CHAPTER 3

MEDICATION HISTORIES

3.1 Medication Histories of Cirrhosis

3.2 Medication Histories of Ascites
3.3 Medication Histories of Peptic Ulcer
Disease

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3.1 MEDICATION HISTORIES OF CIRRHOSIS

Table 3.1a:
CASE NUMBER : 01
PATIENT DEMOGRAPHICS
 NAME Ahmed saeed
 AGE/GENDER 55y/male
 ADDRESS Dir
DIAGNOSIS: Cirrhosis(HBV ascites)
CHIEF COMPLIANTS PRESCRIBED TREATMENT STANDARD COMPARISON
TREATMENT
Garcia-Tsao G, Lim
Joseph.,2009
Melena Hospital treatment Small varices
Abdominal distention Inj octreotide 1amp I/V STAT then Start propranolol (20 mg Pharmaco-
Anorexia 5MP in 1000cc D/W at 15 drops b.i.d. therapy given I
Nausea Inj cefotaxime 1gm I/V TDS(ATD) spontaneous bacterial hospital is
Inj Omeprazole 40mg I/V STAT peritonitis (SBP)
then OD Cefotaxime (2 g i.v.
according to
Inj metoclopramide I/V TDS every 12 h) STG(standard
Inj Vit k I/V OD (3days) Ascites treatment
Syp Lactulose 30ml TDS(continue) Spironolactone guidelines)
alone
Paracentesis (start at 50 – 100 mg q.d.,
Inf haemaccel 500cc I/V STAT single morning dose)
Discharge medicine Or Spironolactone (50 –
Tab spiromide(spironolactone- 100 mg q.d.) + frusemide
frusemide)20mg OD for 2 weeks (start at 20 – 40 mg q.d.,
Tab propranolol 10mg TDS single morning dose
DRUG RELATED PROBLEM FREQUENCY
Untreated condition 1
Random blood sugar is above 140mg/dL so it should be checked for continuous 2 days for the probability of
diabetes
Dose adjustment and excessive dose reference: Martin J, Cloase LA, Jordan B et al.,2009
Excessive dose Omeprazole-40mg Management: in cirrhotic patient 1
dose should not exceed 20mg daily
Dose adjustment in Omeprazole Management: Omeprazole dose 1
hepatic impairment should not exceed 20mg daily

Cost related problem (Neshat MQ.2007) 3

GENERIC BRANDS MANUFACTURER RETAIL PRICE
Inj Cefotaxime 1gm By generic(prescribed here) Novartis 218Rs
Cefax Mass pharma 145Rs
Cefatax Bosch 150Rs
Inj metoclopramide 10mg Maxolon(prescribed here) GSK 118Rs
Metoclon Indus pharma 80Rs
Maxaclor polyfine 50Rs
Syp Lactulose 120ml Duphalac (prescribed here) High Noon 148Rs
Lilac Getz pharma 124Rs
Werilax Werrick 93Rs

