CONFIDENTIAL 1 PH/JUNE 2020/PHD222

UNIVERSITI TEKNOLOGI MARA

COURSE : HOSPITAL PHARMACY

COURSE CODE : PHD222
INDIVIDUAL : 13TH JULY 2020 (To be submitted)
ASSIGNMENT

CASE 2

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

Mr B is a 67-year-old retired miner who presents to hospital as an emergency with acute

shortness of breath and a cough productive of green sputum. Mr B has a past medical
history of COPD and had a myocardial infarction 10 years ago. He smokes 35
cigarettes per day and has done so for the last 45 years. Spirometry has shown that his
FEV1 is 58% of predicted. He weighs 45 kg.

When he is well his assessment test (CAT) score is 8. There are no known drug
allergies.

Mr B’s regular medication is:

• aspirin 75 mg daily,
• bisoprolol 10 mg daily,
• simvastatin 20 mg at night,
• salmeterol 25 microgram pressurized metered dose inhaler (pMDI) two puffs twice
daily.
CONFIDENTIAL 2 PH/JUNE 2020/PHD222

On examination:

• blood pressure (BP) 130/75 mmHg,

• temperature 38.6 °C,
• pulse 98 bpm,
• respiratory rate 28 breaths/min.

Investigations:

• white blood cell count 20.8 × 109 L,

• creatinine 140 mmol/L – his baseline was 93 mmol/L 3 months ago,
• Hb – normal,
• oxygen saturation 84% on 28% oxygen via Venturi mask,
• chest X-ray – no consolidation seen.

Arterial blood gases on 28% oxygen:

pH 7.30 (7.35–7.45)
pO2 7.26 kPa (10–13 kPa)
pCO2 8.3 kPa (4.7–6.0 kPa)
HCO3 24 mmol/L (22–26 mmol/L)

Mr B shows no clinical improvement and appears to be tiring. He is transferred to the

intensive care unit (ICU) in case ventilation (invasive or non-invasive) may be needed.
In the ICU, the intensivists wish to increase his medical treatment.

Few hints as questions for case evaluation;

1. What is the diagnosis, and how was this determined?

2. What do the arterial blood gases show, and how would you suggest this is
managed?
3. What would you expect to see on Mr B’s prescription chart for acute management
of his condition?
4. What options are there?
5. How should aminophylline be administered?
6. What treatment options would you recommend for Mr B once he has recovered
from his acute illness?
7. Are there any other medications that require optimization?