3.2 Medication Histories of Ascities: Table 3.2a

3.
2 MEDICATION HISTORIES OF ASCITIES
Table 3.2a
CASE NUMBER : 01
PATIENT DEMOGRAPHICS
 NAME Gul Inam
 AGE/GENDER 60y/female
 ADDRESS Kalaam
DIAGNOSIS: Moderate ascites(cirrhotic)
CHIEF PRESCRIBED STANDARD COMPARISON
COMPLIANTS TREATMENT TREATMENT
(Garcia-Tsao G,
LimJoseph.,
2009)
Abdominal distention Hospital treatment Salt restriction Pharmacotherapy
Urine retention body Syp vidaylin 1 – 2 g / day given I hospital is
aches constipation (multivitamin)2TSF Spironolactone alone according to
fever TDS (start at 50 – 100 mg STG(standard
Lactulose enema BD q.d., single morning treatment
Tab spironolactone dose) guidelines)
100mg 1 OD Or Spironolactone (50
Tab frusemide 40mg 1 – 100 mg q.d.) +
OD frusemide (start at 20
Syp Lactulose TDS – 40 mg q.d., single
Discharge medication morning dose
Tab spironolactone
100mg OD
Tab frusemide 40mg 1
OD
Syp Lactulose 30ml
TDS
DRUG RELATED PROBLEM FREQUENCY
Untreated condition Fever and body aches 1
Miscellaneous problems 1
Monitoring of electrolyte balance in case Management: Monitor plasma potassium, high
of diuretic therapy risk of hyperkalemia in renal impairment
47
Table 3.2b:
CASE NUMBER : 02
 NAME Usman bibi
 ADDRESS Landikotal Peshawar
DIAGNOSIS: Malignant ascites (known case of CLD)
( Garcia-Tsao G,
Lim Joseph.,2009
Drowsiness and Hospital treatment
abdominal pain from NG intubation Total paracentesis Pharmaco-
last 5 days Catheterization + i.v. albumin (6 – therapy given I
Constipation Inj cefotaxime 1g I/V 8 g / l of ascites hospital is
Distended abdomen TDS(ATD) removed) according to
Confusion Inf metronidazole I/V If < 5 l of ascites STG(standard
TDS(stopped) is removed, a treatment
Lactulose enema PR STAT synthetic plasma guidelines)
then BD volume expander
Syp Lactulose 30ml TDS may be used
Multivitamin supplements instead of albumin
I/V STAT Continue with salt
Tab bisacodyl 4 nocte restriction and
Inj metoclopramide I/V BD diuretic therapy as
Paracentesis done tolerated
Inf haemaccel Spironolactone
Syp Eplazyme(digestive alone (start at 50 –
enzymes)2TSF TDS 100 mg q.d.,
Discharge medication single morning
Tab spironolactone 100mg dose)
OD
Reference of dose adjustment & excessive dose
(Martin J, Cloase LA, Jordan B et al.,2009)
Untreated condition Any procedure has not been done to find out the 1
primary cause of malignant ascites
Requiring dose 1
adjustment in Metronidazole In severe liver disease reduce dose
hepatic impairment to one third and give once daily.
Excessive dose Management: In severe liver disease reduce dose 1
Metronidazole TDS to one third and give once daily
Cost related problem (Neshat MQ.2007-08) 3
GENERIC BRANDS MANUFACTURER RETAIL PRICE
Inj Cefotaxime 1gm By generic(prescribed here) Novartis 218Rs
Cefax Mass pharma 145Rs
48
Cefatax Bosch 150Rs
Syp Lactulose 120ml Lilac(prescribed here) Getz pharma 124R s
Duphalac High Noon 148Rs
Werilax Werrick 93Rs
Inj metoclopramide Maxolon(prescribed here) GSK 118Rs
10mg Metoclon Indus pharma 80Rs
Maxaclor polyfine 50Rs
RFTs not performed and drugs metoclopramide and Management: Monitor plasma
frusemide need proper monitoring of RFTs. potassium, high risk of hyperkalemia
in renal impairment
49
Table3.2c:
CASE NUMBER : 03
 NAME Samina
 AGE/GENDER 60 y/female
 ADDRESS Landikotal Peshawar
DIAGNOSIS Malignant ascites(UTI)
CHIEF COMPLIANTS PRESCRIBED STANDARD COMPARISON
TREATMENT TREATMENT
(Garcia-Tsao G, Lim
Joseph.,2009)
Abd distention Hospital treatment
Vomiting off and on Inj metoclopramide I/V Spironolactone Pharmacotherap
Heart burn,dysurea SOS (50 – 100 mg q.d.) + y given I
body aches Inj ranitidine I/V BD frusemide (start at 20 hospital is
(History of several Inj tramadol – 40mgq.d single according to
paracentesis) /dimenhydrinate I/V morning dose STG(standard
SOS Cefotaxime (2 g i.v treatment
Inj cefotaxime 1g I/V q12 h) guidelines)
TDS(ATD) Continue therapy for
Syp tres-oris 7 days
forte(Multivitamin
supplements) 2TSF BD
Discharge medication
Tab spironolactone
100mg OD
Tab frusemide 100mg
1OD
GENERIC BRANDS MANUFACTURE RETAIL PRICE
R
Inj metoclopramide 10mg Maxolon(prescribed) GSK 118Rs
Metoclon Indus pharma 80Rs
Maxaclor polyfine 50Rs
Inj ranitidine 2ml ×5’s Zantac(prescribed) GSK 110Rs
