PHARMACOTHERAPY II: CASE ANALYSIS

"EVALUATION OF SELECTION
AND DOSAGE OF ANEMIA
THERAPY IN TUBERCULOSIS
PATIENTS AT OTANAHA
HOSPITAL"
PHARMACO
THERAPY II
MEMBER :
1. DELVIYANTI R. MOKO
(821420038)
2. EFFI KURNIASIH
(821420042)
3. AMELIA PUTRI (821420047)
4. LUTHFIA NURFADILAH ARIFIN
(821420054)
GROUP I B-S1 PHARMACY 2020
CASE
● Mr S.A sigh fever, cough And often a rise congested during five day. Complaint anything else voice
croak, heartburn , nauseous, vomit, bowel movements watery slimy, and urination normal, And
patient feel weak. Drugs Which give non patient during treated stay that is IVFD NaCl 8 tpm ,
transfusion PRC 1x1, Azithromycin 1x1 500 mg, PCT 3x1, NAC-e 3x1 200mg, UDCA 2x1, inj
Omeprazole 1 x 1 ampoule iv, inj Ondansetron 3x1 ampoule IV, inj ceftriaxone 1x2 gr IV. Drug
Which give nonmoment patient go home that is Cefixime 2x20 grams, Omeprazole 2x1,
Azithromycin 1x1 mg, 3x1 mg PCT, 3x1 NAC, 2x1 UDCA. Based on results diagnosis patient suffer
TB lungs, Pneunomia, Hypertension, Hepatoma, Cholelithiasis, Anemia, Syndromedyspepsia.
Results Inspection physique show Pressure Blood 160/60 mm Hg, Pulse 104 /min, Frequencybreath
20 x/min, Temperature 38.5, Hb 8.8 g%. And Inspection Lab from patient GOT 112, SGOT 14,
SGPT 33, Leukocytes 7,200 /uL, Erythrocyte 2,890/uL, Platelets 158,000/uL, Hematocrit, 24.8 %,
MCV 85.8 fL, MCH 30.4pg, MCHC 35.5 %,Lymphocytes22.6%,Monocytes5.1 %, GDS 112
mg/dL,Urea45 mg/dL,Creatinine0.71 mg/dL. Patients also carry out additional examinations in the
form of: inspection ultra sound abdomen, TCM, And Photo Thorax. History disease owned by the
patient that is Diabetes mellitus and hypertension. During 6 day take care stay pressure blood
patient gradually normal but cough Which suffered No getting better so that doctor still prescribe
drug that is cefixime 2x200 mg(for 5 days), omeprazole 2x1, azithromycin 1x1, paracetamol 3x1, na-
acetylcysteine 3x1, UDCA 3x1, and on day to 7 patient allowed For go home.
 SOAP
SOBJECTIVE

02 OBJECTIVE

03 ASSESSMENT

04 PLAN
 subjective 02
03
Name : Mr. SA
04
Age : 74 years

Weight : 46 kg

Height : 148 cm

Complaint : heartburn, vomiting, coughing, fever, hoarseness, watery chapters, as usual,

weakness, shortness of breath often occur.

 Main diagnosis:
TB lung without of bacteria or histological confirmation

 Secondary diagnosis:
essential (primary) hypertension, anemia unspecified, calculus of
gallbladder without cholecystitis
 OBJECTIVE
Checking Type normal range Lab results Information

Blood pressure <120/80 mmHg 110 / 70 mmHg Normal

Thrombocytes 170-380.10 mmHg 158,000 mmHg Normal

Lymphocytes 800-40.00 mmHg (15-45 %) 22.6 % Normal

Monocytes 100-800 mmHg (0-11%) 5.1 % Normal

N. Segment 35-70 % 72.3 % Abnormal

04
03

02
OBJECTIVE
Checking Type normal range Lab results Information

Hemoglobin 14 -18 g/dL 8,8 g/dL abnormal

Hematocrit 38.8 – 50 % 24,8 % abnormal
Erythrocytes 4,5 - 6,5 x10^6 2890 jt/uL Abnormal
Leukocytes 4 – 11 x10^3 7200 jt/uL Normal
MCV 80-96 fl 85.8 fL Normal
MCH 27-33 pg 30,4 pg Normal
MCHC 32-36 % 35.5 % Normal 04
03

