No Case

1 Mr. X, 63 y.o. MRS caused by unbearable pain. Dated on 21/12/2017.

Injected with ketorolac in the emergency room. VAS test shows the scale
of 9. The soreness is mainly in the back spine. The patients currently
undergo gilotrifulin chemotherapy for the first time. The other complaints
are about headache, nauseous feeling, and fatigue. The doctor diagnosed
the patients is infected with lung cancer (NSCLC) metastases which
spreads to the bones and the spine (stage 4).
The medication obtained by the patients: Furosemideinj, tramadol 50 mg,
ketorolac inj, allopurinol, KSR, ondansetron 4 mg, sucralfate syrup.
2 Mr. A, 55 y.o. was brought to emergency room due to headache and
nausea for about a week. Vomiting 3 times a day. The patient also
complains about the pain and stiffness on both sides of the knee, the wrist,
and the foot. The symptoms are felt in the morning at the time the patients
wake up for about 30 minutes. The patient is still conscious with the GCS
of 456. The doctor diagnosed that the patient is contracted by RA and
glomerulonephritis.
The medications for the patient are: Amlodipine 10 mg, spironolactone 25
mg, ketorolacinj 30 mg, MTX 75 mg, prednisone 5 mg
3 A patient, Mr. AR, 62 y.o., H/W 176cm/60kg, was brought to the
emergency room due to vomiting blood, darkened feces, and fever. The
vomiting has happened around 2 days with the frequency of 2 each day.
The darkened feces have happened also around 2 days, nausea, diarrhea
(-). The fever has lasted for 3 days with headache and fatigue. The doctor
diagnosed the patient is contracted with Hematemesis Melena+ Varices
esophageal + Cirrhosis hepatic and suggested hospitalization. The patient
has infected by hepatitis B for 10 years ago based on the medical history.
The medications during hospitalization: Vitamin K, Transamin, Panzo,
Yadim, Kanamycin, Lactulac, propranolol, spironolactone and
lamivudine.
4 A patient, male, 39 y.o., weighted 37kg was brought into the emergency
on 28 August 2016 with the conditions as follows: fever, nausea, fatigue,
sunken eyes, and decreased skin turgor. Based in his friend’s explanation
the patient has the diarrhea since yesterday with the frequency of 8 times
a day, liquid feces with blood and mucus. The patient has drunk ORT but
the body rejected it. The patient also complaint about the pain within the
oral cavity especially when swallowing food that has been last for a week
resulting on the decreased appetite. There is a white spot on the oral
cavity.
The patient is suggested to get hospitalization. The doctor diagnosed the
patient suffer from diarrhea candidiasis.
The feces examination resulted on shigella (+)
The medication: PCT, metronidazole, metoclopramide, kaolin peltin, RL,
TPN.
5 A female patient, 45 y.o., H/W 165cm/50kg was brought to the hospital
on 7 January 2018 and complained to have nausea that has been last for 3
days and jaundice in the last 2 days. She also complains about the pain in
the urinary tract during urinating process. She has taken an intensive
medication using TBCHRZE for almost 2 months (currently in the 50 th
day).
She is an alcoholic
The medications are: Ulsikur, Tomit, Binozyt, curcuma., paracetamol,
INH, Rifampicin, Ethambutol, and pyrazinamide.
6 A male, 67 y.o. H/W 170cm/65kg was brought to the emergency on 12
 January 2018 at 3 p.m. due to fatigue, nauseous, tachycardia, tremor, and
hallucinations 2 hours prior entering the hospital. Previously the patient is
exposed to an ulcer attack in the morning at 10 a.m. Instinctively, the
patients drank Neo Napacin 2 tablets at once and another 2 after an hour
to reduce the asthma.
Medical history shows the patient is infected by intermittent asthma.
Medications taken are Neo Napacin and Ventolin inhaler. However, the
patient forgot how to use the inhaler. The doctor diagnosed the patient is
poisoned by teofilin. After 4 days of hospitalization, the patient is
diagnosed to have HAP.
The medications are: activated charcoal, ranitidine, ondansetron, oxygen,
amlodipine, floxacap, paracetamol.
7 Mr. F. 67 y.o. was brought to the hospital complaining about the sore on
the left chest, left shoulder, and the back. the pain felt severe. The patient
is also feeling nauseous and vomiting and having cold sweat. The pain is
felt from around 6 p.m. The patient comes to the emergency around 11.30
p.m.
The EKG examination shows ST elevation lead 12.
The medications are: Oxygen, aspilet, omeprazole, warfarin, valsartan,
ISDN.
8 A patient, 55 y.o. male weighted about 80kg was brought to the
emergency due to paraesthesia leading to numbness on the left fingers.
The numbness spreads to the whole arm. The symptom has last for 5
hours before.
The diagnosis shows that the patient is contracted with TIA attack.
The medications are: bisoprolol 5mg 1x1 tablet, aspirin 80 mg 1x1, O2,
insulin glargine 10 IU, alteplase 70 mg iv.
