CASE 4:

Pneumonia
COPD
Drug-Induced Gastritis
Alcohol Withdrawal Seizure
Navato
Ocampo
Oliveria
Panganiban
Peros
Case:
HPI
• FDM, 57 years old to ER
• Fever, severe right-sided chest pain and difficulty of
breath
• 2 days PTA productive cough with rust-colorer
sputum
• Increasing malaise, fever with chills, epigastric pain
described as burning aggravated by intake of
prednisone

Past Medical History

• Long history of COPD with 2 inhalers,
metaproterenol 2-4 puffs PRN and ipratonium 2-4
puffs PRN, with prednisone 30mg PO daily tablet 2
months ago
• Phenytoin 400 mg PO HS due to Alcohol
Withdrawal Seizure
Case:
Personal and Social History:
• Smoker for 25 years
• Alcohol abuser (rehab 1 year ago)
• Allergic to Ampicillin

Physical Exam
• General Survey: Diaphoretic, agitated, weak looking
and in CR distress
• Vital Signs: BP-140/90mmHg, RR-35/min, HR-
125/Min,Temp-39.5 C, Weight- 65 kg, Height- 163
cms
• CVS- tachycardia, regular rhythm
• Chest and Lungs: prolonged expiratory phase, bi-
basal rales and rhonchi, dullness on the right lower
lung field
• GIT:(+) epigastric tenderness
• Neurologic: lethargic
Case:
Laboratory Exam

• HCO3- 33mEq/L (33mmol/L); BUN -59 (21);

Creatinine- 106.1 (1.2)
• Phenytoin-59.4mg/dL(15mcg/L); Guaiac test-
positive
• ABG:PO2- 70, PCO2- 47, pH- 7.3
• Peak flow: FEV1-60% (per-B2-agonist), FEV1/FVC-
70% (post-B2-Agonist)
• Sputum Gram’s stain: >50 leukocytes/hpf, 0-5
epithelial cells/hpf, gram(+) cocci in pairs- many
• CBC: WBC- 18.6 x 10ˆ9, Hct-0.49, Hgb-180, PMN-
0.88,L-0.22
• Chest X-ray- Right lower lobe consolidation 4
Pneumonia
BASIS OF THE PROBLEM
• Productive cough with rust-colored sputum
• Moderate to high grade fevers with chills
• Chest pain
• Vitals:
• RR: 35/mins
• HR: 125/mins
• Temp: 39.5C
• Chest and lung findings: bi-basal rales and
rhonchi, dullness on the right lower lung field
BASIS OF THE PROBLEM
• CBC:
• WBC: 18.6 x 10^9 (Increased)
• RBC :4.5 x 10^9
• Hct:0.49
• Hgb: 180 (Increased)
• PMN: 0.88 (increased)
• L: 0.22 (decreased)

• Chest X-ray
• Right lower lobe consolidation
THERAPEUTIC OBJECTIVES
• Stabilize the patients vitals
• To administer proper antimicrobial therapy
for the patient
• To prevent further complications of the
disease
 Non-Pharmacologic
Therapy

• Adequate hydration
• Oxygen therapy for hypoxemia
• Assisted ventilation when necessary are
critical to successful treatment
• Adequate nutrition
 PHARMACOLOGICAL THERAPY

PENICILLINS CEPALOSPORINS CARBAPENEM MACROLIDES FLUOROQUINOLO

NE

EFFICACY +++ +++ +++ +++ +++

SUITABILITY +++ +++ ++ +++ ++

SAFETY + +++ + ++ +

COST +++ ++ + + +++

 TREATMENT
• Cephalosporin
• macrolides
CEPHALOSPORIN CEFTRIAXONE CEFTAZIDIME CEFOTAXIME