Ranitidine Ferozsons 63Rs
Ranulcid Merck Marker 64Rs
Inj Cefotaxime 1gm By generic(prescribed) Novartis 218Rs
Cefatax Bosch 150Rs
50
Table 3.2d:
CASE NUMBER : 04
 NAME Khan bibi
 ADDRESS Peshawar
DIAGNOSIS: Ascites (HBV,CLD)
(Garcia-Tsao G, Lim
Joseph.,2009)
Abd distention- Hospital treatment
10days Inj cefotaxime 1g I/V Spironolactone (50 Pharmacotherapy
Swelling of body TDS(ATD) – 100 mg q.d.) + given I hospital is
Pain abdomen Inj ranitidine 40mg I/VBD frusemide (start at according to
Anorexia Syp Lactulose 30ml TDS 20 – 40mgq.d STG(standard
Tab spiromide(aldactone single morning treatment
frusemide)20mg dose guidelines)
2OD(stopped) Cefotaxime (2 g i.v
Inf haemaccel 5ooml I/V q12 h)
STAT Continue therapy
Inj frusemide 40mg I/V OD for 7 days
Tab spironolactone 100mg
OD
OD
Tab frusemide 40mg 1/v
OD
Inj Cefotaxime By generic(prescribed here) Novartis 218Rs
1gm Cefax Mass pharma 145Rs
Cefatax Bosch 150Rs
Inj ranitidine 2ml Zantac(prescribed here) GSK 110Rs
×5’s Ranitidine Ferozsons 63Rs
Ranulcid Merck Marker 64Rs
Syp Lactulose Lilac(prescribed here) Getz pharma 124R s
120ml Duphalac High Noon 148Rs
LFT’s are checked for once &RFTS Management: Monitor RFTS for the plasma K
after the use of diuretic therapy have levels and LFTS should be checked in cirrhotic pt.
51
not been checked
Table 3.2e:
CASE NUMBER : 05
 NAME Qazi Ahmed
 AGE/GENDER 65y/male
 ADDRESS Dir
DIAGNOSIS: Malignant ascites (B&C negative)
(Garcia-Tsao G, Lim
Joseph.,2009)
Abdominal distention Hospital treatment Total paracentesis +
Weight loss Tab ciprofloxacin i.v. albumin (6 – 8 g / Pharmacotherap
Loose stool(3-4 250mg 1 BD l of ascites removed) y given I
episodes) Inf metronidazole If < 5 L of ascites is hospital is
400mgTDS removed, a synthetic according to
Tab Pantoprazole plasma volume STG(standard
40mg 1 OD expander may be used treatment
paracentesis instead of albumin guidelines)
Discharge Continue with salt
medication restriction and diuretic
Tab spironolactone therapy as tolerated
100mg OD Spironolactone alone
Syp Eplazyme 2TSF (start at 50 –100mg
TDS q.d., single morning
dose)
Tab ciprofloxacin Novidate Sami 151Rs
250mg Ciproquine Macter 120Rs
Cp zaf Zafa 35Rs
Reference: David S.Tatro.2004
1.Counselling in case of quinolone administration no Management: avoid milk intake but if
counselling has been done abt milk intake along with milk can not be avoided lengthen the
ciprofloxacin intake because it has interaction with intake of milk and drug as much as
milk of significant rating-2(onset rapid, severity possible.
moderate and suspected documentation)
2.as spironolactone has been given but no K level Proper monitoring of K level should be
monitoring done
3.primary cause of malignancy not known Cell cytology or biopsy test should be
performed to find out the primary cause
of ascites
52
Table 3.2f: CASE NUMBER : 6
 NAME Mrs. Aurangzeb
DIAGNOSIS: Ascites (HCV cirrhotic & RTI)
Garcia-Tsao G,
Lim Joseph .2009
Hospital treatment
Abdominal pain Inj cefotaxime Na1g I/V Spironolactone Pharmacotherapy
Abdominal distention TDS(ATD)(stopped) (50 – 100 mg given I hospital is
Anorexia Tab spironolactone 100mg q.d.) + frusemide according to
Cough usually at night 2OD (start at 20 – STG(standard
acidity Tab frusemide 40mg 2OD 40mgq.d single treatment
Fever Syp Lactulose 30ml morning dose
guidelines)
TDS(continue) Cefotaxime (2 g
Syp Gaviscon(antacid) i.v
Inf Levofloxacin 500mg q12 h)
I/V OD Continue therapy
Inj Avil(pheneramine for 7 days
maleate)/decadran I/V
STAT
2 OD(1week)
Tab frusemide 40mg 2OD
(1week)
Tab propranolol 10mg
TDS(continue)
Drug interaction Levofloxacin-antacid(David S.Tatro.2004) 1
SIGNIFICANT SEVERITY/ MANAGEMENT
RATING/ONSET DOCUMENTATION If concurrent use can not be
2/raipd Moderate/probable avoided give antacid before or 2
hours after the quinolone
GENERIC BRANDS MANUFACTURER RETAIL
PRICE
Inj Cefotaxime 1gm Claforan(prescribed here) Sanfi Aventis 240Rs
By generic Novartis 218Rs
Cefatax Bosch 150Rs
Syp Lactulose 120ml Duphalac (prescribed here) High Noon 148Rs
Lilac Getz pharma 124R s
Miscellaneous problems RFT monitoring Management: Because of diuretic 1
53
therapy regular monitoring of RFTS should be done
Table 3.2g: CASE NUMBER : 07

