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PROBLEM LIST
HYPERTENSION
DIABETES MELLITUS
COMMUNITY AQUIRED PNEUMONIA

CASE PRESENTATION FOR
HYPERTENSION

SUBJECTIVE
PATIENT COMPLAINS OF VERTIGO
OBJECTIVE
1) LAB PARAMETERS : BP: 130/90 mm/hg
2) MEDICAL HISTORY : HYPERTENSION
X 7YRS
3) MEDICATION HISTORY : TB
OLMESAR(1-0-0)
4) FAMILY HISTORY : NIL
5) SOCIAL HISTORY : NIL

Assessment
(1) Diagnosis
on the basis of subjective +objective + patient
complain +lab parameters the final diagnosis is
HYPERTENSION
(2) Etiology
It may be due to age , weight , life style …
(3) Need of therapy
If hypertension is not controlled or cured it can lead
to complications like :- MI , CCF , Arrthymia

Common electrolyte solution
Brand name :- INJ RL
Generic name :- ringer lactate solution
Class :- electrolyte solution

Brand name :- INJ NS
Generic name :- normal saline
Class :- sterile solution

Assessment of current therapy
Brand name :- tb.olmesra
Generic name :- olmesartan
Class :- angiotensin II antagonist
m/a :- Olmesartan is a selective and competitive angiotensin
II Type 1 (AT1) receptor antagonist and hence it blocks the
vasocontrictor and aldosterone-secreting effects of
angiotensin II.
Administration :- may be taken with or without food
Adr :- Dizziness, headache, abdominal pain, dyspepsia,
diarrhoea, gastroenteritis, nausea, chest pain, bronchitis,
cough, pharyngitis, rhinitis, arthritis, back pain, fatigue
c/I :- pregnancy and biliary obstruction

 Generic name :- tb. rozuvastatin
 Class:- dislypedemic agent
 Brand name :-tb rozustat
 m/a :-Rosuvastatin is a selective and competitive inhibitor of HMG-CoA
reductase, the rate-limiting enzyme in cholesterol synthesis. It increases the
number of hepatic LDL receptors on the cell surface, enhancing uptake and
catabolism of LDL. It also decreases apolipoprotein B, triglycerides and
increases HDL.
Administration :-May be taken with or without food.
 Adr :- Headache, dizziness, constipation, nausea, vomiting, abdominal pain,
myalgia, chest pain, peripheral oedema, depression, insomnia
 c/I :- Severe renal impairment, active liver disease, unexplained persistent
elevations of serum transaminases; hypersensitivity. Pregnancy, lactation.

Brand name :- inj Rantac
Generic name :- Ranitidine
Class :- Antacids , antirefulx agents and anti
ulcerant
m/a :- Ranitidine blocks histamine H2-receptors in
the stomach and prevents histamine-mediated
gastric acid secretion.
Administration :- Should be taken on an empty
stomach. Take 15-30 min before meals.
Adr :- Headache, dizziness. Rarely hepatitis,
thrombocytopaenia, leucopaenia, hypersensitivity,
confusion, gynaecomastia, impotence, somnolence,
vertigo, hallucinations.
c/I :- Porphyria.

Case presentation for
diabetes

SUBJECTIVE
PATIENT COMPLAINS OF VERTIGO
OBJECTIVE
1) LAB PARAMETERS : urine sugar 4+
2) MEDICAL HISTORY : Diabetes x 5yrs
3) MEDICATION HISTORY : tb.xilia M2 fort(1-0-1)
tb.Galvus met (0-0-
1)
1) FAMILY HISTORY : NIL
2) SOCIAL HISTORY : NIL

Assessment
(1) Diagnosis
DIABETES
MELLITUS
(2) Etiology
(3) Need of therapy
If diabetes is not controlled or cured it can lead to
complications like :-
Neuropathy,nephropathy.retinopathy…..

Assessment of current
therapy
brand name :- lantus
Generic name :- insulin glargine
Class :- insulin preparation
m/a :- Insulin lowers blood glucose levels. It regulates
carbohydrate, protein and fat metabolism by inhibiting
hepatic glucose production and lipolysis, and enhancing
peripheral glucose disposal.
Administration :-Take before meals.
Adr :- Hypoglycaemia, insulin resistance, lipoatrophy,
hypokalaemia, blurred vision.
c/I :- Hypoglycaemia.

