CASE PRESENTATION ON COPD

with Maxillary sinusitis in DM-2

Ujjawal sharma
190823207034
SUBJECTIVE DATA
Demographic details:
• Patient name :- mr. kantibhai patel
• Age :- 55 year
• Sex:- male
• Ward :- general medicine
• Date of admission :- 25/9/2017
• Date of discharge :- 30/9/2017
Complaints of the patients on date of
admission:-

• Headache for 2 days

• Pain in right side of jaw since 5 days
• Difficulty in breath
Medical history:- k/c/o DM-2 for the past 10 year
Medication history:- metformin 500mg ,1-0-1 for the
past 10 year
Social history:- small businessman , rural area of
recidance , no addiction

*clinical pharmacist remarks :- family history

and previous allergies history missing
OBJECTIVE DATA
Physical examination:

RS :- B/L AE+
CVS :- S1S2+
CNS :- Concious , oriented

*clinical pharmacist remarks :- general examination

, spo2,RBS , GU , PUPIL missing
Vital 25/9 26/9 27/9 28/9 29/9 30/9
BP 130/90 136/90 146/96 132/90 122/80 139/86
PULSE 78 78 76 88 86 84
TEMP. AF AF AF AF AF AF
PROVISIONAL DIAGNOSIS
Breathing problems with k/c/o DM 2
Laboratory data
PARAMETER 25/9
Hb (13-17 g/dl) 8.5
TLC ( 4000-11000) 9700
Urine: pus cells ( 0-1/hpf) 2-3

Epi.cell (0-1/hpf ) 1-2

PCV ( 40-50%) 24.7

MCV (86-100fL) 71.4
MCH (27-33pg/cell) 24.0
RBC (4.7 -6.1 million/cell) 3.46
RDW 18

IRON PROFILE
TIBC (250-370 µg/dl) 432
s.Ferritin (20-250) 245
 ASSESSMENT
Final diagnosis :

COPD with Maxillary sinusitis in DM-2

*clinical pharmacist remarks :- patients having

iron deficiency anemia but not write in final
diagnosis
 ABOUT DISEASE
Chronic obstructive pulmonary disease :-
• Chronic obstructive pulmonary disease (COPD) is a
preventable and treatable disease state characterized by
airflow limitation that is not fully reversible.
• The airflow limitation is usually progressive and is
associated with an abnormal inflammatory response of
the lungs to noxious particles and gases, primarily
caused by cigarette smoking.
• Although COPD affects the lungs, it also produces
significant systemic consequences.
• Shortness of breath, especially during physical activities.
• Wheezing.
• Chest tightness.
• A chronic cough that may produce mucus (sputum) that
may be clear, white, yellow or greenish.
• Frequent respiratory infections.
• Lack of energy.
• Unintended weight loss (in later stages)
• Swelling in ankles, feet or legs
Causes
•  asthma
• Pollution
• Smoking
• Age
• Chemical exposure
• Chronic bronchitis
• AAT defeciency
Complication
• Respiratory infections. People with COPD are more likely to
catch colds, the flu and pneumonia.
• Heart problems
• Lung cancer
• High blood pressure in lung arteries
• Depression
Maxillary sinusitis :-
• Maxillary Sinusitis is the inflammation of the
paranasal sinuses caused by a virus, bacteria,
or fungus.
• The infection can also result after an allergic
reaction – when the immune system attacks
the healthy body cells.
• This infection may be associated with both
bacterial and fungal infections.
 symptoms :-
• facial pain or pressure
• nasal congestion
• reduced ability to smell
• Headache.
• Bad breath.
• Fatigue.
• Cough.
Causes :-
• The sinus produces mucus lining which
performs the function of smelling, protecting
against dust, blocked nose, and more. Some of
its most possible causes include:
• Common cold, or influenza flu.
• Viral infections.
• Bacterial infections.
• Hay fever and other allergies.
Diabetes mellitus 2 :-
• A chronic condition that affects the way the body
processes blood sugar (glucose).
• With type 2 diabetes, the body either doesn't
produce enough insulin, or it resists insulin.
sign & symptoms :-
 increased thirst
 frequent urination
 Hungriness
 fatigue
 blurred vision
 poor wound healing
Complication :-
• Retinopathy
• Neuropathy
• Nephropathy
• Diabetic foot
• Ketoacidosis
• Hypertension
• Heart attack
Need of therapy:-
• Prevent further compliance.
• Maintaining current condition.
• Reduce risk of mortality.
• Get the condition to normal. 
Standard therapy for DM-2 :-
Standard therapy for copd :-
CURRENT THERAPY
Brand name Generic name Dose Frequency Duration
Inj. Augmentin Amox/clav 1.2 8hr 25-30/9
Inj. HAI Insulin actrapid insulin 6-8-6 unit 8 hr 25-30/9

