UNIVERSITY OF SANTO TOMAS

FACULTY OF PHARMACY

DISPENSING 2 LECTURE (PHA 6130)

Adverse Drug Reaction Activity
OBJECTIVES:
1. To evaluate student understanding of using ADR assessment tools, specifically the Naranjo
scale;
2. To familiarize students in other concepts of adverse drug reactions through group
discussions.

INSTRUCTIONS: Analyze each case given and answer the questions provided for each. Indicate
the references used for each case after your group’s answers per case using the APA format. (45
points)

CASE 1.
Mr. JD, a 63-year-old male, has been diagnosed with Alzheimer’s disease. He is currently on
Memantine 20mg/tab, ½ tab 2x a day per orem and Citicoline 500mg cap, 1 cap once daily in the
morning. However, he has been presenting with increasing forgetfulness and more frequent bouts
of confusion. His neurologist started Mr. JD on Rivastigmine 9.5mg patch every 24 hours
transdermally.
Upon initiation, his wife reported that the patient frequently wakes up in the middle of the
night due to vivid nightmares. She said that the patient hasn’t been the same since the new
medication was prescribed and would like to know if Rivastigmine may have caused this.

Questions:
1a. What ADR did the patient experience for this case? Showing the Naranjo scale scoring, assess
the probability of Rivastigmine in causing the identified ADR.
1b. Provide a brief discussion of the assessment score.
1c. Based on clinical evidence, what pharmacist recommendation/s may be provided to the
prescriber, patient, or patient care providers?

CASE 2.
Patient HM is being managed as a case of Congestive Heart Failure, and is maintained on
Digoxin 0.25mg tab, 1 tab once daily per orem and Carvedilol 6.25mg tab, 1 tab 2x a day per orem.
Due to inadequate urine output, she was started on Furosemide drip 200mg in NSS 100mL running
at 7mg/H in order to prevent edema and congestion. Fluid intake was also limited.
A few hours after initiation of Furosemide drip, patient vomited approximately 150mL before
going into Ventricular Tachycardia. Furosemide drip was clamped. ACLS was provided and
Amiodarone 150mg in NSS 80mL was given for 10 minutes followed by Amiodarone 600mg in NSS
300mL to run for 24 hours.
Digoxin serum concentration was found to be at elevated level (5.6ng/mL). Digoxin Immune
Fab 160mg in NSS 150mL was given.

UST – Faculty of
Pharmacy
 UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY

Questions:
2a. What ADR did the patient experience for this case? Showing the Naranjo scale scoring, assess
the probability of Furosemide in causing the identified ADR.
2b. Provide a brief discussion of the assessment score.
2c. What could have been done to prevent this ADR?

CASE 3.
Patient KR is an 82-year-old male previously admitted for Diabetic Ketoacidosis and was
subsequently discharged on Metformin 1 gram tablet 3x a day per orem and Insulin Glargine 14
units once daily at bedtime subcutaneously. He also had pre-renal Acute Kidney Injury, but refused
work-up.
He was rushed to the ER as his neighbor saw him on the floor with labored breathing and
cold clammy extremities. Initial laboratory results showed the following: Serum Creatinine 4.2mg/dL,
Sodium 138mEq/L, Potassium 3.6mEq/L and CBG of 321mg/dL. Arterial blood gas was drawn with
the following values: pH 6.7, HCO3- 1.8mEq/L, Lactate of 18mmol/L.
Patient was admitted to the ICU and was started on Hemodialysis. Metformin was
discontinued. Insulin drip therapy was initiated.

Questions:
3a. What ADR did the patient experience?
3b. What predisposing factors of patient KR could have contributed to the occurrence of this ADR?
3c. Based on clinical information, provide a brief discussion on the evidence that Metformin can
cause this ADR.

UST – Faculty of
Pharmacy