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Management
Course in the Wards
Discharge Plans
Management: Course in the Wards
• Hospital Day 1: Admission Day
– Requested to be started on:
• Ceftriaxone 2g/IV OD
• Azithromycin 500mg/tab 1tab OD for 3days
• Erdosteine 300mg/cap 1cap BID
• Paracetamol 500mg/tab 1tab q4 prn for T> 38C
• Amlodipine 5mg/tab 1tab OD
Note: Medications were not started due to financial constraints
• Furosemide 40mg/IV 1dose and Salbutamol neblization
q4 were requested
Management: Course in the Wards
• Hospital Day 2
– Patient was hypertensive at 180/100mmHg
• was given Amlodipine 10mg/tab
– Ceftriaxone was started
Management: Course in the Wards
• Hospital Day 3
– Salbutamol was shifted to Combivent nebulization
q12, with gentle chest physiotherapy after each
nebulization
– Patient had a BP of 140/90mmHg
• Was started on Metoprolol 50mg/tab 1tab BID
Management: Course in the Wards
• Hospital Day 4
– Ceftriaxone was shifted to Cefuroxime 500mg/tab
1tab BID to complete 7days
• Was not done due to financial constraints
• Hospital Day 5
– Azithromycin, FeSO4 + FA, Metoprolol, as
previously ordered, were started
Management: Course in the Wards
• Hospital Day 6
– Cefuroxime, as previously ordered, was started
• Hospital Day 7
– Patient’s condition improved and was stable
• discharge
Management: Discharge Plans
• Pharmacologic
• Non-Pharmacologic
• Check-Up
Discharge Plans: Pharmacologic
• Azithromycin
– MOA: blocks transpeptidation by binding to 50s ribosomal
subunit of susceptible organisms and disrupting RNAdependent protein synthesis at the chain elongation step.
– AE: Mild to moderate nausea, vomiting, abdominal pain,
dyspepsia, flatulence, diarrhoea, cramping; angioedema,
cholestatic jaundice; dizziness, headache, vertigo,
somnolence; transient elevations of liver enzyme values.
– Dosage: 500mg/tab, 1 tablet OD for 3 days
– SRP: Php 150.00
Discharge Plans: Pharmacologic
• Cefuroxime
– MOA: binds to one or more of the penicillin-binding
proteins (PBPs) which inhibits the final transpeptidation
step of peptidoglycan synthesis in bacterial cell wall, thus
inhibiting biosynthesis and arresting cell wall assembly
resulting in bacterial cell death.
– AE: Large doses can cause cerebral irritation and
convulsions; nausea, vomiting, diarrhoea, GI disturbances;
erythema multiforme, Stevens-Johnson syndrome,
epidermal necrolysis, anaphylaxis, nephrotoxicity,
pseudomembranous colitis.
– Dosage: 500mg/tab, 1 tablet BID for 7 days
– SRP: Php 75.00
Discharge Plans: Pharmacologic
• Amlodipine
– MOA: relaxes peripheral and coronary vascular smooth
muscle. It produces coronary vasodilation by inhibiting the
entry of Ca ions into the voltage-sensitive channels of the
vascular smooth muscle and myocardium during
depolarisation. It also increases myocardial O2 delivery in
patients with vasospastic angina.
– AE: Headache, peripheral oedema, fatigue, somnolence,
nausea, abdominal pain, flushing, dyspepsia, palpitations,
dizziness. Rarely pruritus, rash, dyspnoea, asthenia, muscle
cramps. Potentially Fatal: Hypotension, bradycardia,
conductive system delay and CCF.
– Dosage: 10mg/tab, 1 tablet BID
– SRP: Php 22.00
Discharge Plans: Pharmacologic
• Metoprolol
– MOA:Metoprolol selectively inhibits β-adrenergic
receptors but has little or no effect on β2-receptors except
in high doses. It has no membrane-stabilising nor intrinsic
sympathomimetic activity.
– AE:Bradycardia, hypotension, arterial insufficiency, chest
pain, CHF, oedema, palpitation, syncope, gangrene;
dizziness, fatigue, depression, confusion, headache,
insomnia, short-term memory loss, nightmares,
somnolence; pruritus, rash, increased psoriasis, reversible
alopecia, Heart failure, heart block, bronchospasm.
– Dosage: 50mg/tab, 1 tablet BID
– SRP: Php 4.00
Discharge Plans: Pharmacologic
• Erdosteine
– MOA:contains two sulfhydryl groups, which are freed after
metabolic transformation in the liver. The liberated
sulfhydryl groups break the disulphide bonds, which hold
the glycoprotein fibres of mucus together. This makes the
bronchial secretions more fluid and enhances elimination.
– AE:Epigastralgia, nausea, vomiting, loose stools, spasmodic
colitis, headache.
– Dosage: 300mg/cap, 1 capsule BID
– SRP: Php 19.00
Discharge Plans: Pharmacologic
• Ferrous Sulfate + FA
– MOA:Ferrous sulfate facilitates O2 transport via
haemoglobin. It is used as iron source as it replaces iron
found in haemoglobin, myoglobin and other enzymes.
– AE: GI irritation, abdominal pain and cramps, nausea,
vomiting, constipation, diarrhoea, dark stool and
discoloration of urine; heartburn.
– Dosage: 500mg/tablet, 1tablet BID
– SRP: Php 20.00
Discharge Plans: Non-Pharmacologic
• Getting plenty of rest and drinking of lots of fluids
• Active lifestyle (e.g . Daily exercise)
• Preventive measures
– Flu shot —for people at high risk, particularly the
elderly, because pneumonia may be a complication of
the flu
– Pneumococcal vaccine —recommended for:
• People over aged 65, or those who have a chronic
illness, such as diabetes or sickle-cell disease
• Children under two years old
Discharge Plans: Non-Pharmacologic
• Lifestyle interventions:
– Reduction of dietary salt intake (<6g NaCl/day)
– Moderate alcohol consumption
• Men: </= 2 drinks per day
• Women: </= 1 drink per day
– Adapt DASH dietary plan
• Diet high in fruits and low-fat dairy products, reduced
saturated and total fat
– Physical activity
• Regular aerobic activity (e.g. brisk walking for 30
mins/day)
Discharge Plans: Check-up
• Return to UST Hospital for Check-up after 1
week or immediately when condition
worsens.