 Pharmaceutical Care

‫آ‬No Case
1 Pain. Cancer Pain Mr. X, 63 y.o. MRS caused by unbearable pain. Dated on 21/12/2017.
Injected with ketorolac in the emergency room. VAS test shows the scale
of 9. The soreness is mainly in the back spine. The patients currently
undergo gilotrifulin chemotherapy for the first time. The other
complaints are about headache, nauseous feeling, and fatigue. The
doctor diagnosed the patients is infected with lung cancer (NSCLC)
metastases which spreads to the bones and the spine (stage 4).
The medication obtained by the patients: Furosemide inj, tramadol 50
mg, ketorolac inj, allopurinol, KSR, ondansetron 4 mg, sucralfate syrup.
History of complaint: Dyspepsia
Medication history: Tramadol (home medication)
VS: Blood pressure 140/70 mmHg, HR 88/minutes, RR 20/minutes
Lab examination result: creatinine 1 mg/dL, BUN 19,2 mg/dL, GDA 120
mg/dL, GDP 120 mg/dL, GD2JPP 200 mg/dL, Na 120 mmol/L, K 2
mmol/L, Cl 91 mmol/L, SGOT 35 mg/dL, SGPT 35 mg/dL, uric acid 7,
albumin 2
2 Pain. Joint Pain Mr. A, 55 y.o. was brought to emergency room due to headache and
nausea for about a week. Vomiting 3 times a day. The patient also
complains about the pain and stiffness on both sides of the knee, the
wrist, and the foot. The symptoms are felt in the morning at the time the
patients wake up for about 30 minutes. The patient is still conscious with
the GCS of 456. The doctor diagnosed that the patient is contracted by
RA and glomerulonephritis.
The medications for the patient are: Amlodipine 10 mg, spironolactone
25 mg, ketorolac inj 30 mg, MTX 75 mg, prednisone 5 mg
History of complaint: frequent malaria cases
Medication history: methotrexate, chloroquine, sulfasalazine for the last
3 months.
VS: Blood pressure 170/120 mmHg, HR 86/minutes, RR 2/minutes, T
36,40C
Lab examination result: SpO2 99%, Na 125 mmol/L, K 5,9 mmol/L, Cll
107,8mmol/L, WBC 8800/µL, Hb 7,8 g/dL, HCT 24,9 %, MCV 68,8,
MCH 22,3, MCHC 32,4, BUN 51 mg/dL, creatinine 1,8 mg/dL, GDA
110 mg/dL,
Blood gas analysis result: HCO3 18, pH 7,2, pCo2 16,2, troponin (-)
3 Gastro A patient, Mr. AR, 62 y.o., H/W 176cm/60kg, was brought to the
Hematemesis emergency room due to vomiting blood, darkened feces, and fever. The
Melena + Varices vomiting has happened around 2 days with the frequency of 2 each day.
esophageal + The darkened feces have happened also around 2 days, nausea, diarrhea
Cirrhosis hepatic (-). The fever has lasted for 3 days with headache and fatigue. The
doctor diagnosed the patient is contracted with Hematemesis Melena+
Varices esophageal + Cirrhosis hepatic and suggested hospitalization.
The patient has infected by hepatitis B for 10 years ago based on the
medical history.
The medications during hospitalization: Vitamin K, Transamin, Panzo,
Yadim, Kanamycin, Lactulac, propranolol, spironolactone and
lamivudine.
VS: Blood pressure 120/60 mmHg, HR 84/minutes, RR 25/minutes, T
37.6◦C, abdominal circumference ++
Lab examination result: Hematocrit 11.5 SI (%), Hemoglobin 3.2 g/dL,
 Leukocyte 13000mm3, SGOT 80u/L, SGPT 82 u/L, albumin 2,3 g/dL,
Bilirubin tot 1.36, bilirubin direct 0.34
4 Gastro A patient, male, 39 y.o., weighted 37kg was brought into the emergency
Chronic diarrhea on 28 August 2016 with the conditions as follows: fever, nausea, fatigue,
+ Candidiasis + sunken eyes, and decreased skin turgor. Based in his friend’s explanation
opportunistic the patient has the diarrhea since yesterday with the frequency of 8 times
infection of HIV a day, liquid feces with blood and mucus. The patient has drunk ORT but
the body rejected it. The patient also complaint about the pain within the
oral cavity especially when swallowing food that has been last for a
week resulting on the decreased appetite. There is a white spot on the
oral cavity.
The patient is suggested to get hospitalization. The doctor diagnosed the
patient suffer from diarrhea candidiasis.
The feces examination resulted on shigella (+)
The medication: PCT, metronidazole, metoclopramide, kaolin peltin,
RL, TPN.
