Management

Course in the WardsDischarge Plans

Management: Course in the Wards• Hospital Day 1: Admission Day

– Requested to be started on:• Ceftriaxone 2g/IV OD• Azithromycin 500mg/tab 1tab OD for 3days• Erdosteine 300mg/cap 1cap BID• Paracetamol 500mg/tab 1tab q4 prn for T> 38C• Amlodipine 5mg/tab 1tab ODNote: Medications were not started due to financial constraints

• Furosemide 40mg/IV 1dose and Salbutamol neblization q4 were requested

Management: Course in the Wards

• Hospital Day 2– Patient was hypertensive at 180/100mmHg

• was given Amlodipine 10mg/tab

– Ceftriaxone was started

Management: Course in the Wards

• Hospital Day 3– Salbutamol was shifted to Combivent nebulization

q12, with gentle chest physiotherapy after each nebulization

– Patient had a BP of 140/90mmHg• Was started on Metoprolol 50mg/tab 1tab BID

Management: Course in the Wards

• Hospital Day 4– Ceftriaxone was shifted to Cefuroxime 500mg/tab

1tab BID to complete 7days• Was not done due to financial constraints

• Hospital Day 5– Azithromycin, FeSO4 + FA, Metoprolol, as

previously ordered, were started

Management: Course in the Wards

• Hospital Day 6– Cefuroxime, as previously ordered, was started

• Hospital Day 7– Patient’s condition improved and was stable

• discharge

Management: Discharge Plans

• Pharmacologic• Non-Pharmacologic• Check-Up

Discharge Plans: Pharmacologic

• Azithromycin – MOA: blocks transpeptidation by binding to 50s ribosomal

subunit of susceptible organisms and disrupting RNA-dependent protein synthesis at the chain elongation step.

– AE: Mild to moderate nausea, vomiting, abdominal pain, dyspepsia, flatulence, diarrhoea, cramping; angioedema, cholestatic jaundice; dizziness, headache, vertigo, somnolence; transient elevations of liver enzyme values.

– Dosage: 500mg/tab, 1 tablet OD for 3 days– SRP: Php 150.00

Discharge Plans: Pharmacologic• Cefuroxime

– MOA: binds to one or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death.

– AE: Large doses can cause cerebral irritation and convulsions; nausea, vomiting, diarrhoea, GI disturbances; erythema multiforme, Stevens-Johnson syndrome, epidermal necrolysis, anaphylaxis, nephrotoxicity, pseudomembranous colitis.

– Dosage: 500mg/tab, 1 tablet BID for 7 days – SRP: Php 75.00

Discharge Plans: Pharmacologic• Amlodipine

– MOA: relaxes peripheral and coronary vascular smooth muscle. It produces coronary vasodilation by inhibiting the entry of Ca ions into the voltage-sensitive channels of the vascular smooth muscle and myocardium during depolarisation. It also increases myocardial O2 delivery in patients with vasospastic angina.

– AE: Headache, peripheral oedema, fatigue, somnolence, nausea, abdominal pain, flushing, dyspepsia, palpitations, dizziness. Rarely pruritus, rash, dyspnoea, asthenia, muscle cramps. Potentially Fatal: Hypotension, bradycardia, conductive system delay and CCF.

– Dosage: 10mg/tab, 1 tablet BID– SRP: Php 22.00

Discharge Plans: Pharmacologic• Metoprolol

– MOA:Metoprolol selectively inhibits β-adrenergic receptors but has little or no effect on β2-receptors except in high doses. It has no membrane-stabilising nor intrinsic sympathomimetic activity.

– AE:Bradycardia, hypotension, arterial insufficiency, chest pain, CHF, oedema, palpitation, syncope, gangrene; dizziness, fatigue, depression, confusion, headache, insomnia, short-term memory loss, nightmares, somnolence; pruritus, rash, increased psoriasis, reversible alopecia, Heart failure, heart block, bronchospasm.

– Dosage: 50mg/tab, 1 tablet BID– SRP: Php 4.00

Discharge Plans: Pharmacologic

• Erdosteine – MOA:contains two sulfhydryl groups, which are freed after

metabolic transformation in the liver. The liberated sulfhydryl groups break the disulphide bonds, which hold the glycoprotein fibres of mucus together. This makes the bronchial secretions more fluid and enhances elimination.

– AE:Epigastralgia, nausea, vomiting, loose stools, spasmodic colitis, headache.

– Dosage: 300mg/cap, 1 capsule BID– SRP: Php 19.00

Discharge Plans: Pharmacologic

• Ferrous Sulfate + FA – MOA:Ferrous sulfate facilitates O2 transport via

haemoglobin. It is used as iron source as it replaces iron found in haemoglobin, myoglobin and other enzymes.

– AE: GI irritation, abdominal pain and cramps, nausea, vomiting, constipation, diarrhoea, dark stool and discoloration of urine; heartburn.

– Dosage: 500mg/tablet, 1tablet BID– SRP: Php 20.00

• Getting plenty of rest and drinking of lots of fluids• Active lifestyle (e.g . Daily exercise)• Preventive measures– Flu shot —for people at high risk, particularly the elderly,

because pneumonia may be a complication of the flu

– Pneumococcal vaccine —recommended for: • People over aged 65, or those who have a chronic

illness, such as diabetes or sickle-cell disease• Children under two years old

Discharge Plans: Non-Pharmacologic

• Lifestyle interventions:– Reduction of dietary salt intake (<6g NaCl/day)– Moderate alcohol consumption

• Men: </= 2 drinks per day• Women: </= 1 drink per day

– Adapt DASH dietary plan• Diet high in fruits and low-fat dairy products, reduced

saturated and total fat– Physical activity

• Regular aerobic activity (e.g. brisk walking for 30 mins/day)

Discharge Plans: Non-Pharmacologic

Discharge Plans: Check-up

• Return to UST Hospital for Check-up after 1 week or immediately when condition worsens.