EFFICACY +++ +++ +++

SUITABILITY +++ ++ ++

SAFETY +++ ++ +++

COST ++ ++ ++
MACROLIDE ERYTHROMYCIN AZITHROMYCIN CLARITHROMYCIN

EFFICACY ++ +++ +++

SUITABILITY ++= +++ +++

SAFETY ++ +++ ++

COST ++ +++ +++

DRUG OF CHOICE: CEFTRIAXONE

• Pharmacodynamics:
• Prevents bacterial cell wall synthesis by
binding to and inhibiting cell wall
transpeptidases
DRUG OF CHOICE: CEFTRIAXONE
• Pharmacokinetics:
• Absorption:
• Well absorbed IM. Time to peak plasma
concentration :2 hr
• Distribution:
• Widely distributed into most body tissues and
fluids.
• Metabolism
• Partially metabolized
• Excretion:
• Via urine (40-65% unchanged drug) and the
remainder in the bile via feces.
DRUG OF CHOICE: CEFTRIAXONE
• Adverse reactions:
• Hypersensitivity reactions
• Skin rashes
• Gastrointestinal complications
• Nausea
• Vomiting
• Diarrhea
DRUG OF CHOICE: CEFTRIAXONE
• Drug interactions:
• Alcohol: may cause disulfiram like
reactions
• (drug to drug) Aminoglycosides:
produces a synergistic antimicrobial
activity
• May increase effects of anticoagulants
DRUG OF CHOICE: AZITHROMYCIN
• PHARMACODYNAMICS
• Prevents bacterial protein synthesis by
binding to the 50S ribosomal subunit
DRUG OF CHOICE: AZITHROMYCIN
• Pharmacokinetics
• Absorption
• Rapidly absorbed from the GI tract
• Distribution
• Extensively distributed In the tissues (skin, lungs,
tonsils)
• Metabolism
• In the liver to inactive metabolites
• Excretion
• Mostly in the feces
• Less than 10% is excreted in the urine
• Terminal elimination half life is 68 hours
DRUG OF CHOICE: AZITHROMYCIN
• Adverse reactions
• CNS: dizziness, vertigo, headache
• CV: palpitations, chest pain
• GI: Nausea, vomiting, diarrhea,
abdominal pain
• Skin: rashes
DRUG OF CHOICE: AZITHROMYCIN
• Drug interactions (drug-drug)
• Antacids containing aluminum and
magnesium; do no alter bioavailability
but delay absorption and may reduce
peak plasma levels.
• Theophylline: Macrolides may increase
plasma theophylline levels by decreasing
theophylline clearance.
 Fatima University Medical Center – Valenzuela.
20 MacArthur Highway, Valenzuela, 1440 Metro Manila
Telephone no.: 8804677

Name: FDM
Address: Brgy. Marulas, Valenzuela City Age: 57 y/o

Date: August 23,2019

Ceftriaxone #10 vials

Sig: Give 2 grams or 1 vial

through IV once a day for 10
days

Panganiban, kevin brian M.D.

License no.: 123456
PTR no.: 654321
 Fatima University Medical Center – Valenzuela.
20 MacArthur Highway, Valenzuela, 1440 Metro Manila
Telephone no.: 8804677

Name: FDM
Address: Brgy. Marulas, Valenzuela City Age: 57 y/o

Date: August 23,2019

Azithromycin 500mg/tablet
#6 tablets

Sig: Take one 500 mg/tablet for day 1

and start taking 250 Mg tablet for 2 to 5
days

Panganiban, Kevin Brian M.D.

License no.: 123456
PTR no.: 654321
ANSWERS
TO TASK
DEFINE AND CLASSIFY PNEUMONIA ACCORDING TO
SEVERITY AND ETIOLOGY

• PNEUMONIA is an infection of the

pulmonary parenchyma, the portion distal
to the terminal bronchioles and comprising
the respiratory bronchioles, alveolar ducts,
alveolar sacs, and alveoli.

