PHARMACOTHERAPEUTICS – II

CASE PRESENTATION ON PSORIASIS

BY: SRIRAM A
381710574
CASE SUMMARY
 Mr. X is a 57 year old male patient who was admitted in the
General medicine department. He works as a basketball
coach. The patient was admitted on 23/08/2020. He had
complains of non-radiating continuous bilateral leg pain for
15 days and constipation since 17/08/20. While taking his
medical history, he was known to have psoriasis (past 10
years) and diabetes (for the past 5 years). He also had
hypertension for 2 years. He was not on regular medication
for DM and hypertension and was undergoing Ayurveda
treatment for psoriasis.
 He was diagnosed with Systemic hypertension, Type 2 DM,
Psoriasis, Diabetic Retinopathy, Neuropathic pain.
FINDINGS
SUBJECTIVE:
 COIMPLAINTS ON ADMISSION: non-radiating

continuous bilateral leg pain for 15 days and

constipation since 17/08.
 Medical History: k/c/o psoriasis x 10yrs, k/c/o

Hypertension x 2yrs and DM x 5yrs

 Medication history: Not on regular medication for

diabetes and hypertension, Undergoing ayurvedic

treatment for psoriasis.
FINDINGS
OBJECTIVE:
PHYSICAL EXAMINATION: Dry scaly white
lesions, conscious, afebrile and oriented.
VITAL SIGNS:
 TEMP:

 BP: 130/85 mmHg

 PR: 88 beats/min

 RR: 24 breaths/min
 LAB INVESTIGATIONS
PARAMETERS REPORT NORMAL VALUE
DLC N-83% N- 48-77%
L-9.4% L- 10-40%
ESR 24 mm 0-22 mm
FBS 175 mg/dl 80-110 mg/dl
HbA1c 9%
 LAB INVESTIGATION

LAB INVESTIGATION REPORT

HIV TEST Negative
FINAL DIAGNOSIS
 Systemic hypertension
 Type II diabetes mellitus
 Diabetic Retinopathy
 Nueropathic pain
 DRUG CHART
BRAND NAME GENERIC NAME DOSE 23 24 25 26 27 28 29
&FRE
Q
T. Pan 40 Pantoprazole 1-0-0 / / / / / / /
T. Cardioplus Vitamin B12+ 1 mg / / / / / /
Vitamin B6+ Vitamin OD
A+ Vitamin C+Folic
Acid (Vitamin B9)+
Copper+ Selenium+
Zinc+ Vitamin E+
Chromium+
Manganese.
T.Ultacet Tramadol(37.5mg)+ SOS / / / / / /
Acetaminophen(325
mg)
T.Paracetamol Acetaminophen 500mg / / / / / / /
SOS
T. Diabend Gliclazide 80mg½ / / / / /
-0-1
DRUG CHART
BRAND NAME GENERIC NAME DOSE 23 24 25 26 27 28 29
&FRE
Q
T. Gabalin Pregabalin 100mg / / / / /
1-0-1
T. Cardace Ramipril 2.5 mg / / / / / /
½-0-1/2
Inj. Ketanov Ketorolac 1amp / / /
BD
T. Augmentin Amoxicillin+clavulun 625 mg / / / /
ic acid 1-0-1
Syp. Dulphalac Lactulose 15ml /
0-0-1
DISCHARGE MEDICATIONS
DRUG DOSE AND FREQUENCY
T. Diabend 80mg ½-0-1/2

T. Gabalin 100mg 1-1-1

T. Cardace 2.5 mg ½-0-0

T. Cardioplus 1mg 1-0-0

T. Augmentin 625 mg 1-0-0 (3DAYS)

T. Folvite 5mg 1-0-0 (3DAYS)

Diprosalic ointment
 ASSESSMENT AND PLAN
ASSESSMENT PLAN
AGE: 57 Adult dosing
SEX: MALE
FINAL DIAGNOSIS:
Systemic hypertension
Type II diabetes mellitus
Diabetic Retinopathy
Nueropathic pain

