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3.3 MEDICATION HISTORIES OF PEPTIC ULCER DISEASE
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Table 3.3a:CASE NUMBER : 01
PATIENT DEMOGRAPHICS NAME ZAFAR ALI AGE/GENDER 60Y/M ADDRESS BUNIR
DIAGNOSIS: Duodenal ulcer, upper GI bleed (Known case of HCV)CHIEFCOMPLIANTS
PRESCRIBEDTREATMENT
STANDARDTREATMENT(Berardi RR,Welage LS. 2005)
COMPARISON
Melena, epigastric pain-1week Haemetemasis-one dayConstipation from last3days
Hospital treatmentInj octreotide 50mcg then10amp,1LD/W@15drops
per minuteInf haemaccel I/V statInj Omeprazole 40mg BDInj metoclopramide I/V statthen ODSyp Lactulose 30ml TDSDischarge medicineClarithromycin 500 mg BDCap Omeprazole 40mg BD
Amoxicillin 1g BD
Hp-eradicationOmeprazole 20 mg BDClarithromycin 500 mgtwice DailyAmoxicillin 1 g twicedailyTreatment duration is10 to 14 days
Omeprazole20mg BD should
be given
DRUG RELATED PROBLEMDose adjustment and excessive dose reference:Martin J, Cloase LA, Jordan B et al.,2009
FREQUENCY
Excessive dose Omeprazole 40mg 1Dose adjustmentin hepaticimpairment
Omeprazole 40mg Management: In cirrhotic patientOmeprazole dose should not exceed20 mg daily
Drug interactionReference:DavidS.Tatro.2004
Omeprazole-clarithromycin
1
SIGNIFICANTRATING/ONSET SEVERITY/DOCUMENTATION MANAGEMENT
3/delayed Minor/suspected Based on available data nospecial action is needed.Co-administration of thesesagents may be beneficial intreatment of h pylorieradication.
Cost related problem (Neshat MQ.2007-08) 4GENERIC BRANDS MANUFACTURER RETAIL PRICECap Omeprazole40mg
Risek (prescribed here)lozal
Omega
Getz pharma Novartis
Ferozsons
259Rs200Rs
180RsInj metoclopramide10mg
Maxolon(prescribed here)MetoclonMaxaclor
GSK Indus pharma
polyfine
118Rs80Rs50Rs
Syp Lactulose120ml
Duphalac (prescribed here)LilacWerilax
High NoonGetz pharmaWerrick
148Rs124Rs93Rs
CapClarithromycin500 mg
Klaricid (prescribed here)Claritek Clarion
AbbottGetz pharmaFerozsons
648Rs370Rs297Rs
Miscellaneous problemsReference: David S.Tatro.2004
2
counselling Not done in case of clarithromycin because it has interaction with food(significantrating2,delayed onset, moderate severity,suspected documentation)
Management: proper counselling for drugintake.Give antimicrobial before one hour of mealTake with liquids other than grape fruit juice
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Table 3.3b: CASE NUMBER :02PATIENT DEMOGRAPHICS
NAME Zubaida AGE/GENDER 40/f ADDRESS Peshawar
DIAGNOSIS: Peptic ulcer disease/depressionCHIEF COMPLIANTS PRESCRIBED
TREATMENTSTANDARDTREATMENT(Berardi RR,Welage LS. 2005)
COMPARISON
Abd.pain and epigastricdiscomfort-15days,sleepdisturbed and sunking of heart
Hospital medicationInj ranitidine 50mg I/VBD(stopped)Inj ciprofloxacin 200mg I/VBD(stopped)Tab dothiepen HCl25mg
nocte(continue)Inj metoclopramide I/V BDDischarge medicationCap amoxicillin 1g BD-14daysCap Esomeprazole 40mg OD-1monthCap clarithromycin 500mg BD
Esomeprazole 40 mgdailyClarithromycin 500mg twice DailyAmoxicillin 1 g twice
dailyTreatment duration is10 to 14 days
Pharmacotherapygiven I hospital isaccording toSTG(standardtreatmentguidelines )
DRUG RELATED PROBLEMS FREQUENCYCost related problem (Neshat MQ.2007-08) 5GENERIC BRANDS MANUFACTURER Inj ranitidine 2ml 5s Zantac(prescribed here)
Ranitidine
Ranulcid
GSK Ferozsons
Merck Marker
110Rs63Rs
64RsTab ciprofloxacin 250mg Novidate (prescribed here)
CiproquineCp zaf
SamiMacter Zafa
151Rs120Rs35Rs
Inj metoclopramide 10mg Maxolon(prescribed here)MetoclonMaxaclor
GSK Indus pharma
polyfine
118Rs80Rs50Rs
Esomeprazole 40mg Esso (prescribed here) NexumE-Mepra
ShaiganGetzAkson
159Rs323Rs130Rs
Cap Clarithromycin 500 mg Klaricid (prescribed here)Claritek
Clarion
AbbottGetz pharma
Ferozsons
648Rs370Rs
297RsMiscellaneous problemsReference: David S.Tatro.2004
1
