1. Therapeutics minor case presentation Acute exacerbation of COPD 12Q1326

2. SCENARIO: here is a male patient Shanmukappa Arakeri of 65yrs 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.

3. 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( cumm)
13,760
Increased
Neutrophils(40-60) 83
Lymphocytes(20-60) 12
Decreased
Monocytes(1-4) 05
ESR(<10mm/hr) 80

4. SOAP NOTE
SUBJECTIVE: here is a 65y 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.

5. ASSESSMENT:
PROBLEM LIST-
1.Breathlessness
2.Cough with expectoration
3.COPD
Breathlessness: due to hypertrophy of mucus gland and 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.

6. 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.

7. Trade names Generic names indication dose Day 1 2 1 Inj. taxim
s.no
Trade names
Generic names
indication
dose
Day 1 2 1
Inj. taxim
cefotaxime
Prophylaxis for hospital born infection
1gm
101 +
Inj. Rablet
rabeprazole
Prophylaxis for Ab induced hyprgastric secrtn
20mg
100 3
Duolin neub
Salbutamol+ ipratropium
breathlessness
1111 4
Sy. Brozodex
bromohexien
Cough with expectoration
2tsp
111 5
Inj.deriphylline
Theophylline+etiophylline
bronchodialition
1amp 6
T. calpol
paracetamol
fever
500mg
sos

8. 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.

9. 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.