• Route of transmission:
• Inhalation of contaminated droplets
• ASPIRATION FROM THE OROPHARYNX=MOST
COMMON
• Hematogenous spread
DEFINE AND CLASSIFY PNEUMONIA ACCORDING TO
SEVERITY AND ETIOLOGY

• Classifications:
• community-acquired (CAP)
• hospital-acquired (HAP)
• ventilator-associated (VAP)
• health care– associated pneumonia
(HCAP), was introduced recently.
DEFINE AND CLASSIFY PNEUMONIA ACCORDING TO
SEVERITY AND ETIOLOGY

Newly identified pathogens include

metapneumoviruses, the coronaviruses
responsible for severe acute respiratory
syndrome (SARS) and Middle East
respiratory syndrome (MERS), and
community-acquired strains of MRSA.

Streptococcus pneumoniae
DEFINE AND CLASSIFY PNEUMONIA ACCORDING TO
SEVERITY AND ETIOLOGY

Less commonly, fungal and viral

pathogens cause VAP, usually
affecting severely
immunocompromised patients.
HOSPITAL-ACQUIRED PNEUMONIA

In general, the most important pathogens are:

-Pseudomonas aeruginosa
-Methicillin-sensitive Staphylococcus aureus
-Methicillin-resistant S. aureus (MRSA)

Other important pathogens:

-enteric gram-negative bacteria

Methicillin-sensitive S. aureus, Streptococcus

pneumoniae, and Haemophilus influenzae

P. aeruginosa, MRSA, and enteric gram-negative

organisms
2. Basis of the Problem (Pneumonia)
• Smoker for 25 years
• Alcohol abuser
• Chills
• Febrile
• Productive cough
• Rust-colored Sputum
• Chest pain
• Tachycardia
• Chest X-Ray: Right Lower Lobe Consolidation of the lungs
• Percussion: DULL
3. Diagnostics (Pneumonia)
• Chest X-Ray
• Gram’s Stain and Sputum Culture
• Blood Culture
• Urinary Antigen Tests
• Polymerase Chain Reaction
• Serology
• Biomarkers
4. Drugs used in management of
Pneumonia

• PENICILLIN

• CEPHALOSPORINS

• MACROLIDES

• CARBAPENEMS

• FLUOROQUINOLONES
COPD
 BASIS OF THE PROBLEM
HPI:
• Productive cough
• Difficulty of breathing

Past Medical History:

• Patient has long history of COPD

Personal and Social History:

• Patient is a smoker for 25 years

Physical Exam:
• General survey: Patient in cardiorespiratory
distress
• Chest and lungs: Prolonged expiratory and
ronchi is heard upon auscultation
 THERAPEUTIC OBJECTIVES

Reduce symptoms:
• Relieve symptoms
• Improve exercise tolerance
• Improve health status

Reduce risk:
• Prevent disease progression
• Prevent and treat exacerbations
• Reduce mortality
 Non-Pharmacologic
Therapy
1. Pulmonary Rehabilitation

• Comprehensive treatment program that incorporates

Exercise, education, psychosocial and nutritional counseling.

• It improves health-related quality of life, dyspnea and

exercise capacity in COPD patients

• It also helps to reduce rates of hospitalization over a 6-12

month period
 Non-Pharmacologic
Therapy
2. Lung Volume Reduction Surgery

• In selected patients with Emphysema, surgery to remove the most

emphysematous portions of lung improves exercise, lung function,
and survival

• Patients with UPPER LOBE-PREDOMINANT EMPHYSEMA and LOW

POST-REHABILITATION EXERCISE CAPACITY benefits most

• Patients with FEV1 <20% and either diffusely distributed

emphysema on CT scan or diffusing capacity of lung for carbon
monoxide ARE NOT CANDIDATES FOR LVRS
 Non-Pharmacologic
Therapy
3. Lung trasplantation
• COPD is 2nd leading indication for lung
transplantation
• Candidates for lung transplant:
 Very severe airflow limitation
 Severe disability despite maximal medical therapy
 Free of significant comorbid conditions such as liver,
renal, or cardiac disease
 PHARMACOLOGICAL REGIMEN
SHORT SHORT ACTING CORTICOSTEROIDS METHYLXANTHINES
ACTING B2- ANTICHOLINERGICS
ADRENERGIC
AGONISTS
EFFICACY
+++ +++ +++ +++

