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3.

3 MEDICATION HISTORIES OF PEPTIC ULCER DISEASE

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Table 3.3a:
CASE NUMBER : 01
PATIENT DEMOGRAPHICS
• NAME ZAFAR ALI
• AGE/GENDER 60Y/M
• ADDRESS BUNIR
DIAGNOSIS: Duodenal ulcer, upper GI bleed (Known case of HCV)
CHIEF PRESCRIBED STANDARD COMPARISON
COMPLIANTS TREATMENT TREATMENT
(Berardi RR,
Welage LS.2005)
Melena, epigastric pain- Hospital treatment Hp-eradication
1week Haemetemasis- Inj octreotide 50mcg then Omeprazole 20 mg BD Omeprazole
one day 10amp,1LD/W@15drops Clarithromycin 500 mg 20mg BD should
Constipation from last per minute twice Daily be given
3days Inf haemaccel I/V stat Amoxicillin 1 g twice
Inj Omeprazole 40mg BD daily
Inj metoclopramide I/V stat Treatment duration is
then OD 10 to 14 days
Syp Lactulose 30ml TDS
Discharge medicine
Clarithromycin 500 mg BD
Cap Omeprazole 40mg BD
Amoxicillin 1g BD
DRUG RELATED PROBLEM FREQUENCY
Dose adjustment and excessive dose reference:
Martin J, Cloase LA, Jordan B et al.,2009
Excessive dose Omeprazole 40mg 1
Dose adjustment Omeprazole 40mg Management: In cirrhotic patient
in hepatic Omeprazole dose should not exceed
impairment 20 mg daily
Drug interaction 1
Reference:
David Omeprazole-clarithromycin
S.Tatro.2004
SIGNIFICANT SEVERITY/ MANAGEMENT
RATING/ONSET DOCUMENTATION
3/delayed Minor/suspected Based on available data no
special action is needed.
Co-administration of theses
agents may be beneficial in
treatment of h pylori
eradication.
Cost related problem (Neshat MQ.2007-08) 4
GENERIC BRANDS MANUFACTURER RETAIL PRICE
Cap Omeprazole Risek (prescribed here) Getz pharma 259Rs
40mg lozal Novartis 200Rs
Omega Ferozsons 180Rs
Inj metoclopramide Maxolon(prescribed here) GSK 118Rs
10mg Metoclon Indus pharma 80Rs
Maxaclor polyfine 50Rs
Syp Lactulose Duphalac (prescribed here) High Noon 148Rs
120ml Lilac Getz pharma 124Rs
Werilax Werrick 93Rs
Cap Klaricid (prescribed here) Abbott 648Rs
Clarithromycin Claritek Getz pharma 370Rs
500 mg Clarion Ferozsons 297Rs

Miscellaneous problems 2
Reference: David S.Tatro.2004
counselling Not done in case of clarithromycin 56
Management: proper counselling for drug
because it has interaction with food(significant intake.
rating2,delayed onset, moderate severity, Give antimicrobial before one hour of meal
suspected documentation) Take with liquids other than grape fruit juice
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Table 3.3b: CASE NUMBER :02
PATIENT DEMOGRAPHICS
• NAME Zubaida
• AGE/GENDER 40/f
• ADDRESS Peshawar
DIAGNOSIS: Peptic ulcer disease/depression
CHIEF COMPLIANTS PRESCRIBED STANDARD COMPARISON
TREATMENT TREATMENT
(Berardi RR,
Welage LS. 2005)
Abd.pain and epigastric Hospital medication Pharmacotherapy
discomfort-15days,sleep Inj ranitidine 50mg I/V Esomeprazole 40 mg given I hospital is
disturbed and sunking of BD(stopped) daily according to
heart Inj ciprofloxacin 200mg I/V Clarithromycin 500 STG(standard
BD(stopped) mg twice Daily treatment
Tab dothiepen HCl25mg Amoxicillin 1 g twice guidelines)
nocte(continue) daily
Inj metoclopramide I/V BD Treatment duration is
Discharge medication 10 to 14 days
Cap amoxicillin 1g BD-14days
Cap Esomeprazole 40mg OD
-1month
Cap clarithromycin 500mg BD
DRUG RELATED PROBLEMS FREQUENCY
Cost related problem (Neshat MQ.2007-08) 5
GENERIC BRANDS MANUFACTURER
Inj ranitidine 2ml ×5’s Zantac(prescribed here) GSK 110Rs
Ranitidine Ferozsons 63Rs
Ranulcid Merck Marker 64Rs
Tab ciprofloxacin 250mg Novidate(prescribed here) Sami 151Rs
Ciproquine Macter 120Rs
Cp zaf Zafa 35Rs
Inj metoclopramide 10mg Maxolon(prescribed here) GSK 118Rs
Metoclon Indus pharma 80Rs
Maxaclor polyfine 50Rs
Esomeprazole 40mg Esso (prescribed here) Shaigan 159Rs
Nexum Getz 323Rs
E-Mepra Akson 130Rs
Cap Clarithromycin 500 mg Klaricid (prescribed here) Abbott 648Rs
Claritek Getz pharma 370Rs
Clarion Ferozsons 297Rs
Miscellaneous problems 1
Reference: David S.Tatro.2004
Counselling in case of quinolone administration no Management: avoid milk intake but if milk can
counselling has been done abt milk intake along with not be avoided lengthen the intake of milk and
ciprofloxacin intake because it has interaction with milk drug as much as possible
of significant rating-2(onset rapid, severity moderate
and suspected documentation)

