Therapeutics minor case presentation Acute exacerbation of COPD

SCENARIO: here is a male patient Shanmukappa Arakeri of 65 yrs bearing I. P no: 25369 is admitted to male medical ward has been hospitalized since 2 days. Chief complaints: c/o cough with expectoration since 1 month c/o breathlessness since 1 month HISTORY OF PRESENT ILLNESS: patient was apparently normal 1 month back since then he developed cough with expectoration which is whitish in colour about a cup per day, more in the evening and morning.

He also complaints of breathlessness which is insidious in onset presented both on exertion and on taking rest since 1 month. Social history: alcoholic & beedi smoker since 20 yrs. DIAGNOSIS: Acute exacerbation of COPD Laboratory investigation: CBC values WBC(400011000 cumm) 13, 760 Increased Neutrophils(40 -60) 83 Increased Lymphocytes(20 -60) 12 Decreased Monocytes(1 -4) 05 Increased ESR(<10 mm/hr) 80 Increased

SOAP NOTE SUBJECTIVE: here is a 65 y old male patient complaining of breathlessness and cough with expectoration since 1 month. OBJECTIVE: • Increased WBC count indicates infection. • Increased neutrophil & monocytes count indicates COPD. • Decreased lymphocytes indicates severe illness. • ESR increase in acute/ chronic infection.

ASSESSMENT: § PROBLEM LIST 1. Breathlessness 2. Cough with expectoration 3. COPD Breathlessness: due to hypertrophy of mucus gland excessive mucus production leading to breathlessness. Cough with expectoration: it is a reflex mechanism to expel out sputum which triggers the chemo and mechano receptors COPD: it is a chronic obstructive pulmonary disease associated with air flow limitation due to abnormal inflammatory response of lungs to allergens.

• • • GOALS OF THERAPY To subside signs and symptoms To improve the quality of life To prevent further complications and exacerbations To reduce morbidity and mortality.

s. n o Trade names Generic names indication dose Day 1 2 1 Inj. taxim cefotaxime Prophylaxis for hospital born infection 1 gm 101 + + 2 Inj. Rablet rabeprazole Prophylaxis for Ab induced hyprgastric secrtn 20 mg 100 + + 3 Duolin neub Salbutamol+ ipratropium breathlessness 1111 + + 4 Sy. Brozodex bromohexien Cough with expectoration 2 tsp 111 + + 5 Inj. deriphylline Theophylline+et bronchodialition iophylline 1 amp 111 + + 6 T. calpol paracetamol 500 mg sos + + fever

• Clinical Pharmacist Intervention: • Drug -drug Interaction: • 1. Theophylline + salbutamol : Moderate Interaction. Effect : Increases cardiovascular side effects such as Increased Heart rate, Increased PR & BP. Management: monitor serum K+ levels, BP & PR.

2. Theophylline+rabeprazole: Moderate interaction Effect: rabeprazole increases the effect of theophylline. Management: patients should be closely monitored for the development of toxicity, particularly serum theophylline levels.