VS: Blood pressure 110/70mmHg, HR 90/minutes, RR 22/minutes, T
38,9 °C
Lab examination result: SGOT 37 u/L, SGPT 36 u/L, CD4 cel 150
cell/mm3, albumin 3,3, Leukocyte 13000mm3,
5 Resp MDR TB A female patient, 45 y.o., H/W 165cm/50kg was brought to the hospital
on 7 January 2018 and complained to have nausea that has been last for
3 days and jaundice in the last 2 days. She also complains about the pain
in the urinary tract during urinating process. She has taken an intensive
medication using TBCHRZE for almost 2 months (currently in the 50 th
day).
She is an alcoholic
The medications are: Ulsikur, Tomit, Binozyt, curcuma., paracetamol,
INH, Rifampicin, Ethambutol, and pyrazinamide.
VS: Blood pressure 110/80 mm Hg, HR 78/minutes, RR 22/minutes, T
390 C
Lab examination result: Hb 11,5 g/dL, Leukocyte 14,5 x 10 3 ,Platelets
256 x 103, Rbc 3.5, MCH 93.9 pg/sel , MCHC 35 g/dL, PTT 14 seconds,
seconds, aPTT 31.5 seconds, K 3 mEq/L, Na 120 mEq/L, Cl 90 mEq/L,
Ca 8 mEq/L, creatinine serum 0.76 mg/dL, BUN 15 mg/dL,PH 7.48,
HCT 32.9 %, SGOT 215 g/dL, SGPT 220 g/dL, alb 3,95, GDA 121
g/dL,TC 160 g/dL
6 Resp A male, 67 y.o. H/W 170cm/65kg was brought to the emergency on 12
Poisoning & January 2018 at 3 p.m. due to fatigue, nauseous, tachycardia, tremor, and
Pneumonia hallucinations 2 hours prior entering the hospital. Previously the patient
Ventilator is exposed to an ulcer attack in the morning at 10 a.m. Instinctively, the
patients drank Neo Napacin 2 tablets at once and another 2 after an hour
to reduce the asthma.
Medical history shows the patient is infected by intermittent asthma.
Medications taken are Neo Napacin and Ventolin inhaler. However, the
patient forgot how to use the inhaler. The doctor diagnosed the patient is
poisoned by teofilin. After 4 days of hospitalization, the patient is
diagnosed to have HAP.
The medications are: activated charcoal, ranitidine, ondansetron,
oxygen, amlodipine, floxacap, paracetamol.
History of complaint: intermittent asthma, dyspepsia
Medication history: neo napacin, cimetidine
Allergic: cephalosporin anti biotic
VS: Blood pressure 80/60 mmHg, HR 105/minutes, RR 40/minutes, T
 390C
Lab examination result: AL 14 x 10 3, K 3 mEq/L, Na 130 mEq/L, Cl 95
mEq/L, Ca 7 mEa/L, creatinine serum 1,5 mg/dL, BUN 35 mg/dL, uric
acid 9 mg/dL,
Blood gas: PH 5,5, PCO2 60 mmHg, PO2 75mmHg
7 Cardio Stemi Mr. F. 67 y.o. was brought to the hospital complaining about the sore on
the left chest, left shoulder, and the back. the pain felt severe. The patient
is also feeling nauseous and vomiting and having cold sweat. The pain is
felt from around 6 p.m. The patient comes to the emergency around
11.30 p.m.
The EKG examination shows ST elevation lead 12.
The medications are: Oxygen, aspilet, omeprazole, warfarin, valsartan,
ISDN.
History of complaint: Hypertension
Medication history: Valsartan 80 mg andamlodipine 5 mg
VS: Blood pressure 185/120 mmHg, T 36,40C, HR 75/minutes, RR
33/minutes
Lab examination result: WBC 13.3 x 103g/dL, Hb 11,8 g/dL, platelet 299
mg/dL, troponin 0,05 mg/dL, GDA 118 mg/dL, Chol total 268 mg/dL,
HDL 35 mg/dL, LDL 160mg/dL,creatinine serum 0,9 mg/dL, INR 1,4
mg/dL
8 Cardio A patient, 55 y.o. male weighted about 80kg was brought to the
Stroke Ischemic emergency due to paranesthesia leading to numbness on the left fingers.
The numbness spreads to the whole arm. The symptom has last for 5
hours before.
The diagnosis shows that the patient is contracted with TIA attack.
The medications are: bisoprolol 5mg 1x1 tablet, aspirin 80 mg 1x1, O2,
insulin glargine 10 IU, alteplase 70 mg iv.
History of complaint: Hypertension for 7 years and DM for 3 years.
VS: Blood pressure: 202/140 mmHg, RR 32/minutes, HR 87/minutes,
sa02 93 %.
Lab examination result: WBC 9,6x 103 g/dL, Hb 12 g/dL, platelet 230
mg/dL, GDS 170 mg/dL, Chol total 200 mg/dL, HDL 50 mg/dL, LDL
140 mg/dL,creatinineserum 0,65 mg/dL, BUN 15 mg/dL, NIHSS 1,2,
HbA1c 6,7%.