40
Table 3.1b
CASE NUMBER : 02

PATIENT DEMOGRAPHICS
 NAME Dilawar khan
 AGE/GENDER 57y/male
 ADDRESS Peshawar
DIAGNOSIS: Cirrhosis(HCV UGI bleed)
CHIEF PRESCRIBED STANDARD TREATMENT COMPARISON
COMPLIANTS TREATMENT (Garcia-Tsao G, Lim
Joseph.,2009)
Melena Hospital treatment Acute variceal hemorrhage
Haemetemasis Inj octreotide 1amp I/V Pharmacological therapy initiated Octreotide
(HCV cirrhosis from 8 STAT then 5MP in as soon as diagnosis is suspected therapy for 3-5
years) 1000cc D/W at 15 drops Octreotide 50 mcg i.v. bolus days not
for 72 hrs followed by continuous infusion 50 maintains
Inj ranitidine 50mg I/V mcg / h (3 – 5 days) because of
BD Small varices economical
Inj cefotaxime 1gm I/V Start propranolol (20 mg b.i.d. condition
TDS(ATD) spontaneous bacterial peritonitis
Syp Lactulose 30ml (SBP)
TDS(continue) Cefotaxime (2 g i.v. every 12 h)
Therapeutic Ascites
Paracentesis Spironolactone alone (start at 50 –
Inf haemaccel 500cc 100 mg q.d., single morning dose)
I/V STAT Or Spironolactone (50 – 100 mg
Discharge medicine q.d.) + frusemide (start at 20 – 40
Tab spironolactone mg q.d., single morning dose
100mg OD
Tab propranolol 10mg
TDS
DRUG RELATED PROBLEM FREQUENCY
Cost related problem (Neshat MQ.2007-08) 3
GENERIC BRANDS MANUFACTURER RETAIL PRICE
Inj ranitidine 2ml ×5’s Zantac(prescribed here) GSK 110Rs
Ranitidine Ferozsons 63Rs
Ranulcid Merck Marker 64Rs
Syp Lactulose 120ml Lilac(prescribed here) Getz pharma 124R s
Duphalac High Noon 148Rs
Werilax Werrick 93Rs
Inj Cefotaxime 1gm By generic(prescribed here) Novartis 218Rs
Cefax Mass pharma 145Rs
Cefatax Bosch 150Rs

41
Table 3.1c:
CASE NUMBER : 03
PATIENT DEMOGRAPHICS
 NAME Shabana
 AGE/GENDER 60y/female
 ADDRESS Peshawar
DIAGNOSIS: Cirrhosis(HCV ,CLD tense ascites)
CHIEF COMPLIANTS PRESCRIBED STANDARD COMPARISON
TREATMENT TREATMENT
Garcia-Tsao G, Lim
Joseph.,2009
Abdominal distention from Hospital treatment spontaneous bacterial
2 days Inj cefotaxime 1gm I/V peritonitis (SBP) Pharmacothera
Pain in abdomen from 2 TDS(ATD) Cefotaxime (2 g i.v. py given I
days Syp Lactulose 30ml every 12 h) hospital is
(known case of HCV & TDS(continue) Ascites
CLD) Inj insulin 70/30 S/C Spironolactone alone
according to
known case of diabetes Tab spironolactone 100mg (start at 50 – 100 mg q.d., STG(standard
and bronchial asthma 2OD single morning dose) treatment
Tab frusemide 40mg 2OD Or Spironolactone (50 – guidelines)
Salbutamol nebulization 1cc 100 mg q.d.) + frusemide
TDS (start at 20 – 40 mg q.d.,
Beclomethasone dipropionate single morning dose
nebulization 1cc BD
Therapeutic Paracentesis
Inf haemaccel 500cc I/V STAT
Tab co-amoxiclav 1g BD
Discharge medicine
Tab spironolactone 100mg OD
Tab frusemide 40mg 2OD
Beclomethasone dipropionate
nebulization 1cc BD
Tab co-amoxiclav 1g BD
DRUG RELATED PROBLEM FREQUENCY
Cost related problem (Neshat MQ:.2007-08) 3
GENERIC BRANDS MANUFACTUR RETAIL PRICE
ER
Inj Cefotaxime 1gm By generic(prescribed here) Novartis 218Rs
Cefax Mass pharma 145Rs
Cefatax Bosch 150Rs
Inj insulin 70/30 Humulin 70/30(prescribed here) Eli Lilly 406Rs
Zensulin 70/30 Zafa 310Rs
Syp Lactulose 120ml Lilac(prescribed here) Getz pharma 124R s
Duphalac High Noon 148Rs
Werilax Werrick 93Rs

