A 70-year old male patient was admitted to the male medicine wards with complaints of cough with expectoration since 20 days, anorexia, pedal oedema, chest pain, haemoptasis since 10 days, low grade fever, weakness.

1. A Case Study On
Pneumonia
AJITA SADHUKHAN
- PHARM D. 3RD YEAR
- ROLL NO. : 1
- ENROLMENT NO. : 150821207001

2. It Is an inflammatory process of the lung parenchyma that is commonly
caused by infectious agents.
DEFINITION: 2

3. IPD No.: 17015384
Age: 70 years
Weight :62 kg
Department: Male Medicine Ward
Sex: Male
Unit: III
Date of Admission: 2/12/17
Date of Discharge: 9/12/17
Patient Demographics 3

4. C/O cough with expectoration since 20 days, anorexia, chest pain, pedal edema,
haemoptasis since 10 days, low grade fever, weakness
PMHx : TB
MHX: NAD
Family Hx : NAD
Social Hx: NAD
Pregnancy Status: NAD
ALLERGIES : NKA
Reason for admission
4

5. PHYSICAL EXAMINATION:
 General: decreased appetite, B/L pedal edema
 R: 20/min
 SPO2: 98%
 CVS: S1 S2 heard
 RS: Lt crepts +
 CNS: conscious, oriented
 BP: 136/80 mm Hg
 PR: 110/min
 TEMP: normal
 PA: Soft
OBJECTIVES 5

6. LABORATORY PARAMETERS OBSERVED VALUE NORMAL RANGE UNIT
Hb 10.5 11.5-18 g%
WBC 7930 4000-11000 Cells/cu mm
Neutrophils 74 40-70 %
Eosinophils 04 1-6 /cu mm
Lymphocytes 18 20-40 /cu mm
Monocytes 04 2-10 /cu mm
Basophils 00 0-1 /cu mm
RBC 4.01*10^12 3.8-5.8*10^12 /cu mm
ESR 109 1-20 Mm/hr
PCV 33.7 40-54 %
Platelets 307000 1.5-4*10^5 /cu mm
Se. Urea 61 10-45 Mg/dL
Se. Na+ 125 130-145 mEq/L
Se. K+ 3.5 3-5 mEq/L
Se. Cl- 100 98-106 mEq/L
Lab. Investigation reports [first day]
6

7. Others:
 AST (<40 IU/L) : 24
 ALT (<40 IU/L) : 13
 Se. ALP: 165
 Bili. Total (0.2-1.2 mg/dL) : 0.4
 Bili. Direct (0-0.25 mg/dL) : 0.2
 Albumin (3.5-5 mg/dL) : 2.4
 Ser. Creatinine (0.4 -1.5) : 1.5
 MCV: 34.0
 RDW-CV: 74.8%
 MCH: 26.8
 MCHC: 31.2
 CRP (<6.6 mg/dL) : 107.7
 Urine analysis: Protein and blood in trace amount
7

8. LRTI
PROVISIONAL DIAGNOSIS 8

9.  A 70 year old male patient was admitted to Med. ward-3 with complaints of
cough with expectoration since 20 days, anorexia, chest pain, pedal
edema, haemoptasis since 10 days, low grade fever, weakness.
 Based on lab report, patient’s Hb, RBC count, lymphocytes, MCHC, MCH
levels are abnormally decreased. ESR, CRP and neutrophils are abnormally
increased. Hence, patient was diagnosed with Pneumonia.
9

10. FINAL DIAGNOSIS:
Pneumonia
10

11. For UTI:
To relieve cough with expectoration.
To prevent anorexia.
To prevent low grade fever and weakness.
To prevent or treat chest pain.
To eradicate pedal edema.
To prevent haemoptasis.
GOALS OF TREATMENT 11

12. DAY 1
T: normal
P: 114/min
R: 20/min
B.P.: 130/90 mmHg
SPO2: 97%
RS: Lt. crepts
CVS: NAD
CNS: NAD
PA: NAD
C/O cough with expectoration since 20 days, anorexia, pedal edema
12