02
 OBJECTIVE

Checking Type normal range Lab results Information

GDS <200 mg/dL 112 mg/dL Normal

urum <50 mg/dL 45 mg/dL Normal

Kreatinine 0.7-1.3 mg/dL 0.71 mg/dL Normal

SGOT 5-35U/L 24 U/L Normal
SGPT 7-56 U/L 33 U/L Normal
04
03

02
 04 02
assessment 03
Name Indication based on case indication Dosage based on case dose Side effects Information
literature literature

cefixime indicated For treatment pneumonia 100 - 200 mg per 2 x 200 mg Effect side light form Cefixime will
exacerbation I day (medscape) for 5 days nauseous/vomit there is at increase rate or
bronchitis chronic 2 patient How ever No effect sodium
Which caused by until need replaced with aminohipurat
isolate prone to antibioticsother. Urticaria through
Streptococcus happen on One patient competition drug
pneumoniae and after 3day treatment sour (anionic) For
Haemophilusinfluenzae cefixime and disappear cleaning tubule
(medscape) after treatment cefixime kidney.
stopped-right. No found
change Good on rate
enzyme heart nor function
kidney on all patient
during treatment cefixime.
 04 02
assessment 03
Name Indication based case indication Dosage based on case dose Side effects Information
on literature literature

acetaminophen painful light until fever tablet : 325mg, 3×1 Angioedema, disoriented, There are no
currently,painful 500mg caplet : Dizzy,Rash contraindications
after operation 325mg, 500mg, maculopapularpruritus, with other drugs.
unplug 650mg Rash, Hyperammonemia,
tooth,pyrexia. Syndrome Stevens-
Johnson, necrolysis
epidermal toxic,Urticaria,
Bleeding gastrointestinal,
Edemalarynx,
Agranulocytosis,
leukopenia, neutropenia,
Pancytopenia,
thrombocytopenia,
thrombocytopenicpurpura
,Hepatotoxicity,Fail heart,
Nephrotoxicity,
pneumonia,
Anaphylactoid
 04 02
assessment 03
Name Indication based case indication Dosage based case dose Side effects Information
on literature on literature

UDCA Treatment of Treatment of Dissolvingrockb UDCA 2x1 Itchy rash; No There is

(Ursodeoxycholic gallstones, gallstones ile: 8until10 difficult breathe; contraindicated
AC ID) cholesterol mg/kg orally swelling on face, with drug which
(drugs, 2022) perday, given in lips, tongue, or in give And dose
2 until 3 dose throat. which in give
divided Already
Prevention of appropriate
gallstones: 300
mg orally twice
a day
 04 02
assessment 03
Name Indication based case indication Dosage based on case dose Side effects Information
on literature literature

Omperazole Eradication H. dyspepsia Mature: 40mg 2x1 Disturbance Omeprazole is a

Pylori in a very a day given digestion, like class of drugs
manner related through infusion diarrhea, Sick used for the
intravenously during20-30 stomach, treatment
with disease ulcer minute until gift nauseous, ogastritis.
pepticum, ulcer oral lypossible. bloating, and also Omeprazole is a
stomach and constipation head drug that can
duodenum, or Dizzy suppress gastric
disease acid secretion
refluxgastro- with the PPI
esophagus,ulcerat (Proton Pump
ion related Inhibitor) class.
NSAIDs Omeprazole is
believed to have
strong potential
in reducing
stomach acid in
gastritis patients
(Sumarni, 2019).
 04 02
assessment 03
Name Indication based case indication Dosage based on case dose Side effects Information
on literature literature
N-acetylcysteine infection channel dilute sputum 200 mg 3×1 200 mg Disturbance give in a manner
breath Which be channel digestion separated with
marked light,for example, antibiotics certain
hypersecretion nauseous,vomit,
mucus, thick And dyspepsia.
sticky
 04 02
assessment 03
Name Indication based on case Dosage based on case Side effects Information
literature indication literature dose