Inj. Lantus Insulin glargine 10 unit 10pm 25-30/9

Tab. Acetal Aceclofenac 100mg 1-0-0 26-30/9

Inj. 0.9% NS with1Ꙩ MVI 10ml im 80cc/hr 25-30/9
500ml

Tab. Zerodol Aceclofenac 100mg 0-0-1 25-30/9

Neb. Duolin with 6hr & 8hr 26-30/9
budecort

cap. Pregaba-M Pregabalin + 75mg + 0-0-1 27-30/9

methylcobalamin 750µg

Syp. Cremaffin plus MgOH 2tsp 0-0-1 27-30/9

Inj. Iron sucrose 1Ꙩ in Given over OD 29-30/9
300ml NS 3hr

Otrivin nasal drop Xylometazoline 2 drops 2-2-2

1)Inj. AUGMENTIN
Generic name :- amoxicillin/clavulanate potassium
Brand name :- augmentin
Class:- antibiotics
Dose :- 1.2
Frequency :- 8hourly
MOA :- Amoxicillin binds to penicillin-binding proteins within the
bacterial cell wall and inhibits bacterial cell wall synthesis.
Clavulanic acid is a β-lactam, structurally related to penicillin, that
may inactivate certain β-lactamase enzymes
Indication :- sinusitis , UTI, community acquired pneumonia , LRTI
ADR:- anaphylaxis , diarrhea , steven- johnsan syndrom , hepatitis ,
hypersensitivity reaction
Drug – Drug interaction::-
2) Inj. HAI
Generic name :- human actrapid insulin
Brand name :- HAI
Class :- Fast acting insulin and analogus
Dose :- 6-8-6 unit
Frequency :- 8 hr
MOA:- The blood glucose lowering effect of insulin is due to the
facilitated uptake of glucose following binding of insulin to
receptors on muscle and fat cells and to the simultaneous
inhibition of glucose output from the liver.
Indication :- diabetes mellitus
ADR :- pain, rednessDecreased blood glucose levels · Decreased
potassium levels
Drug –Drug interaction :-
3) inj. Lantus
Brand name : lantus
​Generic name:- insulin glargine
​Dose : 10 unit
​frequrncy: 10 pm
Class : long acting insulin
​Indication:- diabetes mellitus type 1 or type 2
​MOA:- Insulin and its analogs lower blood glucose levels by
stimulating peripheral glucose uptake, especially by
skeletal muscle and fat, and by inhibiting hepatic glucose
production. Insulin inhibits lipolysis in the adipocyte,
inhibits proteolysis, and enhances protein synthesis.
ADR :- hypoglycemia , hyperglycemia , hypokalemia , edema
, body fluid retention.
​.​
4) Tab. Acetal
Generic name :- aceclofenac
Brand name :- acetal
Class :- NSAID
Dose :- 100mg
Frequency :- 1-0-0
MOA:- aceclofenac is largely based on the inhibition
of prostaglandin production by selectively
inhibiting COX-2 .
Indication :- relieving pain and inflammation
osteoarthritis, rheumatoid arthritis, throat pain,
back pain, toothache, or pain in the muscles.
ADR:- Nausea, vomiting, diarrhoea, flatulence,
constipation, dyspepsia, abdominal pain, melaena.
5 ) Tab. Zerodol :-
Generic name : aceclofenac
Brand Name : zerodol
Class : NSAIDS
Dose : 100mg
Freq :0-0-1
MOA: aceclofenac is largely based on the inhibition of
prostaglandin production by selectively inhibiting COX-2 
Indication : rheumatoid arthritis, throat pain, back pain,
toothache, or pain in the muscles.
ADR: Allergic skin reactions, Gastric, Mouth ulcer, Bloody
and cloudy urine, Fatigue, Abdominal pain,
Constipation,Diarrhea.

