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7/27/2019 Groupcase Presentation
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GROUP CASE
PRESENTATION
SATELLITE PHARMACY
CLERKSHIP2010/2011
GROUP B
CASE: UROSEPSIS
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PATIENT S CMR
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PATIENT PARTICULARS
NAME: MISS ABC BED/WARD: C1/17
AGE: 70
DIAGNOSIS : UROSEPSIS
DATE OF ADMISSION: 12/7/2010
DATE OF DISCHARGE : 8/8/2010
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Brief overview : UROSEPSIS
Definition: sepsis (septicaemia syndrome) caused by urinarytract infection
Urosepsis in adults comprises approximately 25% of all sepsiscases and in most cases is due to complicated urinary tract
infections (UTIs) Classic presentation: fever, chills, hypotension in somepatient
Patients who are more likely to develop urosepsis include:infant,elderly patients, diabetics, immunosuppressed
patients (such as transplant recipients), patients receivingcancer chemotherapy or corticosteroids and patientswith acquired immunodeficiency syndrome(HIV)
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Clinical diagnostic criteria of sepsis
Associated with Systemic Inflammatory
Response Syndrome(SIRS):
i) Temperature > 38 C or < 36 C
ii) Heart rate > 90 beats per minute
iii)Respiratory rate > 20 breaths or PaC02 < 32
mmHgiv) White blood cells > 12 x 10^9/L
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For therapeutic purposes, the diagnostic criteria
of sepsis should identify patients at an early stageof the syndrome, prompting urologists andintensive care specialists to search for and treatinfection, initiate appropriate therapy, and
monitor for organ failure and other complicationsIn the case of urosepsis the clinical evidence of
UTI is based on symptoms, physical examination,sonographic and radiological features, and
laboratory data, such as bacteriuria andleucocyturia.
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Pathophysiology of urosepsis
Micro-organisms reach the urinary tract by wayof the ascending, haematogenous or lymphaticroutes. For urosepsis to be established, from the
urinary tract the pathogens have to reach thebloodstream. The risk of bacteraemia is increasedin severe urogenital infections such aspyelonephritis and acute bacterial prostatitis, and
is facilitated by obstruction.systemicinflammatory response syndrome (SIRS) is thentriggered
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General Management of Urosepsis
Effective treatment eliminates the infectious sources, andimproves organ perfusion. Treatment of urosepsiscomprises four basic strategies:
i) supportive therapy (fluid replacement therapy for
stabilisation and maintaining blood pressure, manage fluidand electrolyte balance)
ii) antimicrobial therapy (initiate with broad spectrumantibiotic within in the first hour)
iii) control or manage of the complicating factor, &
iv) specific sepsis therapy(eg.corticosteroid, insulin, etc)
All four strategies need to be started as early as possible.
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Appropriate and early diagnosis of sepsis isimportant to enable commencement oftreatment without delay-if left untreated it
can cause severe sepsis & septic shock According to Kumar et al.s data [7],we have 1
h to administer broad-spectrum antibiotics.We have 6 h to stabilise haemodynamicsaccording to early goal-directed therapy. Wehave 24 h to apply adjunctive therapy
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Severe Sepsis association with organ
dysfunction, hypoperfusion or hypotension-
may include but are not limited to lacticacidosis, oliguria or an acute alteration of
mental status
Septic shock- Sepsis with hypotension
despite adequate fluid resuscitation
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DRUG THERAPY GIVEN(based on CMR)
HYDROCHLOROTHIAZIDE
NIFEDIPINE
AMLODIPINE
PCM
LOVASTATION
TAZOCIN
OMEPRAZOLE UNASYN
RANITIDINE
MAXOLON(
COLCHICINE
TICLIDOPINE
PREDNISOLONE
METOPROLOL
MIST KCL
NEUPOGEN ALBUMIN
SYPLACTULOSE
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Hydrochlorothiazide( HCTZ)
INDICATION: Management of mild tomoderate hypertension, treatment of edemain congestive heart failure, corticosteroid
therapy and nephrotic syndrome ACTION: Inhibits sodium reabsorption in the
distal tubules causing increased excretion ofsodium(&chloride) and water
Half life: 5.6-14.8 hour
Onset of action ~ 2hours (duration 6-12hours)
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DOSAGE
IN ADULT
EDEMA(25-100mg/day , max 200mg/day)
HTN(12.5-50mg/day)
In elderly patient : 12.5-25 mg once daily
(from the prescription dose given is 25mg po od)
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Warning /Precaution
Should avoid in renal disease(ineffective)
Electrolyte disturbance(hypokalemia, hyponatremia etc) can occur
May precipitate gout(cause hyperuricemia)
Use in caution with diabetes patient(may alter glucose control)
Use in caution in patient with high cholesterol ADR: 1-10% :orthostatic hypotension, photosensitivity,
hypokalemia, hyponatremia, anorexia, epigastric distress
ContraindicationsHypersensitivity to thiazides, related diuretics, orsulfonamide-derived drugs; anuria; renal decompensation
Hepatic impairment:Minor alterations of fluid and electrolytebalance may precipitate hepatic coma; use drug with caution
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DRP detected: Drug-drug interactions
1) Hydrochlorothiazide + prednisolone
Levels/effect of hydrochlorothiazide may beincreased by corticosteroid (prednisolone)
still can be used together2) Hydrochlorothiazide + amlodipine
The antihypertensive effect of amlodipine andthiazide diuretics may be additive. Management
consists of monitoring blood pressure duringcoadministration, especially during the first 1 to 3weeks of therapy.
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PATIENT CARE CONSIDERATIONS
Administration/Storage
If drug is administered as single dose, give in
morning.
Administer drug with food or milk to minimize
GI irritation.
Store tablets in tightly closed container at
room temperature
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Assessment/Interventions
Monitor patient's BP with patient lying down and standing.
Monitor serum potassium, calcium, magnesium, sodium, ABGs, uricacid.
Monitor renal ( BUN, creatinine) and liver (ALT, AST) function tests.
Monitor blood glucose levels in diabetic patients.
Observe closely for anaphylaxis (shortness of breath, rash, edema)after first dose.
Report muscle weakness, cramps, nausea, blurred vision, ordizziness to health care provider
Advise patient to limit sodium intake for optimal drug effect
Caution patient to avoid sudden position changes to preventorthostatic hypotension
Advise patient that drug may cause drowsiness and to use cautionwhile driving or performing other tasks requiring mental alertness