Ondansetron According to US FDA Over come First given injection 8 mg Injection Effect side Which Drug This should
that use injection nauseous And Ondansetron intravenously usually happen is not used during
Ondansetron only vomit in a manner slowor infused Sick head, sedation, pregnancy And
Have two indication during 15 minute quick diarrhea, sensation Mother period
that is CINV and before given chemotherapy. reddish or warm on breast-feed
nauseous vomit post And Nauseous And vomit head and the Because
operation. consequence induction by epigastrium, and possibility
radio therapy: Given 8 mg therarely happening secreted in breast
Ondansetron orally each 12 that is milk
hours. Dose First should enhancementthe
given 12 hours amino transferasesa
symptomatic
 04 02
assessment 03
Name Indication based on case indication Dosage based on literature case dose Side effects Information
literature

Azithromycin often Pneumonia Dose mature 500 mg, with 1x1 50 gr Gastrointestinal Azithromycin
Azithromycin given on indication frequency gift drug as much disorders, Toxicity in Work with hinder
Zithromax disease like One timea day, And give the Liver CYP3A4 so that
pneumoniacommunity, naverage five day depends produce
bronchitis chronic type bacteria reason metabolites Which
with exacerbation , And severity disease patient. hinder enzyme
sinusitis, cytochrome P450
urethritis, disease so that increase
inflammation on concentration
pelvis, Andinfection various drug
bacteria other. inserum,like
Besides That, Also can theophylline,
used on infection anticoagulantoral,
complex Which caused cyclosporine And
by Mycobacterium metilprednisolone.
avium the can
experience deployment
in a manner
wide(Kirst, 2021).
 04 02
assessment 03
Name Indication based on case indication Dosage based on literature case dose Side effects Information
literature

Ceftriaxone Ceftriaxone is an Pneumonia Dose of 2 grams per day 1x2 grams Common side effects Ceftriaxone is a
antibiotic that is (where the dose should not be include dermatology broad-spectrum
widely used to treat more than 2 g/kg BW/day (rashes), third-generation
common infections (Aberg, Ja, 2009) gastrointestinal cephalosporin
such as pneumonia and (diarrhoea), antibiotic. Giving
urinary tract infections. hematology ceftriaxone to
(Inoue, 2017) (leukopenia), hepatic patients with
(increased impaired kidney
transaminases), local and liver function,
(allergy at the blood levels of
injection site) and cephalosporins
renal. should be
monitored and
dosage adjustments
made.
 Medication and transfusion table
Day Cefix Ceftry Omz Ondans Aztro PCT UDCA N-ace Ivfd nacl prc Ket
transfusion
Morning
4/9/23 Afternoon
Afternoon
Evening 2g/24 1x500 2 bags Antigen
hours/IV mg/orally (1bag/day) swab +
abdominal
ultrasound
again

5/9/23 Morning 2 bags

(1bag/day)

Afternoon
Afternoon
Evening NaCl 0.9%

6/9/23 Morning 1x2 g/IV 1x1, amp/IV 3x1, amp/IV 1x100 3x500 3x200mg/ NaCl 8 tpm 2 bags Abdominal
mg/orally mg/orally orally (1bag/day) ultrasound +
Check TCM

Afternoon
Afternoon 2x1/orally Report
ultrasound
results
Evening
7/9/23 Morning 1x1 g/IV 1x1 amp/IV 3x1 amp/IV 1x500g/ 3x500 2x1/orally NaCl 8 2 bags Check
orally mg/orally tpm (1bag/day) TCM
Afterno
on
Afterno
on
Evening
8/9/23 Morning 1x2 g/IV 1x1 amp/IV 3x1 amp/IV 1x500 3x1 2x1/orally 3x1 NaCl 8 2 bags Check
mg/orally tpm (1bag/day) TCM +
PCR
Afterno
on
Afterno
on
Evening
9/9/23 Morning 2g/IV 40 gr/24 1 amp/IV 1x1 3x1 2x1 3x1 NaCl 2 bags Check
hours/IV 0.9% 8 (1bag/day) TCM
tpm
Afterno
on
Afterno
on
Evening
10/9/2 Morning 2x20 1x2 g/IV 1x1 amp/IV 3x1 amp/IV 1x500 3x1 2x1 3x1 NaCl 88 4 ch TCM
3 g/orally mg/orally tpm check +
blood
check
Afterno
on
Afterno 2x200 mg 2x1 3x1 3x1 Medicine
on (5 days) home
Evening
 Day/Date Check up result
4-09-2023 Evening
Hb :8,8 mg/dL
Leukocytes : 7200 /uL
Platelets : 158,000 /uL
ILF :22.6%
GOS : 112 mg/dL
Swab negative (-)
Urea : 45 mg/dL
Creatinine : 0.71 mg/dL
SGOT : 24 U/L
SGPT : 33 U/L
EXAMINA
TION table 5-09-2023 Morning
Cough down, fever
TD : 110/70 mmHg
Temperature : 37,8
N : 95 x/m (Nervus cranial)
RR : 20 x/minute (Respiration rate)
Evening
Cough,
ivfd Nacl 0.9%
Breath No effective
TD : 140/70 mmHg
Temperature: 36,3
N : 71 x/m
RR : 20 x/minute
Day/Date Check up result
6-09-2023 Morning :
Cough,congested,
spo2 : 98% (saturation oxygen)
Afternoon :
TD : 140/60 mmHg
N : 73 x/m
RR : 20 x/minutes
M : 36 nj
Complaint :Cough
Evening :
TD : 120/80 mmHg
Temperature : 36,2
N : 72 x/m
RR : 20 x/minutes
Spo2 : 98 %