13. Day 1 Medication chart
13
DRUG DOSE ROUTE FREQUENCY INDICATIONS
Inj. Cefoparazone + Sulbactam 1.5 g I.V. 1-0-1 Antibiotic
Tab. Clarithromycin 500 mg P.O. 1-0-1 Antibiotic
Inj. DNS/RL + Multivitamin @ 500 ml/hr 1 pint in 500 ml +
10 ml
I.V. 1-0-0 Electrolyte + Multivitamin
supplement
Vit. B12 + Vit. C + folic acid 1 pint I.V. OD Multivitamin supplement
Inj. Tranexamic acid 1 pint I.V. TDS To prevent hemoptosis
Cap. Tamsulosin 0.4 g P.O. 0-0-1 To improve urination
Tab. Folic Acid 5 mg P.O. 1-0-1 To increase Hb
Syp. Bromohexine + Terbutaline + Guaifenesin 2 tsf P.O. 1-1-1 To prevent cough
Inj. Ethamsylate 125 mg I.V. 1-1-1 Prevention and treatment
of capillary hemorrhages
Inj. Pantoprazole 40 mg I.V. 1-0-0 GERD

14. DAY 2
T: normal
P: 114/min
R: 20/min
B.P.: 100/60 mmHg
SPO2: 96%
RS: Lt. crepts
CVS: NAD
CNS: NAD
PA: NAD
C/O cough with expectoration, stool not passed
Adv.: Tab. Concor (2.5 mg), Tab. PCM 500 mg (1-1-1), Tab. Livogen (1-0-1)
14

15. Day 2 Medication chart
15
DRUG DOSE ROUTE FREQUENCY INDICATIONS
Inj. Cefoparazone + Sulbactam 1.5 g I.V. 1-0-1 Antibiotic
Tab. Clarithromycin 500 mg P.O. 1-0-1 Antibiotic
Inj. DNS/RL + Multivitamin @ 500 ml/hr 1 pint in 500 ml + 10 ml I.V. 1-0-0 Electrolyte + Multivitamin
supplement
Vit. B12 + Vit. C + folic acid 1 pint I.V. OD Multivitamin supplement
Inj. Tranexamic acid 1 pint I.V. TDS To prevent hemoptosis
Tab. Folic Acid 5 mg P.O. 1-0-1 To increase Hb
Inj. Traneta I.V.
Cap. Tamsulosin 0.4 g P.O. 0-0-1 To improve urination
Tab. Paracetamol 500 mg P.O. 1-0-1 Fever
Cap. Ferric fumarate + folic acid + ZnSO4 1 cap/day P.O. 0-0-1 Folate deficiency
Tab. Bisoprolol 2.5 mg P.O. 1-0-0 HTN
Syp. Terbutalin + Bromohexin +Guaifenesin +
Menthol
60 ml P.O. 2-2-2 Expectorant
Inj. Ethamsylate 125 mg I.V. 1-1-1 Prevention and treatment

16. DAY 3
T: normal
P: 110/min
R: 20/min
B.P.: 110/70 mmHg
SPO2: 97%
RS: Lt. crepts
CVS: NAD
CNS: NAD
PA: NAD
Adv.: Collect sputum report
16

17. Day 3 Medication chart
17
DRUG DOSE ROUTE FREQUENCY INDICATIONS
Inj. Cefoparazone + Sulbactam 1.5 g I.V. 1-0-1 Antibiotic
Tab. Clarithromycin 500 mg P.O. 1-0-1 Antibiotic
Inj. DNS/RL + Multivitamin @ 500 ml/hr 1 pint in 500 ml + 10 ml I.V. 1-0-0 Electrolyte + Multivitamin
supplement
Vit. B12 + Vit. C + folic acid 1 pint I.V. OD Multivitamin supplement
Inj. Tranexamic acid 1 pint I.V. TDS To prevent hemoptosis
Cap. Tamsulosin 0.4 g P.O. 0-0-1 To improve urination
Tab. Folic Acid 5 mg P.O. 1-0-1 To increase Hb
Syp. Bromohexine + Terbutaline +
Guaifenesin
2 tsf P.O. 1-1-1 To prevent cough
Tab. Paracetamol 500 mg P.O. 1-0-1 Fever
Cap. Ferric fumarate + folic acid +
ZnSO4
1 cap/day P.O. 0-0-1 Folate deficiency
Tab. Bisoprolol 2.5 mg P.O. 1-0-0 HTN
Syp. Terbutalin + Bromohexin
+Guaifenesin + Menthol
60 ml P.O. 2-2-2 Expectorant
Inj. Ethamsylate 125 mg I.V. 1-1-1 Prevention and treatment of
capillary haemorrhages
Tab. Levofloxacin 750 mg P.O. 1-0-0 Pneumonia

