05/03/2023 1

Presented by: Mr. Jagtap Lalit R.Department of Clinical Pharmacy

05/03/2023 2

COPD EXACBATION WITH

CONSOLIDATION , WITH DIABETES

05/03/2023 3

Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD), also known as chronic obstructive lung disease (COLD), and chronic obstructive airway disease (COAD), among others, is a type of obstructive lung disease characterized by chronically poor airflow. It typically worsens over time. The main symptoms include shortness of breath, cough, and sputum production. Most people with chronic bronchitis have COPD.

In absence of concomitant presence of emphysema, the underlying condition may be classified as chronic bronchitis alone, and the exacerbations are then termed "acute exacerbations of chronic bronchitis" (AECB), and shares many characteristics with that of acute exacerbation of COPD. As COPD progresses, exacerbations tend to become more frequent, the average being about three episodes per year.

05/03/2023 4

Name : Mrs. A.B.C.Address : THALNER , DIST.- DHULE. Age : 68 year Sex : FemaleWeight : “73” kgInpatient no : 1755Hospital name : Indira Gandhi Memorial Hospital, ShirpurD.O.A : 19/01/2014D.O.D : 26/01/2014Consultant name : Dr. Pitambar Dighore

PROFORMA

05/03/2023 5

FAMILY HISTORY: Nil

SOCIAL HISTORY: Non alcoholic, Non Smoker, Non Vegetarian .

OCCUPATION: Farmer

05/03/2023 6

COPD with exacerbation.

DIAGNOSIS

05/03/2023 7

ASSOCIATED DISEASE:- None

PAST MEDICATION HISTORY:- Nil

PAST MEDICAL HISTORY:- Nil

05/03/2023 8

Cough from last one week Chest tightness from last one night Wheezing from last one day Breathlessness from last one day Burning sensation from last one day for 2 hours Dysponea Restlessness from last one day

PRESENT COMPLAINTS

05/03/2023 9

DATE 20/09 21/09 22/09 23/09

G.C

Fair

Fair

Fair

Fair

PULSE per min.

83 91 85 80

P/A Soft Soft Soft Soft

B.P. (mmHg) 110/65 130/80 115/72 120/75

ON EXAMINATION

05/03/2023 10

Hemogram :- Normal value

Hemoglobin 9.25gm % 14-16 gm %

Leukocyte count >250 cell/mm3 250 cell/mm3

LABORATORY ANALYSIS

05/03/2023 11

05/03/2023 12

LUNGS VOLUMES AND FLOW RATE MEASUREMENT:

Forced expiratory volume (FEV1) was decrease Forced vital capacity (FVC) was decrease FEV1/FVC ratio was also decrease

Spirometer

05/03/2023 13

ECG REPORT: The report was found to be normal range.

05/03/2023 14

DIAGNOSIS

Chronic Obstructive Pulmonary Disease:-

Physical examination

Chest X-ray.

05/03/2023 15

MEDICATION

05/03/2023 16

MEDICATION DETAIL’S

Srno Medication

Dose mg

Std Dose mg

Frequency Route Date

1. Nebulizer with Duolin (Ipratropium bromide)

0.20 - 1

1-5 6 hrly inh 20-23

2. Nebulizer withBudecort (Budesonide)

0.10 -0.20

0.20 -0.40

8 hrly inh. 20-23

3. Inj Oframax forte (Ceftriaxone sod.)

1500 4000 12 hrly iv 20-23

05/03/2023 17

Srno

Medication Dose

mg

Std Dose mg

Frequency Route Date

4. Inj Efcorlin (Hydrocortisone)

100 400 8 hrly iv 20-21

5. Tab Omnacortil (Prednisolone)

20-20-10

05- 60 8 hrly oral 21-22

6. Syp Grillinctus BM (Bromhexine +Terbutaline)

10 ml 30 ml 12 hrly oral 20-23

05/03/2023 18

POST MEDICATION

Tab Omnacortil 20-20-10 mg thrice in a day for three days

Nebulizer with Duolin 4 times in a day for 5 days

Nebulizer with Budecort thrice in a day for 5 days

Inj Oframax fort 1.5 g daily for 7days

Syp Grillinctus BM 2 t.s.f. for a week

05/03/2023 19

Ceftriaxone with corticosteroids:-

Effect:– Antibiotics increased pharmacological action of corticosteroids such as carbohydrate, fat, protein, calcium metabolism, water excretion, inflammatory, immunologic and allergic responses.

DRUG INTERACTION1

05/03/2023 20

DISCUSSION2

Prescription outcome:-

The diagnosis data analysis shows that haemoglobin was found to be decreased level.

The physician should be prescribed some blood forming agent such as haematinics to the patient only orally/ as possible as blood transfusion.

Ex – Iron and its preparations:-

1) Tb Fersolate 200 mg oral 2) Syp Imferon 10 ml oral

05/03/2023 21

PATIENT COUNSELING

Smoking should be stopped (or go for nicotine replacement therapy)

Eat the iron rich food and blood forming foods.

Available oxygen therapy for emergency acute exacerbation.

Tell the patient not to use inhaler more than six times per day.

Instruct the patient how to use the nasal sprays.

05/03/2023 22

Instruct patient the technique for use of Nebulizer.

Nebulizer

05/03/2023 23

Peak flow meter

Instruct patient the technique for use of Peak flow meter.

05/03/2023 24

Some drugs may cause dizziness so use with caution while driving or performing other task requiring mental alertness

Patient should notify physician if conditions like dizziness, palpitation, nausea, cough, weight loss, swelling in feet and ankles, and sign of infection

Maintain hygienic condition

If any type of side effect occur by drug therapy consult physician immediately

05/03/2023 25

REFERENCES

05/03/2023 26

1. Ivan H. Stockley “Drug Interactions”; third edition, Bluckwell Scientific Publication.

2. www.drugdigest.com

3. IDR, Nov 2006, Page No: 192,273,206.

4. Herfindal T. E. et al, 2006, “Text book of therapeutics” 8th

edition, Lippincott Williams & wilkins, Page No:1348,51.

5. Dipiro J.J. Pharmacotheraphy: “A pathologic approach”, 6th edition 2001, MacGrow Hill publication, Page

No: 947

05/03/2023 27

7. Satosakar R.S. et al, 2006, “Pharmacology and p’cotherapeutics”,19th edition, popular prakashan New Delhi.

8 www.wikipedia.org

9. Drug and dosage, a quick glance by mankind pharmaceuticals.

10. www.netdoctor.com

05/03/2023 28

11. www.emedicine.net

12. Tripathi K.D, 2004 “ Essential of medical pharmacology”, 5th edition, Jaypee Publication.

05/03/2023 29

Thanking

You…