1.
HOBI:
A 35-years old woman with known case of rheumatic heart disease, hx of
hysterectomy for invasive vascular mole 4 days ago. Pt is admission to hospital
in 27/11/2022 complin to lift lower limp swelling gradual onset, progressive in
corneas slight pain, fever, headache, no chest pain, no dyspnea, no cough, no
redness lethargy, there is hx abortion 2 time last time before 4 years 2nd month
another one before 7 years in 4th month. she is diagnosed with deep venous
thrombosis.
Patient case

2.
PMH:
Hx of rheumatic heart disease, hx of hysterectomy for 4 days ago and
hx abortion 2 time last time before 4 years 2nd month another one
before 7 years in 4th month.
Family History:
Father has hypertension.
Mather has heart diseases.
Life style: NO
Signs and symptoms:
Lift lower limp swelling gradual onset, slight pain, fever, headache.
Diagnosis:
DEEP VAIN THROMPOSIS

3.
30/11
29/11
27/11
Date
Wt
37
37.7
Temb
100/50
110/70
100/60
BP
90
90
123
Plus
20
22
RR
98%
Pao2
Vitalsings

4.
LABS:
WBC: (8.3*103/mm3), NEU: (78%), LYM: (14%), HGB: (12.7g/dL),
CRP: (+48mg/L), PTT: (38 sec), INR: (2.67 sec). RBS: (113mg/dL),
Urea: (22mg/dl), Creatinine: (0.5mg/dL),
* URIN COLLECT DATA: 28/11/2022
Protein: trace
Ketone: trace
Leukocyte: positive +2
* ECHO: 28/11/2022
Thickening in valves
EF: 58%
* ABD & Pelvic U/S: 29/11/2022
Pt post hysterectomy before 1 month with LT VDT curate u/s
GB: distended with multiple stone large 7mm.
UB: partial full with thickening cystitis.
pt cyst in lesion 3.4*3.4 cm thick wall with intended edema.
* ECG: 29/11/2022
Sinus tachycardia
•

5.
Current (actual) regimen
Drugused Indication
Actual regimen
Response
(monitoring
parameters
Target
goal
Str. Frq. Rout. Durat. Time Meal
Enoxaparin For DVT 60mg 1*2 Sc 28/11 10 Am
10 Pm
Warfarin For DVT 5mg 1*1 Tab 28/11
Ceftriaxone For CYSITIS 1g 1*2 Iv 28/11
Zaldilar For fever, pain. Sos 1*2 Tab 28/11
Acyclovir Herpes orally 1*3 Inf

6.
Drug interaction
Drug Drug Severity of
interaction
M.O.A Management
Ceftriaxone Warfarin Monitor Ceftriaxone vit k antagonist to
enhance anticoagulation effect
coadmmated with warfarin
Monitor for INR decrease dose of
warfarin
Enoxaparin Warfarin Monitor Both Increase risk of bleeding Monitor for INR decrease dose of
warfarin
Paracetamol Warfarin Monitor Paracetamol enhance effect of
warfarin by vit k antagonist
Monitor for INR and symptoms of
bleeding
Tramadol Warfarin Monitor Tramadol enhance effect of warfarin
by vit k antagonist
Monitor for INR and symptoms of
bleeding
Paracetamol Tramadol Monitor Tramadol decrease absorption of
paracetamol
Monitor to effect of paracetamol

7.
Drugused Indication
Actualregimen Reference
Str. Frq. Rout. Durat. Time Meal
Warfarin For DVT 5mg 1*1 tab Medscape
Nitrofurantoin
+
Macrocrystals
For cystitis 100 1*2 PO 5-7 days Medscape
Pharmasist student plan
Recommendation
1-Monitror for INR frequently.