18. DAY 4
T: normal
P: 110/min
B.P.: 110/70 mmHg
SPO2: 97%
RS: Lt. crepts +
CVS: NAD
CNS: NAD
PA: NAD
C/O coughing, left sided chest pain while breathing
Adv.: Tab. Levofloxacin (750) 1-0-0
Tab. Pan 50 mg (1-1-1)
Collect sputum report
18

19. Day 4 Medication chart
19
DRUG DOSE ROUTE FREQUENCY INDICATIONS
Inj. Cefoparazone + Sulbactam 1.5 g I.V. 1-0-1 Antibiotic
Tab. Clarithromycin 500 mg P.O. 1-0-1 Antibiotic
Inj. DNS/RL + Multivitamin @ 500 ml/hr 1 pint in 500 ml + 10 ml I.V. 1-0-0 Electrolyte + Multivitamin
supplement
Vit. B12 + Vit. C + folic acid 1 pint I.V. OD Multivitamin supplement
Inj. Tranexamic acid 1 pint I.V. TDS To prevent hemoptosis
Tab. Folic Acid 5 mg P.O. 1-0-1 To increase Hb
Syp. Terbutalin + Bromohexin
+Guaifenesin + Menthol
60 ml P.O. 2-2-2 Expectorant
Inj. Ethamsylate 125 mg I.V. 1-1-1 Prevention and treatment of
capillary haemorrhages
Tab. Levofloxacin 750 mg P.O. 1-0-0 Pneumonia

20. DAY 5
T: normal
P: 110/min
B.P.: 110/70 mmHg
SPO2: 97%
RS: Lt. crepts +
CVS: NAD
CNS: NAD
PA: NAD
Adv.: Collect sputum report
20

21. Day 5 Medication chart
21
DRUG DOSE ROUTE FREQUENCY INDICATIONS
Inj. Cefoparazone + Sulbactam 1.5 g I.V. 1-0-1 Antibiotic
Tab. Clarithromycin 500 mg P.O. 1-0-1 Antibiotic
Inj. DNS/RL + Multivitamin @ 500 ml/hr 1 pint in 500 ml + 10 ml I.V. 1-0-0 Electrolyte + Multivitamin
supplement
Choline salicylate + Benzalkonium
chloride
topical Pain relief
Liq. Lactulose 1 tsf P.O. 1-1-1 laxative
Cap. Tamsulosin 0.4 g P.O. 0-0-1 To improve urination
Syp. Bevan 2 tsf P.O. 1-1-1
Tab. Folic Acid 5 mg P.O. 1-0-1 To increase Hb
Tab. Paracetamol 500 mg P.O. 1-0-1 Fever
Inj Pantoprazole 40 mg I.V. 1-0-0 GERD
Tab. Bisoprolol 2.5 mg P.O. 1-0-0 HTN
Syp. Terbutalin + Bromohexin
+Guaifenesin + Menthol
60 ml P.O. 2-2-2 Expectorant
Tab. Levofloxacin 750 mg P.O. 1-0-0 Pneumonia

22. DAY 6
T: 96.9 F
P: 97/min
R: 19/min
B.P.: 110/70 mmHg
SPO2: 95%
RS: Lt. crepts
CVS: NAD
CNS: NAD
PA: NAD
C/O backpain
Adv.: Physiotherapy reference
22