Contd.
Brand name :- insuman rapid
Generic name :- insulin human
Class :- insulin preparation
m/a :- nsulin lowers blood glucose levels. It regulates
carbohydrate, protein and fat metabolism by inhibiting
hepatic glucose production and lipolysis, and enhancing
peripheral glucose disposal.
Adminitration :- Take before meals.
Adr :- Hypoglycaemia, insulin resistance, lipoatrophy,
hypokalaemia, blurred vision.
c/I :- Hypoglycaemia.

contd.
 Brand name :- tb xilia
 Generic name :- glimipride + metformin
 Class :- antidiabetic agent
 m/a : -Glimepiride stimulates the insulin release from functioning
pancreatic β-cells and inhibits gluconeogenesis at hepatic cells. It
also increases insulin sensitivity at peripheral target sites. Metformin
decreases hepatic gluconeogenesis, decreases intestinal absorption
of glucose and improves insulin sensitivity (increases peripheral
glucose uptake and utilisation).
 Administration :- oral
 Adr :- Diarrhoea, vomiting, metallic taste, rash, isolated transaminase
elevations, cholestatic jaundice, allergic skin reactions,
photosensitivity reactions, leukopaenia, agranulocytosis,
thrombocytopaenia, haemolytic anaemia, aplastic anaemia,
pancytopaenia, blurred vision.
 c/I :- Hypersensitivity diabetic ketoacidosis (DKA); renal dysfunction;
CHF (CHF), patients undergoing radiological studies; acute or
chronic metabolic acidosis. Pregnancy, lactation.

Contd.
brand name :tb,galvus met
Generic name :- metformin
Class :- antidiabetic agent
m/a :- it is a dipeptidylpeptidase-4 (DPP-4) inhibitor that improves
glycaemic control by preventing DPP-4 from inactivating the
incretin hormones glucagon-like peptide-1 and glucose-dependent
insulinotropic polypeptide, thus prolonging incretin activity in
response to ingestion of nutrients. This increases insulin
sensitivity, decreases glucagon secretion and improves β-cell
function.
Administration :- Should be taken on an empty stomach. Take
before meals.
Adr :- Hypoglycaemia, delayed gastric emptying, nausea and
vomiting. Flu-like symptoms, headache and dizziness may occur.

Case presentation for
pneumonia

SUBJECTIVE
PATIENT COMPLAINS OF COUGH AND FEVER
OBJECTIVE
1. LAB PARAMETERS : T :- 101.4 F
2. MEDICAL HISTORY : NIL
3. MEDICATION HISTORY :
4. FAMILY HISTORY : NIL
5. SOCIAL HISTORY : NIL

(1) Diagnosis
community aquired pneumonia
(2) Etiology
(3) Need of therapy
If is not controlled or cured it can lead to
complications like :-

Treatment
class antibiotic Dose Organisms
1. Penicillin G 10 lac units IV 4 hourly S. pneumoniae and other gram-positive cocci
2.
Erythromycin
Azithromycin
Clarithromycin
500 mg PO 6 hourly
500 mg PO once daily x 3 days
250 mg PO 12 hourly x 10 days
All above + legionella, mycoplasma and chlamydia
3.
Ciprofloxacin
Sparfloxain
400 mg IV 12 hourly (750 mg PO 12
hourly)
200-400 mg OD x 7-14 days
All above + H. influenzae
4. Cephotaxime 1 gram 12 hourly S. aureus, aerobes
5. Metronidazole 500 mg IV 8 hourly (500 mg PO 8 hourly) Anaerobes
6. Gentamycin 5 mg/kg IV 8 hourly in 3 divided doses Gram-negative bacilli like Klebsiella, pseudomonas
7. Amphotericin 50 mg daily up to 2 grams total dose Fungi

Assessment of current
therapy
Brand name :- inj deriphyllin
Generic name :- theophyllin
Class :- Antiasthmatic & COPD Preparations
m/a :- Theophylline competitively blocks phosphodiesterase which
increases cAMP tissue concentrations causing bronchodilatation,
diuresis, CNS and cardiac stimulation, and gastric acid secretion.
Administration :- May be taken with or without food.
Adr :- Nausea, vomiting, abdominal pain, diarrhoea, headache, insomnia,
dizziness, anxiety, restlessness, tremor, palpitations.
c/I :- Hypersensitivity to xanthine derivatives, porphyria.

brand name :- inj emeset
Generic name :- ondansetron
Class :-antiemetics /supportive care therapy
m/a :-Ondansetron antagonises 5-HT3 receptor, blocking serotonin, both
peripherally on vagal nerve terminals and centrally in the chemoreceptor
trigger zone.
Administration :- Should be taken with food.
Adr :- Headache, malaise/fatigue, constipation; drowsiness, fever,
dizziness, anxiety, cold sensation; pruritus, rash; diarrhoea
c/I :- Use with apomorphine

