Kwame Nkrumah University of Science and Technology

Faculty of Pharmacy and Pharmaceutical Sciences

Department of Clinical & Social Pharmacy

[Pharmaceutical Care Plan Documentation]

KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY

FACULTY OF PHARMACY AND PHARMACEUTICAL SCIENCES

CASE STUDY ON THE OPTIMIZATION OF THE TREATMENT OF

HELICOBACTER PYLORI INDUCED PEPTIC ULCER DISEASE

NAME: ADOMAKO NANA OFORI

INDEX NUMBER: 7875612

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 Kwame Nkrumah University of Science and Technology

Faculty of Pharmacy and Pharmaceutical Sciences

Department of Clinical & Social Pharmacy

[Pharmaceutical Care Plan Documentation]

PATIENT PROFILE

Personal Information

Patient Initials: K.A.B. Gender: MALE Age: 52

Date:19/06/2016 Height: 1.72m Weight:72kg

BMI:24.32kg/m 2

Pharmacy: Panacea, Kwamo Ethnic Origin: Northerner

Presenting complaint: History of Presenting Complaint:

Heartburns, dull pain in the stomach which Excessive burping, heartburns, dull
improves upon eating pain in the stomach which improves
upon eating

Social History: Family History:

No smoking, alcoholic, married with four No known family history of any
children chronic disease

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 Kwame Nkrumah University of Science and Technology

Faculty of Pharmacy and Pharmaceutical Sciences

Department of Clinical & Social Pharmacy

[Pharmaceutical Care Plan Documentation]

Past Medical History: Relevant Signs:

Temperature: 36ºC
BP 136/94mmHg
Patient was diagnosed of peptic ulcer a 6 Pulse: 83bpm
months ago.
Weight: 72kg
BMI: 24.32/m2

Risk Factors
Intake of alcohol, age

Medication History [Past Six Months ]

Prescription Medications
Medication Name Dosage/ Start Stop Reason for use Comment
/ strength/route Frequency Date
Date

Omeprazole 20mg Twice daily Jan 2016 Jan 2016 Acid suppressant Appropriate
Oral

Antibacterial for
Metronidazole H. pylori
Twice daily Jan 2016 Jan 2016 Appropriate
400mg Oral eradication.

Amoxicillin 1g Antibacterial for

Oral Twice daily Jan 2016 Jan 2016 H. pylori Appropriate
eradication.

Allergies: The patient has no allergies.

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 Kwame Nkrumah University of Science and Technology

Faculty of Pharmacy and Pharmaceutical Sciences

Department of Clinical & Social Pharmacy

[Pharmaceutical Care Plan Documentation]

Lifestyle Information- please ask questions which are relevant and appropriate to
the patient
(e.g., exercise, use of: tobacco, alcohol, recreational drugs). Quantify
information where possible (e.g., units of alcohol, frequency of exercise).
The patient is a long distance driver who takes alcohol occasionally. He is married. He’s
usually unable to control his diet and follow the dosage regimen because of the nature of
his work.

Does pt. self-monitor at home?

Blood  Yes Peak  Yes Blood  Yes Ketones  Yes
Pressure Flow Glucose
No No No No

Additional Information

Who organizes the patient’s medications at home?

Patient
 Care taker
 Other:
____________________________________________________________________
____

Suspected adherence concerns? Please describe.

The patient was diagnosed of peptic ulcer earlier and was given medication but
because of the nature of his job, adherence to counselling was a problem. Also,
after symptoms began to resolve, he failed to continue the therapy thinking he
was better.

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 Kwame Nkrumah University of Science and Technology

Faculty of Pharmacy and Pharmaceutical Sciences

Department of Clinical & Social Pharmacy

[Pharmaceutical Care Plan Documentation]

INVESTIGATIONS
No laboratory investigation was performed.

Current Medications
Medication Dosage Start Date End Date Reason for Comment
[name/ strength /Frequency use
Route]
Esomeprazole Twice daily 3/06/16 10/06/16 Acid Appropriate
20mg Oral suppressant

Clarithromycin Antibacterial
500mg Oral Twice daily 3/06/16 10/06/16 Appropriate
for H. pylori
eradication.

Antibacterial
Amoxicillin 1g Oral Twice daily 3/06/16 10/06/16 Appropriate
for H. pylori
eradication
Thrice daily - -
Maalox suspension Antacid
15mL Appropriate

Medical Problems/ Diagnosis

1. Helicobacter pylori induced peptic ulcer

Pharmaceutical Care Problems (Issues)

1. Inadequate counseling on disease condition and medication resulting in
defaulting of medication.
2. Inadequate monitoring and follow-up on patient.