DRUG-DRUG INTERACTIONS:
Tramadol+Pregabalin:(MAJOR)
Both the drugs act on CNS and cause Avoid the combination, use alternative
CNS depression, Respiratory distress, drugs.
coma.
ASSESSMENT AND PLAN
ASSESSMENT PLAN
Tramadol+ Lactulose(moderate):
Can cause electrolyte loss and increase Monitor for electrolyte imbalance
the risk of torsade de pointes ventricular
arrhythmia
Pregabalin+ Ramipril(moderate):
Both potentiates the risk of angioedema Look for signs such as  swelling of the
face, extremities, eyes, lips, or tongue,
and difficulty swallowing or breathing.

Ramipril+ Ketorolac(moderate):
Ketorolac may attenuate the anti Monitor the blood pressure.
hypertensive activity of ramipril.
DRUG-FOOD INTERATIONS:
Tramadol+ Alcohol
Alcohol may potentiate the effect of Monitor the plasma concentration of
tramadol tramadol.
ASSESSMENT AND PLAN:
ASSESSMENT PLAN
Units of platelets and total protein units Platelets- 255x10*3/mcL
are not mentioned Total proteins- 6.3g/dl
Kidney function is not assessed Perform KFT

Temperature is not mentioned

PATIENT COUNSELLING
DRUG RELATED COUNSELLING:
 T.Diabend- You should always carry a sugar candy with

you to counteract an unexpected lowering of blood

sugar levels.
SIDE EFFECTS: Dizziness, constipation, Diarrhea,
skin rash, abdominal pain.
 T.Gabalin- Take with or without food.Swallow whole,

do not crush or chew

SIDE EFFECTS: Peripheral edema, weight gain,
Head ache, somnolence, Diplopia
 PATIENT COUNSELLING

DRUG RELATED COUNSELLING:

 T. Cardace- Rise slowly from sitting or lying position

SIDE EFFECTS: Hypotension, Rashes, Cough,

Fatigue.
 T. Cardioplus- taken at about the same time each day, with

or without food, for example at breakfast time. The tablet

should be swallowed with a sufficient amount of fluid (e.g.
one glass of water). The tablet should not be chewed.
SIDE EFFECTS: headache, influenza-like symptoms
and dizziness.
PATIENT COUNSELLING:
 T. Augmentin- Drug may decrease the effect of oral
contraceptives with concurrent use.Recommend
additional form of birth control.Take at the start of the
meal
SIDE EFFECTS: Rash, diarrhea, loose stool, Nausea,
Vomiting.
 T. Folvite- Should not drink alcohol while taking drug

SIDE EFFECTS: Loss of appetite, Nausea, confusion,

irritability, sleep pattern disturbances.
PATIENT COUNSELLING:
 Diprosalic ointment- Avoid getting ointment in
your eyes, nose or mouth. Don’t use in large
amount in large part of body for longer time.
SIDE EFFECTS: itching, blistering, dryness, red
marks.
 PATIENT COUNSELLING
DISEASE RELATED COUNSELLING:
 HYPERTENSION- Can cause complications like heart

attack, stroke, aneurysm, heart failure, kidney damage,

peripheral artery disease.
 DIABETES MELLITUS- complications include glaucoma,

cataracts, diabetic neuropathy, diabetic nephropathy.

 PSORIASIS- Can cause complications like psoriatic

arthritis, Anxiety, depression, Parkinson’s disease, Obesity

 KINDLY ADHERE TO THE ABOVE MEDICATIONS

TO PREVENT FURTHER COMPLICATIONS

LIFESTYLE MODIFICATION
 Do moderate exercise
 Lose weight
 Sleep well
 Reduce salt intake
 Eat foods less in sugar and fat
 Reduce stress
 Avoid harsh soaps and scrubs.
 Do not dry out the skin
MONITORING PARAMETERS
 BP
 FBS
 Kidney function test
 HbA1c
THANK YOU