 Brand name :- inj cefzone
 Generic name :- ceftriaxone + tazobactam
 Class :-cephalosporins
 m/a :-Ceftriaxone interferes with the biosynthesis of the peptidoglycan
component of the bacterial cell way by binding to and inactivating
penicllin-binding proteins (PBPs). Tazobactam is a penicillanic acid
sulfone derivative with β-lactamase inhibitory properties. It enhances
the activity of β-lactam antibacterials against β-lactamase-producing
bacteria.
 Administration :-May be taken with or without food.
 Adr :- anaphylaxis; diarrhoea; local reactions; blood dyscrasias; rash,
fever,
 c/I :- Hypersensitivity to cephalosporins and β-lactamase inhibitors.

 Brand name :- inj levotas
 Generic name :- levofloxacin
 Class :- quinolones
 m/a :- Levofloxacin exerts antibacterial action by inhibiting bacterial
topoisomerase IV and DNA gyrase, the enzymes required for DNA
replication, transcription repair and recombination. It has in vitro
activity against a wide range of gram-negative and gram-positive
microorganisms.
 Administration :-May be taken with or without food.
 Adr :-Nausea, diarrhoea, constipation, headache, insomnia, inj site
reactions (IV). Ophthalmic: Transient decrease in vision, ocular
burning, ocular pain or discomfort,
 c/I :- Hypersensitivity to levofloxacin or other quinolones

Brand name :- inj asthalin + budecort
Generic name :- budesonide
Class :- Antiasthmatic & COPD Preparations
m/a :-Budesonide controls the rate of protein synthesis, depresses the
migration of polymorphonuclear leukocytes, fibroblasts, reverses
capillary permeability and lysosomal stabilisation at the cellular level to
prevent or control inflammation.
Administration :-Should be taken with food.
Adr :- Loss of skin collagen and SC atrophy; local hypopigmentation of
deeply pigmented skin; dryness, irritation, epistaxis, rarely ulceration
or perforation of the nasal septum; smell and taste disturbances;
hoarseness and candidiasis of the mouth or throat.
c/I :-Hypersensitivity.

 Brand name :- inj pipzar
 Ganeric name :- piperacillin + tazobactam
 Class :- penicillins
 m/a :- Piperacillin has an antimicrobial activity against a wide range of
gm-ve organisms including K. pneumoniae, P. aeruginosa,
Enterobacteriaceae and against gm+ve organisms eg E. faecalis and
B. fragilis. Tazobactam is a penicillanic acid sulfone derivative with
beta-lactamase inhibitory properties. In combination, tazobactam
enhances the activity of piperacillin against beta-lactamase-producing
bacteria.
 Administaration :-with or without food
 Adr :- Diarrhoea, skin rashes, occasionally platelet mediated bleeding,
rigors, malaise, ulcerative stomatitis. Inj-site reactions such as pain
 c/I : -Hypersensitivity.

Brand name :- syp.asthakind
Generic name :- dextromethorphan hydrochloride
Class :- Cough & Cold Preparations
m/a :- Dextromethorphan, a derivative of levorphanol, is an
antitussive agent. It has a central action on the cough center in the
medulla.
Administration :- Should be taken with food.
Adr :- Dizziness, GI disturbances.
c/I :- Patients at risk of developing resp failure. During an acute attack.
Patients receiving MAOI or for 2 wk after discontinuing them.
Persistent or chronic cough..

Brand name :- alerfix total
Generic name :- levocetirizine
Class :- Antihistamines & Antiallergics
m/a :-Levocetirizine, an active isomer of cetirizine, selectively inhibits
histamine H1-receptors.
Administration :- Immediate-release: May be taken with or without
food.
Adr :-Fatigue, somnolence, dry mouth, nasopharyngitis, pyrexia,
cough, epistaxis.
c/I :- End-stage renal disease

 Brand name :- xykaa
 Generic name :- diclofenac + paracetamol
 Class :-Analgesics (Non-Opioid) & Antipyretics / Nonsteroidal Anti-
Inflammatory Drugs (NSAIDs)
 m/a :- Diclofenac is a NSAID (NSAID). Paracetamol is an analgesic
and antipyretic. When used together, the actions of paracetamol set in
earlier and provides pain relief before the effects of diclofenac Na set
in.
 Administration :- with or without food
 Adr :- GI disturbances, nephrotic syndrome, epigastric pain, nausea,
vomiting, diarrhoea, hepatitis, rash, pruritus, wheezing
 c/I :-Hypersensitivity, active peptic ulcer or GI bleeding, history of
allergic responses to aspirin or other NSAIDs, acute porphyria.