Counselling in case of quinolone administration nocounselling has been done abt milk intake along withciprofloxacin intake because it has interaction with milk of significant rating-2(onset rapid, severity moderateand suspected documentation)
Management: avoid milk intake but if milk cannot be avoided lengthen the intake of milk anddrug as much as possible
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Table 3.3c:CASE NUMBER : 03PATIENT DEMOGRAPHICS
NAME M/O SHER AFSER
AGE/GENDER 50y/female ADDRESS Peshawar DIAGNOSIS Peptic ulcer disease(B&C negative)CHIEF COMPLIANTS PRESCRIBED TREATMENT STANDARD
TREATMENT(Berardi RR,Welage LS. 2005)
COMPARISON
Hemetemesis-1dayAbdominal pain andvomiting, black stool andloss of appetite
Hospital treatmentInf Omeprazole 40mg I/V ODInj cefotaxime 1g BD (stopped)Inf haemaccel I/V statInj octreotide 100mcg I/V stat
then 5amp in 1LD/saline@15drops per min(stopped)Inj metoclopramide I/V TDSTab clarithromycin 500mg BDTab amoxicillin 1g 1 ODDischarge medicinetab clarithromycin 500mg BD(14days)Tab amoxicillin 1g OD(14days)Tab Omeprazole 40mgOD(1month)
Hp-eradicationOmeprazole 20 mgBDClarithromycin 500mg twice Daily
Amoxicillin 1 g twicedailyTreatment duration is10 to 14 days
Pharmacotherapygiven I hospital isaccording toSTG(standardtreatmentguidelines)
DRUG RELATED PROBLEMReference: David S.Tatro.2004
FREQUENCY
Drug interaction Omeprazole-clarithromycin 1SIGNIFICANTRATING/ONSET
SEVERITY/DOCUMENTATION
MANAGEMENT
3/delayed Minor/suspected Based on available data no special action isneeded.Co-administration of theses agents may be
beneficial in treatment of h pylori eradication.Cost related problem (Neshat MQ.2007-08) 3GENERIC BRANDS MANUFACTURER RETAIL PRICECap Omeprazole 40mg Risek (prescribed here)
lozalOmega
Getz pharma NovartisFerozsons
259Rs200Rs180Rs
Inj metoclopramide10mg
Maxolon(prescribed here)MetoclonMaxaclor
GSK Indus pharma
polyfine
118Rs80Rs50Rs
Cap Clarithromycin500 mg
Klaricid (prescribed here)Claritek Clarion
AbbottGetz pharmaFerozsons
648Rs370Rs297Rs
Miscellaneous problemsReference: David S.Tatro.2004
2
counselling Not done in case of clarithromycin because it has interaction with food(significantrating2,delayed onset, moderate severity, suspecteddocumentation)
Management: proper counselling for drug intake.Give antimicrobial before one hour of mealTake with liquids other than grape fruit juice
Non-compliance: refused to pass I/V cannula buthowever managed.
Non-compliance during EGD proceeding
Management: pt should be clearly explained about thetherapy and the hazardous effect of not taking
prescribed drug regularly
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Table 3.3d: CASE NUMBER : 04PATIENT DEMOGRAPHICS
NAME Zar wali khan AGE/GENDER 60y/male ADDRESS Deer
DIAGNOSIS: Multiple peptic ulcers(known case of HCV)CHIEF COMPLIANTS PRESCRIBED TREATMENT STANDARD
TREATMENT
(Berardi RR,WelageLS. 2005)
COMPARISON
Melena-3daysHemetemesis-1dayAbd pain-3days
Hospital treatmentInf haemaccel 1000cc I/V STATInf Omeprazole 40mg TDSSyp Sucralfate 2TSF TDSInj metoclopramide I/V BDTab clarithromycin 500mg1BDTab amoxicillin 1g 1 BDInj vit K 10mg I/V ODDischarge medicineSyp Lactulose 2TSF (continue)Clarithromycin 500mg 1BD-14daysTab amoxicillin 1g 1 BD-14daysOmeprazole 40mg 1 OD
Hp-eradicationOmeprazole 20mg BDClarithromycin500 mg twiceDailyAmoxicillin 1 gtwice dailyTreatmentduration is 10 to14 days
Omeprazole20mg BD should
be given to patient (inhepaticimpairment doseof Omeprazoleshould notexceed 20mg)
DRUG RELATED PROBLEMDose adjustment and excessive dose reference:Martin J, Cloase LA, Jordan B et al.,2009
FREQUENCY
Excessive dose Omeprazole 20mg should be given 1Dose adjustment inhepatic impairment
Omeprazole40mg In cirrhotic patientOmeprazole doseshould not exceed 20mg daily
1
Drug interactionDavid S.Tatro.2004
Omeprazole-clarithromycin 1
SIGNIFICANTRATING/ONSET
SEVERITY/DOCUMENTATION
MANAGEMENTBased on available data no special action isneeded. Co-administration of theses agentsmay be beneficial in treatment of h pylorieradication.
