PHARMA B

CASE # 4

COMPLICATED UTI

HPI:
Mr. RT , a 32-year-old,male, married, a canteen cleaner, came in to clinic due to 4 day history of
hypogastric pain with terminal dysuria, polyuria and polydipsia. No prior consult was done, he took
paracetamol for pain which afforded slight relief. No other associated signs and symptoms was noted.
One day PTC, he had low grade fever with body malaise, hence the consult.
No other associated signs and symptoms noted.

Past Medical History:

Has Type 2 DM for 2 years. Her usual treatment is Gliclazide 30 mg 2x a day before meals.
Non hypertensive. Had appendectomy at 18 y/o. Admitted 2x due to uncontrolled
sugar and urinary tract infection.

Family History :
Hypertensive and DM both parents. Only child

Personal and Social History:

High school undergraduate. Smoker of 4-5 sticks /day and occasional alcoholic drinker.
Love to eat fatty foods and softdrinks

Physical Examination: ( pertinent )

General Survey: conscious, coherent, ambulatory, not in CR distress
Vital signs: BP- 120/80mmhg. CR- 87 bpm. RR- 19 cpm T- 37.9 C O2 sat 96 %
Abdomen : flat, NABS, soft, with hypogastric tenderness, no CVA tenderness

Laboratory results ( pertinent findings )

CBC : WBC – elevated with predominance of neutrophil
Urinalysis : pus cell- more than 50 /hpf
Rbc- 3-5

Guide Questions:
1. What is your impression and basis?
2. Additional diagnostic work up you need to request based on the presenting signs and
symptoms.
3. Make a concept map, emphasizing on the pathophysiology of the disease/case.
4. What is your therapeutic objective.
4. Give your non pharmacologic management.
5. Identify the pharmacologic agent using the rational drug use.
6. Discuss the drug of choice as to pharmacokinetic, pharmacodynamics, drug interactions
7. Be able to write correct prescription and follow up advice.
LEPTOSPIROSIS

34 year old, male, came in due to fever

4 days prior to admission, patient started to have fever (tmax 38.4c) associated with chills abdominal pain
and headache. He self medicate with paracetamol which afford temporary relief. 2 days prior to admission
above symptoms persist now noted with yellowish discoloration of skin, abdominal pain, vomiting which
prompted him to seek consult and was subsequently admitted. Pertinent past medical history is
remarkable for allergies to amoxicillin and cefuroxime. He claims to be residing in a flood prone area in
Malabon City. Vital signs upon arrival 120/80, 102bpm, 22cpm and febrile at 38.9 Other physical exam
revealed icteric sclerae, conjunctival suffusion calf tenderness, and 5x4cm linear wound in the lateral
aspect of left foot.

1. What are your differential diagnosis and basis?

2. What is your working diagnosis and basis?
3. Describe the pathophysiology of the problem and formulate a concept map?
4. What are the laboratory test you will request?
5. What are the non-pharmacological management?
6. What is/are the recommended antibiotics for this case?