.
6) cap. Pregaba-M
Generic name :- Pregabalin + methylcobalamin
Brand name :- pregaba-M
Route :- PO
Frequency :- 0-0-1
Dose :- 75mg + 750µg
Indication :- used for neuropathic pain, anemia , seizures ,
numbness and tingling
MOA :- Pregabalin acts by decreasing the pain signals sent
by a damaged nerve in the body. On the other hand,
Methylcobalamin helps rejuvenate and protect damaged
nerve cells by producing a substance called myelin 
ADR :- dizziness, Sleepiness, trouble concentrating, blurry
vision, dry mouth, weight gain, swelling of your hands or
feet
7) Syp. Cremaffin plus :-
Generic name :- cremaffin plus
Brand name :- MgOH
Class :- laxatives.
Dose :- 2TSP
Route :- oral
MOA :- It works by drawing water into your bowels and
making your stools softer and easier to pass.
Indication :-constipation
ADR:- diarrhea, loss of appetite, tiredness.
8) Tab. Iron sucrose :-
Generic name . :- iron sucrose
Dose :- 1Ꙩ in 300ml NS ( GIVEN OVER 3HR)

Route :- IV
Frequency :- OD
MOA :- Iron sucrose injection is in a class of medications
called iron replacement products. It works
by replenishing iron stores so that the body can make
more red blood cells
Indication :- iron defficiency anemia
ADR :- headache , nausea , hypotension
9) Tab. Otrivin nasal :-
Generic name :-otrivin
Brand name :- xylometazoline
Class :- antihistamine
Dose :- 2 puffs
Frequency :- 2-2-2
MOA:-  A sympathomimetic that directly acts on alpha-
adrenergic receptors in arterioles of the nasal mucosa to
produce vasoconstriction resulting in decreased blood
flow.
Indication :- common cold, sinusitis, hay fever, and allergies
ADR:-Temporary burning, stinging, dryness in the nose,
runny nose, and sneezi
PLANNING
Goals of therapy:-
• General goals :- to improve the patients
condition and reduce mortality and morbidity.
• Patient specific goal :-
• to reduce the pain in right side of jaw in
patient .
• Treat headache .
DISCHARGE MEDICATIONS

Drug Generic name Dose Frequency Duration

Inj. HAI Human 6-8-6 unit 1-1-1 15 days
actrapid insulin
Inj. Lantus Insulin glargine 10 unit 10 pm 15 days
Tab. Zerodol Aceclofenac 100mg 1-0-1 15 days
Tab. Febac – XT Ferrous 0-1-0 15 days
ascorbate +
folic acid
Otrivin nasal Xylometazoline 2 drops 2-2-2 15 days
drops
Syp.creamatin mgoH 2tsp 0-0-1 15 days

Clinical pharmacist remark :-

MONITORING PARAMETER
Therapeutic monitoring
1.Augmentin :-check CBC , hepatic function
2.HAI :-check HbA1c
3.Insulin glargine :- check HbA1c , blood glucose level
4.Aceclofenac :- check ESR, CRP
5.Duolin :- check pulmonary function tests
6.Budecort :- check pulmonary function tests
7.Pregabalin :- check Pregabalin levels
8. Iron sucrose :- check sign and symptoms of hypotension
Toxicity monitoring :-

• 1.Augmentin :-check CBC , hepatic function

• 2.HAI :- hypoglycaemia
• 3.Insulin glargine :- hypoglycaemia
• 4.Aceclofenac :-check LFT , RFT
• 5.Duolin :- check pulmonary function tests
• 6.Budecort :- check pulmonary function tests
• 7.Pregabalin :- check Pregabalin levels
• 8. Iron sucrose :- check sign and symptoms of
hypotension
Pharmacist intervention:-
Drug-Drug interaction
Point to patient
Drug related:-
• Don’t miss any medication.
• Consume as prescribed.
• If any adverse reaction occurs, contact physician immediately.
• Do not break or chew tablets. 
• Disease related:- 
•  Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory
lung disease that causes obstructed airflow from the lungs.
• Maxillary Sinusitis is the inflammation of the paranasal sinuses
caused by a virus, bacteria, or fungus.
• Type 2 diabetes is an impairment in the way the body regulates and
uses sugar (glucose) as a fuel. This long-term (chronic) condition
results in too much sugar circulating in the bloodstream.
Lifestyle modification

COPD
Follow up & review
• Follow up after 7 days