Ulgasan,Marimar V.

BS Pharmacy 4A-C

Case Study 1
Patient A is a 30-year-old male who was admitted to the hospital from home after 1 week of
cough, profuse nocturnal sweating, loss of appetite and hyposomnia. He was seen by an
emergency room physician who noted signs of depression. The patient has a history of
intravenous drug abuse and hepatitis B.

Diagnosis

 Infiltrative TB of left lung with cavitation without MTB shedding.

Pathophysiology

Etiology
Tuberculosis (TB) is caused by a type of bacterium called Mycobacterium tuberculosis.
It's spread when a person with active TB disease in their lungs coughs or sneezes and someone else
inhales the expelled droplets, which contain TB bacteria.
Although TB is spread in a similar way to a cold or the flu, it isn't as contagious.
You would have to spend prolonged periods (several hours) in close contact with an infected person to
catch the infection yourself.
Clinical Manifestation

Diagnosis procedure
 TB CULTURE TEST
 TB SKIN TEST
 MENDEL-MANTOUX TEST – one of the major tuberculin skin test
 TB Interferon gamma release assays (IGRAs)
 SPUTUM SMEAR
 FLUORESCENT MICROSCOPY
 CHEST X-RAY
 SERROLOGICAL TEST
 CHEST PHOTOFLUOROGRAPHY
 MICROSCOPIC OBSERVATION DRUG SUSCEPTIBILITY TESTING

Treatment
STANDARD TREATMENT
 For INITIAL treatment of Tuberculosis, start patients on a 4-drug regimen;
 Isoniazid
 Rifampicin
 Pyrazinamide
 Ethambutol/streptomycin
Once the TB isolate is known to fully susceptible, ethambutol or streptomycin can be
discontinued.

ISONIAZID
 AKA isonicotinylhydrazide (INH)
 An antibiotic used for treatment of tuberculosis
 ACTIVE TUBERCULOSIS, often used with rifampicin, pyrazinamide, and either
streptomycin or ethambutol.
 LATENT TB, often used itself.
 Taken orally or IM.
 Common side effects:
 Increase blood levels of liver enzyme
 Numbness of both hands and feet
 Liver inflammation
RIFAMPICIN
 AKA rifampin
  Treats several types of bacterial infection, including tuberculosis, M. avium complex,
leprosy and legionnaires’ disease.
 Almost used together with antibiotics except when given to prevent Haemophilus
influenza type b and meningococcal disease.
 Before treating the patient for a long time measurements of liver enzyme and blood
counts are recommended.
 Common side effects
 Nausea and vomiting
 Diarrhea
 Loss of appetite
PYRAZINAMIDE
 A medication used to treat TB but for active tuberculosis only.
 Common side effects:
 Nausea
 Loss of appetite
 Muscle pain
 Rash
 Gout
 Liver toxicity
 Sensitivity to sunlight
ETHAMBUTOL
 Primarily used to treat tuberculosis
 It treats active TB with rifampicin, isoniazid ,and pyrazinamide.
 Common side effects:
 Problems with vision
 Joint pain
 Nausea
 HA
 Feeling tired
 Liver problems and allergic reactions
STREPTOMYCIN
 Used to treat number of bacterial infection, such as
 Tuberculosis
 M. avium complex
 Enocarditis
 Brucellosis
 Burkholderia infection
 Plague
 Tularemia
 Rat bite fever
 Administered via IV or IM.
 Common side effects:
 Vertigo
 Vomiting
 Numbness of the face
 Fever
 rash
Case proper
A. Patient’s Demographic Data
a. Age: 30-year-old
b. Gender: Male
B. History
Past medical history
Type 2 DM diagnosed 3 months ago
Immunized with BCG
Chief complain/ROS
 Productive cough with hemoptysis
  Shortness of breath that worsens with exertion
 Pleuritic chest pain
 Subjective fevers
 Chills,
 Night sweats
 Fatigue
 10-lb weight loss over the past several weeks.
Physical Examination
General Young male, looks older then stated age
HEENT Depressed, pupils equally round and reactive to light and accommodation
Neck Supple
Resp Unilateral (left side) crepitation
Card Regular rate and rhythm, no murmurs, rubs, or gallops
Abd Slightly distended
Ext No edema
Skin Excoriated, otherwise normal
Neuro Slightly altered, but baseline
Diagnostic results
Vitals
Tmax 38.0ºC
Heart Rate 110 beats per minute
Respiratory Rate 20 breaths per minute
Blood Pressure 130/76
Oxygen Saturation 98% on room air
Labs
Na: 133 Creatinine: 1.8
K: 4.1 WBC: 9.48 x 109/L
Cl: 96 Hgb: 11.4 g/dL (114 g/L)
Platelets: 149 109/L HIV test: Negative
Micro
Blood Culture No growth at 5 days
Sputum Smear 4+ squamous epithelial cells,
Gram Stain 1+ segmented neutrophils, no organisms
AFS (acid fast stain) No organisms
Sputum Culture No growth at 48 hrs
MGIT (mycobacteria growth indicator tube) Negative

Treatment

Patient A was originally administered isoniazid, rifampin, pyrazinamide, and ethambutol for 7
days per week for 8 weeks, followed by isoniazid and rifampin 7 days per week for 24 weeks.
After two months he returned to the hospital, concerned that he had been “coughing up blood”
over the previous 3 days. In addition to hemoptysis, he revealed that, since his previous visit, he
had continued to feel malaise, was continuing to lose weight, and had been experiencing night
sweats.

The emergency room physician immediately transferred the patient for isolation in a local
hospital. A repeat chest radiograph revealed progressive bilateral fibronodular disease with a
“miliary” pattern. The patient was given a 20-month regimen of levofloxacin, kanamycin,
cycloserine, pyrazinamide and prothionamide. Following completion of therapy, closure of the
destruction cavity was found with local pneumofibrosis.

Therapeutic Monitoring
Sputum examination and culture or
Drug susceptibility testing
Chest X-ray
PHARMACY INTERVENTION
Subjective
Patient complains of a productive cough with hemoptysis for the past few days. He also
complains of shortness of breath that worsens with exertion, pleuritic chest pain , subjective
fevers, chills, night sweats, fatigue, and a 10-lb weight loss over the past several weeks.
Objective
Vitals
Tmax 38.0ºC
Heart Rate 110 beats per minute
Respiratory Rate 20 breaths per minute
Blood Pressure 130/76
Oxygen Saturation 98% on room air
Labs
Na: 133 Creatinine: 1.8
K: 4.1 WBC: 9.48 x 109/L
Cl: 96 Hgb: 11.4 g/dL (114 g/L)
Platelets: 149 109/L HIV test: Negative
Assesment
Due to the symptoms experienced by the patient, my assessment, the findings are consistent
with tuberculosis infection.
Plan
 Administration of Rifampicin, Isoniazid, Pyrazinamide, Etambutol/Streptomycin.
 Avoid drinking alcohol.