42
Table 3.1d:
CASE NUMBER : 04
PATIENT DEMOGRAPHICS
 NAME Malik jamshaid
 AGE/GEND 60y/male
ER
 ADDRESS Peshawar
DIAGNOSIS: Cirrhosis(B &C negative,PSE-2)
CHIEF PRESCRIBED STANDARD TREATMENT COMPARISON
COMPLIANTS TREATMENT (Garcia-Tsao G, Lim Joseph et
all.,2009)
Unconscious Hospital treatment hepatic encephalopathy (HE)
PSE-2 Inj ranitidine 50mg I/V BD Lactulose dosage that produces Pharmacotherapy
Known case of Inj cefotaxime 1gm I/V 2 – 3 soft, formed bowel given I hospital is
cirrhosis TDS(ATD) movements per day according to
Syp Lactulose 30ml spontaneous bacterial
TDS(continue) peritonitis (SBP)
STG(standard
Discharge medicine Cefotaxime (2 g i.v. every 12 h) treatment
Tab Ascites guidelines)
spiromide(spironolactone- Spironolactone alone (start at 50
frusemide)20mg 1 OD – 100 mg q.d., single morning
Tab propranolol 10mgTDS dose)
Or Spironolactone (50 – 100 mg
q.d.) + frusemide (start at 20 –
40 mg q.d., single morning dose
DRUG RELATED PROBLEM FREQUENCY
Cost related problem (Neshat MQ. 2007-08) 3
GENERIC BRANDS MANUFACTURER RETAIL PRICE
Inj ranitidine 2ml Zantac(prescribed here) GSK 110Rs
×5’s Ranitidine Ferozsons 63Rs
Ranulcid Merck Marker 64Rs
Inj Cefotaxime 1gm Claforan(prescribed here) Sanfi Aventis 240Rs
By generic Novartis 218Rs
Cefax Mass pharma 145Rs
Cefatax Bosch 150Rs
Syp Lactulose 120ml Duphalac (prescribed here) High Noon 148Rs
Lilac Getz pharma 124R s
Werilax Werrick 93Rs

43
Table 3.1e:
CASE NUMBER : 05
PATIENT DEMOGRAPHICS
 NAME Farooq shah
 AGE/GENDE 55y/male
R
 ADDRESS Peshawar
DIAGNOSIS: Cirrhosis(HBV,CLD)
CHIEF PRESCRIBED STANDARD COMPARISON
COMPLIANTS TREATMENT TREATMENT
(Garcia-Tsao G, Lim
Joseph et all.,2009)
Constipation-3days Hospital treatment hepatic encephalopathy
Altered conciousness- Inj ceftriaxone 1gm I/V (HE) Pharmaco-
3days BD(ATD) Lactulose dosage that therapy given I
Known case of cirrhosis Syp Lactulose 30ml produces 2 – 3 soft, formed hospital is
TDS(continue) bowel movements per day
Syp metronidazole 1TSF TDS spontaneous bacterial
according to
Inj vit K I/V OD-3days peritonitis (SBP) STG(standard
catheterization Ceftriaxone (2 g every 24 h) treatment
Inj ca-gluconate Small varices guidelines)
Discharge medicine Start propranolol (20 mg
Tab propranolol 10mgTDS b.i.d.

DRUG RELATED PROBLEM FREQUENCY

Untreated condition 2
Hb is very low (5.9 but no measurement is taken. Management
Pt. is in unconscious state and suspension is given hemotonics should be given
to relieve constipation enema should be prescribe to the patient for constipation
Dose adjustment in hepatic impairment(Martin J, Cloase LA, Jordan B et al., 2009) 1
Metronidazole Management: In severe liver disease reduce dose to one third and give
once daily
Improper route of administration Lactulose Syp enema should be prescribe 1
Cost related problem (Neshat MQ.2007-08) 2
GENERIC BRANDS MANUFACTURER RETAIL PRICE
Inj ceftriaxone 1gm Rocephin Rosche 477Rs
Cefxone Bosch 180Rs
Titan Macter 144Rs
Syp Lactulose 120ml Duphalac (prescribed here) High Noon 148Rs
Lilac Getz pharma 124R s
Werilax Werrick 93Rs