 Brand name :- mahaflox
 Generic name :- moxifloxacin
 Class :-Quinolones
 m/a :-Moxifloxacin inhibits the topoisomerase II (DNA gyrase) and
topoisomerase IV required for bacterial DNA replication, transcription,
repair and recombination.
 Administration :-Should be taken on an empty stomach. Take on an
empty stomach for rapid effect. Do not take w/in 1 hr of antacids, milk
or other dairy products.
 Adr :- GI disturbances, CNS effects, hypersensitivity-type reactions
 c/I :-Hypersensitivity

planning
DISCHARGE MEDICATION :-
• TB olmesar (1-0-0-)
• TB rozustat 10 (0-0-1)
• TB vobit (1-0-0)
• TB galvus (1-0-1)
• TB xilia M 2 fort 1-0-1
• TB cefakind cv 500(1-0-1)
• TB neurostim (0-1-0)
• TB fructus fiber (1-0-0)
• TB ventidox f (1-0-1)
• TB rabonik dsr (1-0-0)

GOAL OF THERAPY
GENERAL GOAL
1. To improve patients quality of life
2. To prevent from further complications
3. slow progression of disease
PATIENT SPECIFIC GOAL :-
To cure patient complain of :-
 Fever
 Cough
 Virtigo

MONITORING PARAMETER
Therapeutic monitoring
1. RANITIDINE :- monitor blood pressure regularly ,and serum pottasium
levels
2. ONDECETRON :- monitor liver function test
3. Levofloxacin:- monitor for blood glucose
4. Insulin glargin :-Hypoglycemia: May result from excessive insulin dose,
increased work
5. Dextromethorphan :- monitor for frequency of coughing
6. olmesar monitor blood pressure
7. Rosuvastatin, monitor blood tests to prevent from liver failure
8. salbutamol d monitor blood sugar levels regularly because
Salbutamol may cause your blood sugar to rise.
9. Rabeprazole:- monitor patients response to drug therapy
10.Metformin :- monitor blood glucose level and renal function test

Toxicity minitoring
1. insulin :- Fatigue, weakness, nervousness, confusion, headache,
diplopia, convulsions, psychoses, dizziness, unconsciousness, rapid or
shallow respiration, numb or tingling mouth, hunger, nausea, skin
pallor, moist or dry skin
2. Dextromethorphan :-dizziness,nausea
3. Rabeprazole :-check wether treatment Is supportive and symptomatic
4. Metformin :- observe for lactic acidosis

POINTS TO PHYSIAN
According to standard treatment
therapy

Points to patient
Diease related :-
Hypertension :- hypertension is a diagnosis given by a
doctor to a patient with long term increase of blood
pressure…it can be fatal and can create complications if
not treated
Diabetes :- diabetes is a disease in which the body isn't
utilizing the glucose or sugar we eat. This causes the sugar
to build up in the blood. If not treated can cause heart
disease, blindness, kidney failure, and poor circulation of
the lower extremities which leads to amputations.
Community acquired pneumonia :- Pneumonia is an
infection of the lungs that can cause mild to severe illness

Points to patient
1. RANITIDINE :- tell patient to report signs and symptoms of
angioedema immediately , swelling of eyes , lips or tongue
2. Ondecetron :-tell to report if hypotension or chest pain occurs
3. Levofloxacin :- adviced patient to take drug with plenty of fluids
4. Insulin :-Tell patient not to change brand, strength, type, or
dose without physician's knowledge.
5. Olmesartan must be taken regularly for it to work well.
Continue taking Olmesartan even when you feel better.
6. Rosuvastatin should not be taken at the same time as antacids
, antacids, take it at least 2 hours after you have taken
Rosuvastatin.
7. salbutamol Continue taking even when you feel better.
Stopping it may worsen the condition
8. Rabeprazole :-tablet should not be crushed or chewd.
9. Metformn :- not to change drug dose without medical approval

Lifestyle modification
 Take pineapple juice
 Eat more green vegetables
 Avoid food rich in fat and energy
 Limit salt intake to 1-2g /day
 limit exposure to cigarette smoke
 Wash your hands after and before the meal
 Do exercise for 30 min every day.

FOLLOW UP AND REVIEW
Follow up after one month

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