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Pharmaceutical care - Patient profile

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PHARMACEUTICAL CARE PATIENT PROFILE PROFILE NUMBER: 4 PATIENT INITIALS: LW DATE: 13th August 2004 AGE: 81 Male Weight: 65kg Height: 177cm PRESENTING COMPLAINT/HPC: The patient had dysuria with poor urine flow. The patient also had supra pubic pain. DIAGNOSIS: The patient will need a cytoscopy and TURP. This operation is for men (usually over 50) who have difficulty urinating. The operation should improve the force of the stream and the ability to empty. PAST MEDICAL HISTORY: Recurrent urinary tract infections. Peripheral neuropathy and tremor 1997. Cataract extraction from both eyes in 1995. DRUG ALLERGIES: None DRUG THERAPY ON OR DURING ADMISSION: Nil regular medicines. CHANGES TO MEDICATION PROFILE: Trimethoprim 200mg bd added on day 1 for 7 days Ciprofloxacin 500mg bd added on day 8 for 5 days Ceftazidime 1g tds i.v. added on day 14 for 10 days Digoxin 500 micrograms 2 stat doses 500micrograms on day 8 Digoxin 125 micrograms added on day 9 until day 17 Metoprolol 50mg od for 2 days added on day 16, then 50mg bd for 2 days then 50mg tds until Lactulose syrup 10mls tds added on day 9 Senna tablets 2 tablets at night added on day 9 Sodium chloride tablets 2 qds added on day 9 until day 21 Dalteparin 5000iu daily starting post TURP increased to 13000 units on day 21 Paracetamol 1g ...read more.


The loading can be given as two doses of 500 microgram tablets given six hours apart. A predicted digoxin level can be determined using the following equation: Cpdes= DosexSxF = 1000x0.62x1 = 1.75 ?g/Litre. Vd 353.96 The accepted therapeutic range for digoxin is 1 to 2 ng/ml. Hence the loading dose of 1 milligram will give a serum concentration of 1.75 ?g/ml, which is within the therapeutic range. The maintenance dose can also be determined using the following equations: Clearance: 0.06Creatinine Clearance + 0.02Weight 0.06x141+0.02x65 = 9.76 litres/hour Maintenance Dose: Clearance x Cpss x ? SxF 234.24 L/day x 1.5 microgram/Lx1day 1.0 x 0.62 = 566.7 micrograms/day Hence 500 micrograms daily would provide a serum concentration of 1.5 ?g/L. However because of the patient's mild renal impairment a dose reduction is required. According to the Renal Drug handbook, in mild renal impairment the dose range of digoxin that can be used is 125 to 250 micrograms. Instead based on the patient's impaired renal impairment and age 125 micrograms daily was prescribed. Digoxin is a drug with a narrow therapeutic range therefore therapeutic drug monitoring is required to ensure that the serum drug levels are within the therapeutic range. A level was determined 8 hours after the fourth dose (i.e second maintenance dose), a level of 1.2 ng/ml was determined. ...read more.


His calcium levels also began to decrease quite quickly, once corrected, his calcium levels were below the lower limit. I again suggested that more frequent calcium levels be performed before commencing treatment to supplement his calcium. Unfortunately on starting my next rotation I was told that the patient had died, after his stats continued to fall (i.e albumin, pulse rate continued to be erratic,) and a tumour had been located on one of his kidneys. This is the first patient I have looked after who has died. I was upset because at one point he seemed to be improving and returned to his usual jolly self. SUMMATIVE PATIENT MEDICATION PROFILE Medicine Mode of Action Indication Efficacy/Safety Parameters Counselling Points Metoprolol Beta-blocker. Metoprolol is used to treat high blood pressure as well as controlling how quickly your heart beats. It works by relaxing blood vessels so the heart doesn't have to pump as hard. Atrial fibrillation * dizziness * lightheadedness * excessive tiredness * cold hands and feet Cardioprotective properties To be taken regularly. Do not stop taking unless advised by your doctor. Digoxin Controls the rate at which your hearts contract and hence should stop the palpations you are experiencing. Atrial Fibrillation Report promptly: Visual disturbances, weight loss or loss of appetite, nausea vomiting or tremor. Do not stop taking without medical advice. Venita Hardweir Page 1 13/08/2004 ...read more.

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