SUITABILITY
+++ +++ ++ ++

SAFETY
+++ +++ ++ +
COST
+++ +++ ++ +
 PHARMACOLOGICAL REGIMEN
B2- ANTICHOLINERGICS CORTICOSTEROIDS METHYLXANTHINES
ADRENERGIC
AGONISTS

EFFICACY
+++ +++ +++ +++

SUITABILITY
+++ +++ ++ ++

SAFETY
+++ +++ ++ +

COST
+++ +++ ++ +
 PHARMACOLOGIC REGIMEN
Short acting Salbutamol Fenoterol Levalbuterol Terbutaline
B2 agonists

EFFICACY +++ +++ +++ +++

SUITABILITY +++ + ++ +

SAFETY +++ + ++ ++

COST +++ + ++ ++
 PHARMACOLOGIC REGIMEN
Short acting Salbutamol Fenoterol Levalbuterol Terbutaline
B2 agonists

EFFICACY +++ +++ +++ +++

SUITABILITY +++ + ++ +

SAFETY +++ + ++ ++

COST +++ + ++ ++
PHARMACOLOGICAL REGIMEN

ANTICHOLINERGICS IPRATROPIUM TIOTROPIUM

BROMIDE BROMIDE

EFFICACY +++ +++

SUITABILITY +++ ++

SAFETY ++ ++

COST +++ ++
PHARMACOLOGICAL REGIMEN

ANTICHOLINERGICS IPRATROPIUM TIOTROPIUM

BROMIDE BROMIDE

EFFICACY +++ +++

SUITABILITY +++ ++

SAFETY ++ ++

COST +++ ++
 SALBUTAMOL

Pharmacodynamics
Salbutamol is a beta-agonist useful in the treatment of
bronchospasm. This drug selectively stimulates the beta2-
adrenergic receptors of lungs. Bronchodilation results from
relaxation of bronchial smooth muscle, which relieves
bronchospasm and reduces airway resistance

Pharmacokinetics
• Absorption: Readily absorbed from the GI tract.
• Metabolism: Undergoes metabolism in the liver and in the gut
wall.
• Excretion: Via urine (as metabolites and unchanged drug);
faeces (small amounts).
• Onset: W/in 5 min (inhalation); w/in 30 min (oral).
• Duration: Approx 3-6 hr (inhalation); up to 6 hr (oral).
 SALBUTAMOL

Adverse effects: Tremor, headache, tachycardia

Drug Interactions:
corticosteroid, diuretics, xanthines, digoxin
= Increased risk of hypokalaemia w/ K depleting agents

halogenated anaesth (IV)

= Increased uterine inertia

anti-diabetics
=antagonise the effect of anti-diabetics

guanethidine, reserpine, methyldopa, TCAs and MAOIs

=Effects may be altered
 IPRATROPIUM BROMIDE

Pharmacodynamics
Ipratropium bromide causes bronchodilation by blocking the action of
acetylcholine at parasympathetic site in bronchial smooth muscle.

Pharmacokinetics
 Absorption: 10-30% of a dose is deposited in the lungs while only
a small amount reaches systemic circulation. Poorly absorbed
from the GI tract. Bioavailability: 2% (oral /inhalation); 7-28%
(nasal).
 Distribution: Plasma protein binding: ≤9% (oral inhalation); <20%
(nasal).
 Metabolism: Metabolised via ester hydrolysis (41%) and
conjugation (36%).
 Excretion: Via urine and faeces. Elimination half-life: 2 hr (oral
inhalation); 1.6 hr (nasal).
 Onset: Bronchodilation: W/in 15 min.
 Duration: 2-5 hr (oral inhalation).
 IPRATROPIUM BROMIDE

Adverse effects: Dry mouth, tachycardia, palpitations,

arrhythmias, nausea and vomiting, headaches and
dizziness.