 NAME Naveed Ullah
 AGE/GENDER 65y/male
DIAGNOSIS: Ascites (known case of CLD)
CHIEF COMPLIANTS PRESCRIBED STANDARD COMPARISON
TREATMENT TREATMENT
(Garcia-Tsao G,
Lim Joseph.2009)
Melena anorexia Hospital treatment
Abdominal distention Inj octreotide 5amp in 1000cc Pharmacotherapy
Known case of CLD dextrose,15 drops/min for 72 Spironolactone given I hospital is
hours (50 – 100 mg q.d.) according to
Inj ceftriaxone 1g I/V BD + frusemide (start at
Inf metronidazole 100ml I/V 20 – 40mgq.d
STG(standard
TDS single morning dose treatment
Syp Lactulose 30ml TDS Ceftriaxone (2 g guidelines)
Inj Omeprazole 40mg every 24 h)
Tab spiromide(spironolactone- Continue therapy
frusemide)20mg 2 OD for 7 days
Tab spiromide (spironolactone-
frusemide)20mg 2OD(1month)
Cap Omeprazole 40mg 1
OD(1month)
Syp Sucralfate BD(2weeks)
Reference of dose adjustment & excessive dose:
Martin J, Cloase LA, Jordan B et al.,2009
Requiring dose Metronidazole In severe liver disease reduce dose to 2
adjustment in hepatic one third and give once daily.
impairment In cirrhotic patient Omeprazole dose should not
exceed 20 mg daily
Excessive dose Metronidazole TDS Management: 2
In severe liver disease reduce
dose to one third and give
once daily.
In cirrhotic patient
Omeprazole 40mg Omeprazole dose should not
exceed 20mg daily
Syp Lactulose 120ml Duphalac (prescribed here) High Noon 148Rs
Lilac Getz pharma 124R s
RFTs not performed and drugs –spironolactone Management: Monitor plasma potassium,
frusemide need proper monitoring of RFTs high risk of hyperkalemia in renal
impairment.
54
55

3.2 Medication Histories of Ascities: Table 3.2a

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2 MEDICATION HISTORIES OF ASCITIES

Table 3.2g: CASE NUMBER : 07

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