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 Kwame Nkrumah University of Science and Technology

Faculty of Pharmacy and Pharmaceutical Sciences

Department of Clinical & Social Pharmacy

[Pharmaceutical Care Plan Documentation]

PHARMACEUTICAL CARE PLANS (SOAPO)

Pharmaceutical care problem 1

TO OPTIMIZE TREATMENT OF HELICOBACTER PYLORI INDUCED PEPTIC
ULCER
Subjective data
Heartburns, dull pain in the stomach which improves upon eating, anorexia,
excessive burping.
Objective data
Assessment
The subjective data of Heartburns, dull pain in the stomach which improves
upon eating with no history of NSAID intake confirms the diagnoses of H. pylori
induced peptic ulcer.

Appropriateness of prescribed medication

 Esomeprazole is a proton pump inhibitor which works by decreasing the
amount of acid in the stomach which prevents aggravation of the peptic
ulcer disease and also alleviates heartburns which occur as a result of
over-secretion of gastric acid. The dose and route as well as duration is
suitable. (BNF 61ed page 56).

 Clarithromycin is a macrolide antibacterial agent used in the eradication of

Helicobacter pylori which is a causative organism of peptic ulcer. The dose,
route and duration is appropriate for the intended use. (BNF 61ed page 50)

 Amoxicillin is a penicillin antibiotic agent which can be used in the

eradication of Helicobacter pylori which is a causative organism of peptic
ulcer. The dose and route as well as the duration is suitable. (BNF 61ed
page 50).

Monitoring
 Esomeprazole
Efficacy: a decrease in stomach acidity characterized by eradication of heartburn
and stomachache was expected.

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 Kwame Nkrumah University of Science and Technology

Faculty of Pharmacy and Pharmaceutical Sciences

Department of Clinical & Social Pharmacy

[Pharmaceutical Care Plan Documentation]

Toxicity: the patient was monitored for dizziness, confusion, fast or uneven heart
rate, watery or bloody diarrhea, cough or choky sensations as well as dryness of
mouth.
 Clarithromycin
Efficacy: eradication of H. pylori characterized by reduction in abdominal pain
when stomach is empty, anorexia and excessive burping.
Toxicity: the patient was monitored for unpleasant taste in mouth, headache,
insomnia, mild itching and rash.
 Amoxicillin
Efficacy: eradication of H. pylori characterized by reduction in abdominal pain
when stomach is empty, anorexia and excessive burping.
Toxicity: the patient was monitored for black stools, blistering of the skin, bloody
nose, difficulty in breathing and swallowing, fever, general body edema and
vomiting of blood.

Plan
Counsel extensively on the condition and medication since inappropriate
counselling resulted in poor adherence to medication.

Perform a regular follow up by means of phone call during to the course of

treatment to ensure the patient is complying.

Counseling
I advised my patient on his disease condition by saying;
 Peptic ulcer is break of mucosal integrity of the stomach and/or duodenum
leading to local defect due to active inflammation. Peptic ulcers develop as
a result of an imbalance between mucosal protection/repair and aggressive
factors. Gastric infection with the bacterium H. pylori accounts for the
majority of cases of peptic ulcer disease. Transmission of H. pylori occurs
from person to person, following an oral-oral or fecal-oral route. This is an
important factor among causes of Peptic Ulcer disease. If left untreated,
complications such us gastrointestinal bleeding, gastric outlet obstruction,
perforation an even death may result.
I advised my patient to;
 Keep weight in check and avoid sedentary lifestyle.

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 Kwame Nkrumah University of Science and Technology

Faculty of Pharmacy and Pharmaceutical Sciences

Department of Clinical & Social Pharmacy

[Pharmaceutical Care Plan Documentation]

 Allay anxiety and stress.

 Include good sources of fiber like vegetables, fruits, oatmeal, nuts, dried
beans and peas at each meal.
 Eat food slowly and chew it properly.
 Consume food at regular intervals. In general, take small meals every 3
hours.
 Avoid spicy foods since they can make symptoms of peptic ulcer worse.
Avoiding them during exacerbation of symptoms is necessary for
successful treatment.
 Administer medication appropriately (required dose and frequency as well
as mode of administration)
 Avoid or take coffee and alcohol in moderation since coffee stimulates
gastric acid secretion and alcohol can cause gastritis.
On the medications, I told my patient;
 Do not chew or crush esomeprazole tablets. You can swallow whole or
disperse in water.
 Avoid intake of over-the-counter drugs as well as herbal preparation
without the consent of the physician
Outcome/ Evaluation
The intervention was accepted. The patient’s condition improved.

References
• British National Formulary, 65th edition, BMJ Group and Pharmaceutical
Press, Pages 50-56
• Dyspepsia and gastroesophageal reflux disease: Investigation and
management of dyspepsia - symptoms suggestive of gastroesophageal reflux
disease - or both; NICE Clinical Guideline (Sept 2014).
• Standard Treatment Guidelines (2010), 6th edition, Yamens Press Ltd., page
27-