Drug Interactions:
Additive bronchodilatory effect w/ β-adrenergic drugs
and xanthine preparations.
 Fatima University Medical Center – Valenzuela
20 MacArthur Highway, Valenzuela, 1440 Metro Manila
Telephone no.: 8804677

Name: FDM
Address: Brgy. Marulas, Valenzuela City Age: 57 y/o

Date: August 23,2019

Ipratropium Bromide/Salbutamol 500mcg/2.5 mg/2.5ml

(Combivent)
#3

Sig. Give one nebule of Combivent for 3 doses every

15 mins. Via nebulization

WIENALYN C. PEROS, M.D.

License no.: 135422
PTR no.: 024152
 Fatima University Medical Center – Valenzuela
20 MacArthur Highway, Valenzuela, 1440 Metro Manila
Telephone no.: 8804677

Name: FDM
Address: Brgy. Marulas, Valenzuela City Age: 57 y/o

Date: August 23,2019

Ipratropium Bromide/Salbutamol 500mcg/2.5 mg/2.5ml

(Combivent)
#28

Sig. Give one nebule of Combivent every 6 hrs. Via

nebulization

WIENALYN C. PEROS, M.D.

License no.: 135422
PTR no.: 024152
Drug-Induced
Gastritis
 Basis of the
Problem
HPI:
• 2 days PTA, patient experienced epigastric
pain described as burning, aggravated by
intake of prednisone

Past Medical History:

• Patient has long history of COPD and was
prescribed with prednisone 30 mg PO daily
tablet 2 months ago

Personal and Social History:

• Patient is a smoker for 25 years

Physical Exam:
• GIT: (+) epigastric tenderness
 Therapeutic
Objectives
• To treat drug-induced gastritis without the
cessation of causative drug

Specifically,
• To potentiate mucosal defense mechanism
and repair gastric injury; and
• To prevent further complications such as
gastric ulceration or bleeding
 Non-Pharmacologic
Therapy
• Surgical treatment was originally designed to decrease
gastric acid secretion

• Vagotomy is a component of each of these procedures

and is aimed at decreasing acid secretion through
ablating cholinergic input to the stomach.

• Both truncal and selective vagotomy (preserves the

celiac and hepatic branches) result in gastric atony
despite successful reduction of both basal acid output
(BAO; decreased by 85%) and maximal acid output
(MAO; decreased by 50%).
 Non-Pharmacologic
Therapy
• Drainage through pyloroplasty or
gastroduodenostomy is required in an effort to
compensate for the vagotomy-induced gastric
motility disorder.

• To minimize gastric dysmotility, highly selective

vagotomy (also known as parietal cell, super-
selective, or proximal vagotomy) was developed.
Only the vagal fibers innervating the portion of the
stomach that contains parietal cells is transected,
thus leaving fibers important for regulating gastric
motility intact.
 Non-Pharmacologic
Therapy
• Antrectomy is aimed at eliminating an additional
stimulant of gastric acid secretion, gastrin.

• Laparoscopic surgery has led several surgical teams to

successfully perform highly selective vagotomy, truncal
vagotomy/pyloroplasty, and truncal
vagotomy/antrectomy through this approach.

• Endoscopic approaches for the treatment of peptic

disease and its complications has led to a substantial
decrease in the number of operations needed for this
disorder with a drop of >90% for elective ulcer surgery
over the last four decades
 Non-Pharmacologic
Therapy

Food to avoid:
• Spicy foods
• Alcohol
• Coffee and other beverages that contains
caffeine
• Fatty foods
• Fried food
 Pharmacologic Treatment
Acid-Suppressing Agents

H2 receptor Proton-Pump
Antacids
Antagonist Inhibitors

Efficacy +++ +++ +++

Suitability + ++ +++

Safety + + ++

Cost +++ +++ +++

 Pharmacologic Treatment
Acid-Suppressing Agents

H2 receptor Proton-Pump
Antacids
Antagonist Inhibitors

Efficacy +++ +++ +++

Suitability + ++ +++

Safety + + ++

Cost +++ +++ +++

 Pharmacologic Treatment
Proton Pump Inhibitors

Dexlansopra-
Omeprazole Lansoprazole Rabeprazole Pantoprazole Esomeprazole
zole

Efficacy +++ +++ +++ +++ +++ +++

Suitability ++ +++ ++ ++ +++ +

Safety + +++ ++ +++ + ++

+
Cost +++ + + ++ ++ uncommon in
PH
 Pharmacologic Treatment
Proton Pump Inhibitors