23. Day 6 Medication chart
23
DRUG DOSE ROUTE FREQUENCY INDICATIONS
Inj. Cefoparazone + Sulbactam 1.5 g I.V. 1-0-1 Antibiotic
Choline salicylate + Benzalkonium
chloride
topical Pain relief
Liq. Lactulose 1 tsf P.O. 1-1-1 laxative
Cap. Tamsulosin 0.4 g P.O. 0-0-1 To improve urination
Syp. Bevan 2 tsf P.O. 1-1-1
Tab. Folic Acid 5 mg P.O. 1-0-1 To increase Hb
Tab. Bisoprolol 2.5 mg P.O. 1-0-0 HTN
Syp. Terbutalin + Bromohexin
+Guaifenesin + Menthol
60 ml P.O. 2-2-2 Expectorant
Tab. Levofloxacin 750 mg P.O. 1-0-0 Pneumonia

24. DAY 7
T: normal
P: 82/min
B.P.: 120/80 mmHg
SPO2: 96%
CVS: NAD
CNS: NAD
PA: NAD
No fresh complaints.
Patient feels better.
Adv.: Discharge with medication.
24

25. Day 7 Medication chart
25
DRUG DOSE ROUTE FREQUENCY INDICATIONS
Inj. Cefoparazone + Sulbactam 1.5 g I.V. 1-0-1 Antibiotic
Choline salicylate + Benzalkonium
chloride
topical Pain relief
Liq. Lactulose 1 tsf P.O. 1-1-1 laxative
Cap. Tamsulosin 0.4 g P.O. 0-0-1 To improve urination
Syp. Bevan 2 tsf P.O. 1-1-1
Tab. Folic Acid 5 mg P.O. 1-0-1 To increase Hb
Tab. Paracetamol 500 mg P.O. 1-0-1 Fever
Tab. Bisoprolol 2.5 mg P.O. 1-0-0 HTN
Syp. Terbutalin + Bromohexin
+Guaifenesin + Menthol
60 ml P.O. 2-2-2 Expectorant
Tab. Levofloxacin 750 mg P.O. 1-0-0 Pneumonia

26. DISCHARGE MEDICATIONS
26
DRUG DOSE FREQUENCY NUMBER OF DAYS
Syp. Silentt 60 ml 2-2-2 7
Tab. Clarithromycin 500 mg 1-0-0 5
Syp. Duphalac 100 mg 1-1-1 5
Tab. Folic Acid 5 mg 1-0-1 5

27. TREATMENT PLAN:
27
 Pneumonia:
❖ Non-pharmacological treatment:
➢ Oxygen supply
➢ Fluid resuscitation
➢ Chest physiotherapy
❖ Pharmacological therapy:

28.  NOT TREATED FOR increased LFTs.
 MONITOR CLOSELY:
➢ Bisoprolol + Terbutaline : Bisoprolol decreases effects of terbutaline by
pharmacodynamic antagoinism.
➢ Clarithromycin + Levofloxacin : both increase QT intercal. Modify or monitor therapy.
 SERIOUS → USE ALTERNATIVE:
➢ Clarithromycin + Tamsulosin : Clarithromycin increases the levels of tamsulosin by
affecting hepatic/intestinal enzyme CYP3A4 metabolism.
POINTS TO BE INTERVENED WITH THE DOCTOR28

29. PATIENT COUNSELING 29
ABOUT DISEASE
Pneumonia:
Get flu and pneumococcal vaccine.
Seek prompt care if symptoms of dyspnea or fever and rigors
develop.

30. About Medications:
 Dose of drugs
 Frequency of dose
 Route of administrations such as I.V, I.M., t/d, s/c, P.O., S/L.
 Counselling regarding overdose (may cause toxicity), underdose
(submaximal or no response) and missing of dose of medication.
E.G. If a dose is missed, then the patient is to be advised to go for
the next dose, otherwise toxicity of drug may occur.
 Contraindications
 Drug interactions (drug-drug, drug-food)
30

31.  Do not smoke
 Practice healthy lifestyle
 Practice good hygiene
 Wash hands regularly before intake of food
 Take food of high nutritional value and drink plenty of purified water
 Take enough rest
 Drink carrot or spinach juice twice a day to treat pneumonia
 Steam inhalation
Life Style Modifications 31

32. 32