44
Table 3.1f:
CASE NUMBER : 06
PATIENT DEMOGRAPHICS
 NAME Hamida
 AGE/GENDE 40y/female
R
 ADDRESS Swabi
DIAGNOSIS: Cirrhosis(HCV,UGI bleed)
CHIEF PRESCRIBED TREATMENT STANDARD COMPARISON
COMPLIANTS TREATMENT
(Garcia-Tsao G, Lim
Joseph et al.,2009)
Haemetemasis Hospital treatment hepatic encephalopathy
Melena Inj metoclopramide I/V SOS (HE) Pharmacotherap
Known case of HCV Inj Esomeprazole 40mg I/V OD Lactulose dosage that y given I
Decompensated Inj ceftriaxone 1gm I/V produces 2 – 3 soft, hospital is
cirrhosis BD(ATD) formed bowel movements
Inf haemaccel I/V STAT per day
according to
Inj octreotide 1amp I/V STAT spontaneous bacterial STG(standard
then 5amp in 1000ml D/water for peritonitis (SBP) treatment
72 hours Ceftriaxone (2 g every 24 guidelines)
Syp Lactulose 30ml h)
TDS(continue) Small varices
Syp Sucralfate 2TSF BD Start propranolol (20 mg
Discharge medicine b.i.d)
Tab propranolol 10mg TDS Ascites
Tab spironolactone 100mg 1 OD Spironolactone alone (start
at 50 – 100 mg q.d., single
morning dose)
DRUG RELATED PROBLEM FREQUENCY
Reference of excessive dose & dose adjustment: 1
Martin J, Cloase LA, Jordan B et al.,2009
Excessive dose
Esomeprazol Management : In cirrhotic patient Esomeprazole dose should not exceed
e 40mg 20 mg daily
Dose adjustment in hepatic impairment 1
Esomeprazole Esomeprazole dose should not exceed 20 mg daily
Cost related problem (Neshat MQ.2007-08) 3
GENERIC BRANDS MANUFACTURER RETAIL PRICE
Inj metoclopramide Maxolon(prescribed here) GSK 118Rs
10mg Metoclon Indus pharma 80Rs
Maxaclor polyfine 50Rs
Esomeprazole 40mg Esso (prescribed here) Shaigan 159Rs
Nexum Getz 323Rs
E-Mepra Akson 130Rs
Syp Lactulose 120ml Lilac(prescribed here) Getz pharma 124R s
Werilax Werrick 93Rs

45
Table 3.1g:
CASE NUMBER : 07
PATIENT DEMOGRAPHICS
 NAME Jannat Gul
 AGE/GENDE 22y/female
R
 ADDRESS Afghanistan
DIAGNOSIS: Cirrhotic(B &C negative, PSE 2 band ligation)
CHIEF PRESCRIBED STANDARD COMPARISON
COMPLIANTS TREATMENT TREATMENT
(Garcia-Tsao G, Lim
Joseph et al.,2009)
Altered state of Hospital treatment Small varices
consciousness from last Inj cefotaxime 1gm I/V Start propranolol (20 mg Pharmacotherapy
3 days TDS(ATD) b.i.d. given I hospital is
Abdominal distention Syp Lactulose 30ml Spontaneous bacterial according to
Constipation from last TDS(continue) peritonitis (SBP)
few days Lactulose enema STAT then Cefotaxime (2 g i.v. every
STG(standard
OD 12 h) treatment
Inf dextrose/water 5% I/V Ascites guidelines)
STAT then OD Spironolactone (50 – 100
Inj vit K 10mg OD mg q.d.) + frusemide (start
Inj metoclopramide IV SOS at 20 – 40 mg q.d., single
Discharge medicine morning dose
Tab spironolactone 100mg 1 Hepatic encephalopathy
OD (HE)
Tab frusemide 40mg 1 OD Lactulose dosage that
tab propranolol 10mg produces 2 – 3 soft,
TDS(continue) formed bowel movements
per day
DRUG RELATED PROBLEM FREQUENCY
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
Cefatax Bosch 150Rs
Syp Lactulose 120ml Duphalac (prescribed here) High Noon 148Rs
Lilac Getz pharma 124R s
Werilax Werrick 93Rs
Inj metoclopramide Maxolon(prescribed here) GSK 118Rs
10mg Metoclon Indus pharma 80Rs
Maxaclor polyfine 50Rs

46