Dexlansopra-
Omeprazole Lansoprazole Rabeprazole Pantoprazole Esomeprazole
zole

Efficacy +++ +++ +++ +++ +++ +++

Suitability ++ +++ ++ ++ +++ +

Safety + +++ ++ +++ + ++

+
Cost +++ + + ++ ++ uncommon in
PH
Pharmacokinetics
Absorption: Rapidly absorbed, maximum concentration
occurs approximately 2.5 hours
Bioavailability: Approximately 77% (oral)
Time to peak plasma concentration: Approximately 1 hr

Distribution
Plasma protein binding: Approximately 98% primarily to
albumin

Metabolism: Metabolized in the liver by cytochrome P450

system

Excretion: Mainly via urine (approximately 80%), the

remainder in feces (via the bile)
Elimination half-life: 1.1 hr.
Pharmacodynamics
• Inhibit/block final step in gastric acid secretion by
specific inhibition of Hydrogen Potassium
ATPase pump in gastric parietal cells resulting in
blockage of acid secretion

Indications
• Gastric and duodenal ulcers
• Gastro-esophageal reflux disease
• NSAID-associated ulceration
• H.pylori infection
• Peptic ulcer
• Acid-related dyspepsia
• Gastrinoma and other hyperacidity disorder
Side Effects
• Pantoprazole is generally safe, though it might cause:
• Diarrhea
• Headache
• Abdominal pain
• Long-term use but rare may cause hepatic impairment
especially in elderly

Drug Interaction
• Pantoprazole is less likely than omeprazole and
esomeprazole to interact with other drugs, in fact has no
noted significant drug interaction at all.
Charmaine T. Oliveria, M.D.
Room 304, Fatima Medical Center, Valenzuela City
Telephone no.: 8804677

Name: FDM Date: August 23, 2019

Address: Valenzuela City

Pantoprazole 20 mg tablet
(Pantoloc) #28

Sig. Take 1 tablet once a day

at least 1 hr before meal
for 4 weeks

ctoliveria
CHARMAINE T. OLIVERIA, M.D.
License no.: 101593
PTR no.: 010116
 Alcohol
Withdrawal
Seizure
 Alcohol Withdrawal Syndrome
• A characteristic syndrome of motor agitation,
anxiety, insomnia and reduction of seizure
threshold due to abrupt alcohol discontinuation in
an individual with alcohol dependence.

• Wide spectrum of manifestations – ranging from

anxiety, decreased cognition and tremulousness

• One of the most common causes of seizures in

adults.

• Severity of the syndrome is usually proportionate

to the degree and duration of alcohol abuse.

• Can be categorized as mild, moderate or severe

withdrawal, withdrawal seizures and
deliriumtremens
 Alcohol Withdrawal Seizure

• Can occur 8 hours after the last drink but

usually do not manifest more than 48 hours
after alcohol cessation

Can during the first 1-5 days of withdrawal

More prevalent in persons with history of

withdrawal syndromes

Seizures are generalized tonic-clonic seizures

which are brief in duration and resolve
spontaneously
Basis of the Problem
• Alcohol Abuser
• Stopped alcohol 1 year ago under rehabilitation
• Chills and sweating
• General Survey: Agitated
• Older Age (57 yrs old)
• Intake of Phenytoin for Alcohol Withdrawal Seizure
• Diaphoretic
• RR – 35/min (Increased)
• Febrile (39.5)
 Non-Pharmacologic
Therapy
1. Alcoholic rehabilitation
• Core components of the rehabilitation phase of treatment
include cognitive-behavioral approaches to help patients
recognize the need to change, while working with them to
alter their behaviors to enhance compliance.

