3

(462409)

1 2556

Section 1: (make up) 15

2556 15:00-18:00 .

Section 2: 14 2556 14:00-

17:00 .

1.
SLE
2. The American
College of Rheumatology (ACR)
3.

4. monitoring parameters drug efficacy
drug toxicity

1. pharmacy courseware
2.

a. 1 1
b. 2 2 1 2
 2

c. 3 2 3 4
d. 4 3
e. 5 4
3.

1.

pharmacy courseware
2.
5
3.
(posttest 10 )

21 52 163

1

HPI:
2
6

5 PTA




indomethacin 1x3
 3

1 PTA
10

2 PTA

PMI: no U/D

Medication: indomethacin

SH:

ALL: NKDA

PE: VS: BP 110/73 HR 107 temp 37 O2sat 99%

GEN: a young woman with normal consciousness

HEENT: malar rash +ve, discoid Lt. pinna, hair

falling test neg., no pale, no Jx, no oral

ulcer

Heart: regular, no murmur

Lung: clear, no adventrition sound

Abd: soft, not tender

Ext: no joint inflammatory, no edema

Imp: SLE with chest discomfort

Lab :

Liver function
test
Total protein (6.0- 8.3
8.0 g/dL)
 4

Albumin (3.2-5.0 3.6

g/dL)
Globulin (2.8-3.5 4.7
g/dL)
Alk phosphatase 49
(23-98 U/L)
AST (3-35 U/L) 27
ALT (7-33 U/L) 27
Cholesterol (<200 274
mg/dL)
Total bilirubin (0.2- 0.86
1.0 mg/dL)
Direct bilirubin (0- 0.07
0.2 mg/dL)
Hematology
Hb (10-15 g/dL) 12 17
Hct (40-50 %) 35.8 36.6
WBC (5-10 6000 6000
x103/mm3)
Neutrophil (40- 69.7 72.1
75%)
Eosinophil (1-3%) 1.2 0.7
Basophil (0-1%) 0.4 0.2
Lymphocyte (25- 20.1 20.1
35%)
Monocyte (3-6%) 8.6 6.9
Platelet (100-400 112000 112000
K)
Blood chemistry
BUN (7-24 mg%) 7
Creatinine (0.6-1/6 0.4
mg%)
Na (137-150 140
mmol/L)
K (3.5-5.5 mmol/L) 4.0
Cl (98-111 101
mmol/L)
 5

Total CO2 (22-32 25

mmol/L)
Total Ca (7-11 mg 8.2
%)
PO4 (2.5-4.5 mg 2.2
%)
Mg (1.5-2.2 mg%) 2.14
urinalysis
color Light yellow Light yellow
RBC/HPF 0-1 0-1
WBC/HPF 0-1 0-1
pH 7.0 7.5
Specific gravity 1.018 1.010
Albumin -ve -ve
Sugar -ve -ve
Epithelium 5-10 0-1
Hyaline cast -ve -ve

Other lab

Day Anti-HIV NR C3 (550-1200) 84

1 HBsAg -ve C4 (100-400) <63.5
antiHCV -ve ANA titer: positive
ESR 84 Anti-ds-DNA: negative

Day Echo: no chamber dilation, good LV, RV systolic

3 function, no clot was seen. No pericardial effusion
was seen
Imp: normal echogenic study

Medication profile

Date Day Day Day Day Day

1 2 3 4 5
Paracetamol (500) 2 tab PO
prn q 4-6 hr
 6

Chloroquine (250) 1x1 PO

pc
0.02% TA cream bid (

)
0.3% TA cream bid (

)
 7

1. subjective objective data SLE

2.


 8

3.


 9

25 50 155

CC:

HPI: 7

PMH: discoid LE 2549

ALL: NKDA

PE: GEN : a woman with conciousness , Malar rash at face

V/S : Temp 38.5 ,PR 84/min ,RR 20/min , BP

140/80

HEENT : mild pale conjunctiva , no icteric sclera , discoid

rash at left ear, no oral ulcer

Heart : regular rhythm , no murmur

Lung : clear no adventrition sound

EXT : pitting edema 3+

Lab:

Hematology Day 1 Day 2 Day 3

Hb (10-15 g/dL) 7.0
Hct (40-50%) 21
WBC (4.5- 2670 2350 2410
10x103/mm3)
Neutrophil (50-65%) 59 65 53
Eosinophil (0-3%) 1 1 1
Basophil (1-3%) 1 1 1
 10

Lymphocyte (25-35%) 21 19 16
Monocyte (2-6%) 3 4 3
Platelet (150-400x103 40,300 36,600 54,000
/mm3)
 11

Urinalysis : proteinuria 3+ ( Ureine protein = 5.3 g/day), a

modest amount of RBC casts
Other: serum creatinine 2.8 mg/dL , ESR 50 mm/hr , ANA
titer 1:320 , Anti-dsDNA = positive , Lupus anticoagulant =
positive , Coombs test = positive

1.
corticosteroids

2.



ibuprofen (400) 1x3
pc prednisolone (5) 4x3 pc

3.


 12

4. 3





corticosteroid

3


4

3.1

3.2
 13

4.1

4.2