7-09-2023 Morning :
TD : 100/70 mmHg
Temperature : 36.5
N : 78 x/m
RR : 20 x/minutes
Afternoon :
Complaint : Cough But No congested
Abd : 8u
Day/Date Check up result
7-09-2023 TD : 110/70 mmHg
Temperature : 36.5
N : 74 x/m
RR : 20 x/minutes
Complaint : Still cough
Evening
TD : 120/70 mmHg
Temperature : 36,8
N : 71 x/m
RR : 20 x/minutes

8-09-2023 Morning
TD : 120/70 mmHg
Temperature : 36,2
N : 74 x/m
RR : 20 x/minutes
Afternoon
Complaint : Cough but No congested
TD : 120/70 mmHg
Temperature : 36,2
N : 74 x/m
RR : 20 x/minutes
Abd : 8u
Day/Date Check up result
8-09-2023 Evening
Complaint : Cough
TD : 110/70 mmHg
N : 88 x/m
RR : 20 x/minute
Temperature : 37

9-09-2023 Morning
TD : 120/80 mmHg
Temperature : 36
N : 87 x/m
RR : 20 x/minutes
Complaint : Cough
Afternoon
Complaint : weak
TD : 180/80 mmHg
Temperature : 36,4

10-09-2023 Morning
TD : 150/90 mmHg
Temperature : 36,4
N : 89 x/m
RR : 20 x/minutes
Cought (-) And weak reduce
Day/Date Check up result
10-09-2023 Afternoon
Complaint : Cough Identification cough
TD : 150/90 mmHg
N : 88 x/m
Temperature : 36,7
RR : 20 x/minute
(stated can go home)
 04 02
D rp 03
no Category Information ket

1. Indications for no therapy  . Tb lungs,spenomegaly,hepatomegaly,

hepatoma

2. Therapy without - -
indications
3. The dosage is too high - -

4. Too low dose - -

5. Adverse reactions  . acetaminophen

6. Interaction - -
 03 02
planning 04

THERAPY THERAPY NON

PHARMACOLOGY PHARMACOLOGY
 03 02
planning 04
THERAPY PHARMACOLOGY

 Considered for giving therapy in anemia by giving folic acid or vitamin B12

 After carrying out the 2nd tcm test and if it is positive for TB, it is necessary to consider
giving combination therapy isoniazid, pyrazinamide, ethambuhol, rifampicin

 Reconsider using azithromycin

 Consider paracetamol to ibuprofen

THERAPY NON PHARMACOLOGY

 03 02
planning 04
THERAPY NON PHARMACOLOGY

 Considered re-examination of TCM

 It is considered to carry out a microbiological examination to determine

what type of bacteria and provide appropriate therapy to the patient

 Consuming guava juice, and green vegetables such as spinach

 Examination and education is carried out to the next of kin and the
surrounding community

 Pay attention to the patient's nutritional intake

 Reduce high fat foods and should be replaced with foods that are
processed by boiling
THERAPY PHARMACOLOGY
ANEMIA GUIDELINES
PULMONARY TB GUIDELINES

Ministry of Health, 2013

THANK
YOU