2. Relapse prevention education

• Helps patients identify situations in which a return to
drinking is likely (e.g., spending time with heavily drinking
friends or stopping in a bar to meet friends but planning to
only have a nonalcoholic beverage), formulate ways to
avoid the risky situation and if not possible to mitigate the
risks to which they are exposed.
• It is also important to develop coping strategies that
increase the chances of a return to abstinence quickly after
an episode of drinking.
 Non-Pharmacologic
Therapy
3. All patients should try self-help groups
such as Alcoholics Anonymous (AA)
• to assist them in developing a sober
peer group and to learn how to deal
with life’s stresses while remaining
sober.
 Non-Pharmacologic
Therapy
4. Counseling
• focuses on areas of improved functioning in
the absence of alcohol (i.e., why it is a good
idea to continue abstinence), helping
patients to manage free time without
alcohol, encouraging them to develop a
nondrinking peer group, and discussions of
ways to handle stress without drinking.
Therapeutic Management

Major objective: Prevention of seizures, delirium and arrhythmias

Potassium, magnesium, and phosphate balance should be

restored as rapidly as is consistent with renal function

Thiamine therapy is initiated in all cases

Mild alcohol withdrawal does not need any other pharmacologic

assistance
Therapeutic Management

For severe cases – detoxification

Administration of a long acting sedative-hypnotic

drug for alcohol and gradually reducing (tapering)
the dose of the long acting drug

Benzodiazepines:
Chlordiazepoxide and diazepam
Lorazepam and oxazepam
Therapeutic Management
Drug class of choice: Benzodiazepines
Assuming patient has no liver disease:

Chlordiazepoxide Lorazepam Oxazepam

Diazepam

Efficacy +++ +++ +++

+++

Suitability +++ +++ +++ +++

Safety +++ +++ +++ +++

+++
Cost + - - (61.51pesos
($31 per 90 per 5mg/ml,
capsules) 2ml ampule
Diazepam
Administration – 3 approaches

• Diazepam loading, which involves giving a

large dose on day 1, then no further
diazepam (recommended for inpatient
withdrawal
• Symptom-triggered sedation, where doses
of diazepam are administered according to
the severity of withdrawal symptoms.
• Treatment of acute ethanol withdrawal:
Initial dosing should be 10mg IM or IV. If
needed, a follow-up dose of 5 to 10mg is
permissible 3 to 4 hours later. If using the
oral tablet, dosing is 10mg every 6 to 8
hours within the first 24 hours,
then 5mg every 6 to 8 hours thereafter as
needed.
Diazepam

MOA: Positive allosteric modulator of GABAA receptors

Pharmacokinetics
- Nearly complete (>90%) oral or rectal.
- Peak concentrations in 1–1.5 h
- Highly (95–98%) bound to plasma proteins
- extensively metabolized to several active metabolites
- t1/2 of active metabolite N-desmethyldiazepam up to100 h
Toxicity: Sedation
Interactions: Additive with sedative-hypnotics
 Fatima University Medical Center – Valenzuela.
20 MacArthur Highway, Valenzuela, 1440 Metro Manila
Telephone no.: 8804677

Name: FDM
Address: Brgy. Marulas, Valenzuela City Age: 57 y/o

Date: August 23,2019

Diazepam 10mg/ 1 tablet

#30

Sig. Take 1 tab 3 times day or

every after meals

DONABEL NAVATO, M.D.

License no.: 184923
PTR no.: 025684
ANSWERS
TO TASK
2. Basis of the Problem (COPD)
• Smoker for 25 years
• History of COPD
• Cough
• Sputum production
• Dyspnea
• Prolonged Expiratory Phase
• PMH: Metaprotenerol, Ipratropium intake
(Bronchodilators)
• ABG : PCO2 of 47 (Normal range = 35-45)
• :PO2 70 (Normal range = 80-100)
Diagnostics (COPD)
• Chest X-Ray
• Spirometry
• Pulmonary Function Test
• ABG
• Oximetry
• CT scan – for presence and absence
of Emphysema
2. Basis of the Problem (Alcoholic
Withdrawal Seizure)
• Alcohol Abuser
• Stopped alcohol 1 year ago under rehabilitation
• Chills and sweating
• General Survey: Agitated
• Older Age (57 yrs old)
• Intake of Phenytoin for Alcohol Withdrawal Seizure
• Diaphoretic
• RR – 35/min (Increased)
• Febrile (39.5)
3. Diagnostics (Alcoholic Withdrawal
Seizure)

