals interstitial infiltrates in lower zones .

ECG : normal sinus rhythm .

pruritis papules of HIV (dermatology reference)

PROBLEM LIST :

FEVER

COUGH WITH EXPECTORATION

PULMONORY TB

RVD

DIAGNOSIS

RVD WITH PULMONARY TUBERCULOSIS

SOAP FORMAT SUBJECTIVE EVIDENCE :

Here is a 17 yr old female patient presented with a complaints of fever and cough with expectoration and admitted in FMW for 8 days .

OBJECTIVE EVIDENCES :CBC :

WBC : 11100 cumm -slightly increased which indicates presence of infection.

N – 82 % - increased which indicates systemic bacterial infection.

L – 15 % - decreased which indicates ,immunodeficiency or AIDS to attack TH4 cells .

ESR : 60 mm/hr –increased which indicates chronic infection.

MCH – 30.1 decreased the indicates hypochromia .

PCV - 34.8 decreased , which indicates

anaemia

overhydration or blood loss.

OTHER INVESTIGATIONS : sputum test : NEGATIVE (mucoprulent )

chest x –ray reveals interstitial infiltrates in lower zones .

ECG : normal sinus rhythm .

pruritis papules of HIV (dermatology reference)

CD4 count – 340 cells/

ccmm

.

URINE EXAMINATION :

Epithelial cells : 8-10

hpf

increased, which indicates

infiltraton

of urine

VITAL SIGNS :

BP : 110/70 mm/hg

PR :80 bpm

RR :22

TEMP : 37

ASSESMENT : Based upon above subjective evidence and objective evidence

the physician diagnosed the condition as RVD WITH PULMONARY TB .

PROBLEM LIST :

1 . FEVER

2 . COUGH WITH EXPECTORATION

3 . PULMONARY TB

4 . RVD

RVD : Infection with HIV occur through 3 primary modes sexual,parentral and parental.

sexual intercourse , primarily receptive anal and vaginal intercourse is most common transmission.

FEVER : It is usually a symptom of an underlying condition , most often

by an infection. In response to an TB infection , the hypothalamus

May reset the body to a higher temperature, more than normal temp – 98.6 F

COUGH WITH EXPECTORATION :

It is a rapid expulsion of air from the lungs . It can be done deliberately or involuntarily.

PULMONARY TB :

The main cause of TB is Mycobacterium tuberculosis,a small , aerobic, nonmotile bacillus.

TB infection begins when the mycobacterium reach the pulmonary alveoli , where they invade and replicate within endosomes of alveolar macrophages .

GOALS OF THERAPY :

1. Subside the symptoms with appropriate therapy.

2. curing the TB infection and preventing spread in community.

3. Treatment with a single drug can lead to development of drug – resistant TB .

4. Multi drug regimens rid extracellular organisms in the caseating macrophages and activated granulomas, and minimize resistance.

5. The ultimate goal is to decreased mortality and morbidity.

PLAN:

Momate

cream –

momate

furoate

–topical D04 to D08

s.no

Brand

name

Generic name

Dose

1

2

3

4

5

6

7

8

1

Inj.Taxim

1-0-1

cefixime

1gm

iv

Y

Y

2

Inj.Rablet

1-0-0

Rabeprazole

20mg

iv

Y

Y

3

T.Calpol

1-0-1

Paracetamol

150mg

Y

Y

4

Inj.Axipan

1-0-0

Pantoprazole

40mg

iv

Y

Y

5

T.PAN

1-0-0

Pantoprazole

40mg

oral

Y

Y

Y

Y

6

C.Akurit-4

1-0-0

H+R+Z+E

75+150+400+275

Y

Y

7

C.R-

cinex

1-0-0

H+R

450+300

Y

Y

Y

Y

Y

Y

8.

T.Fluconazole

1-0-0

fluconazole

150mg

Y

Y

Y

Y

Y

Y

Y

9.

T.Azithral

0-1-0

azithromycin

500mg

oral

Y

Y

Y

10.

T.Tecrzinc

1-0-0

Levocitrizine

dihydrochloride

5mg

Oral

Y

Y

Y

Y

Y

11.

T.Benadon

1-0-0

Vit-B6

40mg

oral

Y

Y

Y

Y

Y

Y

Y

DRUGS :Fluconazole :MOA : It is a triazole antifungal , acts by inhibiting the fungal cytochrome p-450 dependent enzyme , lanosterol – 14-alpha demethylase ,ergosterol which causes a loss of sterols and an accumulation of 4- alpha – methyl sterols in fungi which is responsible for antifungal activity.

Azithromycin :MOA : It is a macrolide antibiotic inhibits the messenger RNA directed polypeptides and protein synthesis . It exerts this

activity by

binding at 50s ribosomal subunits.

Ethambutol : MOA : It inhibits arabinosyl transferases involved in arabinogalactan synthesis and to interfere with mycolic acid incorporation in mycobacterial cell wall.

Isoniazid : MOA : It inhibits the synthesis of mycolic acid , which are unique fatty acid component of mycobacterium cell wall.

Rifampin :

MOA : It inhibits DNA dependent RNA synthesis . Selective toxicity is that mammalian RNA polymerase does not bind rifampin.

Pyrazinamide :

MOA : Pyrazinamidase converts pyrazinamide to its active form pyrazinoic acid which accumulates in the bacilli .

Accumulation of pyrazinoic acid disrupts membrane potential and interferes with energy product necessary for survival of M.Tuberculosis at an acidic site of infection.

CLINICAL PHARMACIST INTERVENTIONS :ADR :

Because of TAB ETHAMBUTOL – Patient has optic neuritis clinical management :discontinuation of drug .

DRUG INTERACTIONS :

MAJOR :

Fluconazole

+ Azithromycin – results in increase risk of QT prolongation and

Torsades

de point

clinical management : discontinuation of drug /change in frequency of drug .

Moderate :

Fluconazole

+

Rifampicin

– concurrent use of these drugs may decrease

Fluconazole

serum concentrations and Antifungal activity .

PATIENT COUNSELING : 1. Tab . Pantoprazole should be taken before breakfast. 2. R-cinex

should be taken before food

3. Avoid junk foods , and fatty foods .

4 . Avoid smoky and dusty environments.

5.vit B6 should take after food .

6 . Azithromycin should take after meals .

-

DISCHARGE DRUGS :

Tab Azithral – azithromycin – 500mg -0-1-0

Tab pantox – pantoprazole – 40mg – 1-0-0

Tab benadon – vit b6 - 40mg – 1-0-0

Cap R-CINEX – H + R – 450/300 mg – 1-0-0

Tab tecrzinc – levocitrizine

Hcl

– 5 mg – 1-0-0

Momate cream - topical for 15 days ..

THANK YOU