3/delayed Minor/suspected
Cost related problem (Neshat MQ. 2007-08)GENERIC BRANDS MANUFACTURER RETAIL PRICECap Omeprazole 40mg Risek (prescribed here)
lozalOmega
Getz pharma NovartisFerozsons
259Rs200Rs180Rs
Inj metoclopramide 10mg Maxolon(prescribed here)MetoclonMaxaclor
GSK Indus pharma
polyfine
118Rs80Rs50Rs
Cap Clarithromycin 500mg
Klaricid (prescribed here)Claritek Clarion
AbbottGetz pharmaFerozsons
648Rs370Rs297Rs
Miscellaneous problems (Reference: David S.Tatro.2004) 1counselling Not done in case of clarithromycin because ithas interaction with food(significant rating2,delayedonset, moderate severity, suspected documentation)
proper monitoring of LFTs required in cirrhotic patientthat is not done
Management: proper counselling for drug intake.Give antimicrobial before one hour of mealTake with liquids other than grape fruit
juiceRegular check up of LFTs should bedone in order to check the progress.
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Table 3.3e:CASE NUMBER : 05PATIENT DEMOGRAPHICS
NAME Zahid khan
AGE/GENDER 40y/male ADDRESS MalakandDIAGNOSIS: PUD NSAID induced (HCV cirrhotic)CHIEFCOMPLIANTS
PRESCRIBEDTREATMENT
STANDARDTREATMENT(Berardi RR,Welage LS.2005)
COMPARISON
Abdominal pain last10daysAnorexiaVomiting(chronic user of
NSAID)
Hospital treatmentTab spironolactone 100mgOD(continue)Tab Domperidone TDS
before mealInj Ranitidine 50mg I/VBD(stopped)Syp Lactulose 30m 2TSFTDSTab frusemide 20mg 1 BDDischarge medicineTab Esomeprazole 40mg1OD(one month)Syp cyproheptadine 2TSFTDStab propranolol 10mgTDS(continue)
Esomeprazole40 mg dailyStop the NSAIDUse
in cirrhotic patient dose of Omeprazoleshould notexceed 20mgdaily
DRUG RELATED PROBLEMDose adjustment and excessive dose reference:Martin J, Cloase LA, Jordan B et al.,2009
FREQUENCY
Excessive dose Esomeprazole should not exceed 20mg daily 1Dose adjustment inhepatic impairment
Esomeprazole40mg
Management: In cirrhotic patient Esomeprazole doseshould not exceed 20 mgdaily
Cost related problem ( Neshat MQ.2007-08) 2GENERIC BRANDS MANUFACTURER RETAIL PRICEInj ranitidine 2ml 5s Zantac(prescribed here)
RanitidineRanulcid
GSK FerozsonsMerck Marker
110Rs63Rs64Rs
Syp Lactulose 120ml Lilac(prescribed here)DuphalacWerilax
Getz pharmaHigh NoonWerrick
124R s148Rs93Rs
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Table 3.3 f: CASE NUMBER : 06PATIENT DEMOGRAPHICS
NAME Khawar Ali AGE/GENDER 47y/male ADDRESS Peshawar
DIAGNOSIS: PUD(NSAID induced)CHIEFCOMPLIANTS
PRESCRIBED TREATMENT STANDARDTREATMENT(Berardi RR,WelageLS. 2005)
COMPARISON
Abdominal distention&discomfort -1week Vomiting -2daysConstipation-few days(chronic use of
NSAIDs for joint pain)
Hospital treatmentInj Omeprazole 40mg 1 ODInj metoclopramide I/V STATthen ODSyp Lactulose 30ml 2TSF TDSDexamethasone topical ointmentMultivitaminsInf ciprofloxacin 100mg I/VBD(stopped)Tab Allupurinol 300mg BD(stopped)Discharge medicineTab Omeprazole 20mgBD(14days)
Omeprazole 20mg BD
Pharmacotherapygiven I hospital isaccording toSTG(standard
treatmentguidelines)
DRUG RELATED PROBLEM FREQUENCYImproper drugselection
Allupurinol was prescribed for joint pain that is notthe right choice because it is indicated for gout.Management: Nimusilde or Celecoxib is the drug
of choice for joint pain.
1
Cost related problem (Neshat MQ.2007-08) 4GENERIC BRANDS MANUFACTURER RETAIL PRICECap Omeprazole 40mg Risek (prescribed here)
lozalOmega
Getz pharma NovartisFerozsons
259Rs200Rs180Rs
Inj metoclopramide 10mg Maxolon(prescribed here)MetoclonMaxaclor
GSK Indus pharma
polyfine
118Rs80Rs50Rs
Syp Lactulose 120ml Duphalac (prescribedhere)Lilac
Werilax
High NoonGetz pharmaWerrick
148Rs124R s93Rs
Tab ciprofloxacin 250mg Novidate (prescribed here)CiproquineCp zaf
SamiMacter Zafa
151Rs120Rs35Rs
Miscellaneous problemsReference: David S.Tatro.2004
1
Counselling in case of quinolone administration nocounselling has been done abt milk intake along withciprofloxacin intake because it has interaction withmilk of significant rating-2(onset rapid, severitymoderate and suspected documentation)
Management: avoid milk intake but if milk can not be avoided lengthen the intake of milk and drug as much as possible
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