• History
• Physical Examination — Search for
evidence of:
• Liver Failure
• GI Bleeding
• Cardiac Arrhythmias
• Infection
• Glucose or electrolyte imbalance
 2. Basis of the
problem
• Epigastric pain aggravated by intake of prednisone
• Smoker for 25 years
• S/P alcohol abuser
• Epigastric tenderness
• Guaiac test - Positive
3.Diagnostics (Drug-Induced Gastritis)

• History
• (NSAIDs)

• Physical Examination
• (Epigastric Tenderness)
Drugs used in management of COPD

• Bronchodilators
• These medications — which usually come in an inhaler — relax
the muscles around your airways. This can help relieve coughing
and shortness of breath and make breathing easier.

• Inhaled steroids
• Inhaled corticosteroid medications can reduce airway
inflammation and help prevent exacerbations. Side effects may
include bruising, oral infections and hoarseness. These
medications are useful for people with frequent exacerbations
of COPD.
Drugs used in management of COPD

• Combination inhalers
• Phosphodiesterase-4 inhibitors
• A new type of medication approved for people with
severe COPD and symptoms of chronic bronchitis
• This drug decreases airway inflammation and relaxes the
airways

• Theophylline
• This very inexpensive medication may help improve breathing
and prevent exacerbations. Side effects may include nausea,
headache, fast heartbeat and tremor.
Drugs used in management of COPD

• Antibiotics
• Respiratory infections, such as acute
bronchitis, pneumonia and
influenza, can
aggravate COPD symptoms.
Antibiotics help treat acute
exacerbations, but they aren't
generally recommended for
prevention
Drugs used in management of Alcohol
Withdrawal seizure

• Benzodiazepines:
• Benzodiazepines are preferred and are
considered first-line treatment in
patients with AWS.
• These agents reduce the symptoms of
withdrawal including seizures and help
to prevent symptom progression.
Drugs used in management of Alcohol
Withdrawal seizure

• Neuroleptic agents such as the

phenothiazines and haloperidol
• may reduce the severity of some withdrawal effects
and may be beneficial in patients with uncontrolled
agitation

• Anticonvulsants such as carbamazepine,

oxcarbazepine, and divalproex
• may be useful in the treatment of alcohol
dependence by reducing alcohol craving and in
treating AWS through its antikindling effect
 Drugs used in management of Drug-
Induced Gastritis

• Antibiotic medications to kill H. pylori

• For H. pylori in your digestive tract, such as
clarithromycin (Biaxin) and amoxicillin (Amoxil,
Augmentin,) or metronidazole (Flagyl), to kill
the bacterium

• Medications that block acid production and

promote healing. Proton pump inhibitors reduce
acid by blocking the action of the parts of cells
that produce acid.
• These drugs include the prescription and over-the-counter
medications omeprazole (Prilosec), lansoprazole (Prevacid),
rabeprazole (Aciphex), esomeprazole (Nexium),
dexlansoprazole (Dexilant) and pantoprazole (Protonix).
Drugs used in management of Drug-
Induced Gastritis

• Medications to reduce acid production: Acid

blockers — also called histamine (H-2) blockers —
reduce the amount of acid released into your
digestive tract, which relieves gastritis pain and
encourages healing.
• Available by prescription or over-the-counter, acid blockers
include ranitidine (Zantac), famotidine (Pepcid), cimetidine
(Tagamet HB) and nizatidine (Axid AR).

• Antacids neutralize existing stomach acid and can

provide rapid pain relief.
•THANK YOU