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Table 3.3c:
CASE NUMBER : 03
PATIENT DEMOGRAPHICS
• NAME M/O SHER AFSER
• AGE/GENDER 50y/female
• ADDRESS Peshawar
DIAGNOSIS Peptic ulcer disease(B&C negative)
CHIEF COMPLIANTS PRESCRIBED TREATMENT STANDARD COMPARISON
TREATMENT
(Berardi RR,
Welage LS.2005)
Hemetemesis-1day Hospital treatment Hp-eradication Pharmacotherapy
Abdominal pain and Inf Omeprazole 40mg I/V OD Omeprazole 20 mg given I hospital is
vomiting, black stool and Inj cefotaxime 1g BD (stopped) BD according to
loss of appetite Inf haemaccel I/V stat Clarithromycin 500
Inj octreotide 100mcg I/V stat mg twice Daily
STG(standard
then 5amp in 1L Amoxicillin 1 g twice treatment
D/saline@15drops per daily guidelines)
min(stopped) Treatment duration is
Inj metoclopramide I/V TDS 10 to 14 days
Tab clarithromycin 500mg BD
Tab amoxicillin 1g 1 OD
Discharge medicine
tab clarithromycin 500mg BD
(14days)
Tab amoxicillin 1g OD(14days)
Tab Omeprazole 40mg
OD(1month)
DRUG RELATED PROBLEM FREQUENCY
Reference: David S.Tatro.2004
Drug interaction Omeprazole-clarithromycin 1
SIGNIFICANT SEVERITY/ MANAGEMENT
RATING/ONSET DOCUMENTATION
3/delayed Minor/suspected Based on available data no special action is
needed.Co-administration of theses agents may be
beneficial in treatment of h pylori eradication.
Cost related problem (Neshat MQ.2007-08) 3
GENERIC BRANDS MANUFACTURER RETAIL PRICE
Cap Omeprazole 40mg Risek (prescribed here) Getz pharma 259Rs
lozal Novartis 200Rs
Omega Ferozsons 180Rs
Inj metoclopramide Maxolon(prescribed here) GSK 118Rs
10mg Metoclon Indus pharma 80Rs
Maxaclor polyfine 50Rs
Cap Clarithromycin Klaricid (prescribed here) Abbott 648Rs
500 mg Claritek Getz pharma 370Rs
Clarion Ferozsons 297Rs
Miscellaneous problems 2
Reference: David S.Tatro.2004
counselling Not done in case of clarithromycin Management: proper counselling for drug intake.
because it has interaction with food(significant Give antimicrobial before one hour of meal
rating2,delayed onset, moderate severity, suspected Take with liquids other than grape fruit juice
documentation)
Non-compliance: refused to pass I/V cannula but Management: pt should be clearly explained 60 about the
however managed. therapy and the hazardous effect of not taking
Non-compliance during EGD proceeding prescribed drug regularly
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Table 3.3d: CASE NUMBER : 04
PATIENT DEMOGRAPHICS
• NAME Zar wali khan
• AGE/GENDER 60y/male
• ADDRESS Deer
DIAGNOSIS: Multiple peptic ulcers(known case of HCV)
CHIEF COMPLIANTS PRESCRIBED TREATMENT STANDARD COMPARISON
TREATMENT
(Berardi RR,
Welage
LS.2005)
Melena-3days Hospital treatment Hp-eradication
Hemetemesis-1day Inf haemaccel 1000cc I/V STAT Omeprazole 20 Omeprazole
Abd pain-3days Inf Omeprazole 40mg TDS mg BD 20mg BD should
Syp Sucralfate 2TSF TDS Clarithromycin be given to
Inj metoclopramide I/V BD 500 mg twice patient (in
Tab clarithromycin 500mg Daily hepatic
1×BD Amoxicillin 1 g impairment dose
Tab amoxicillin 1g 1× BD twice daily of Omeprazole
Inj vit K 10mg I/V OD Treatment should not
Discharge medicine duration is 10 to exceed 20mg)
Syp Lactulose 2TSF (continue) 14 days
Clarithromycin 500mg 1×BD-
14days
Tab amoxicillin 1g 1× BD-
14days
Omeprazole 40mg 1× OD
DRUG RELATED PROBLEM FREQUENCY
Dose adjustment and excessive dose reference:
Martin J, Cloase LA, Jordan B et al.,2009
Excessive dose Omeprazole 20mg should be given 1
Dose adjustment in Omeprazole40mg In cirrhotic patient 1
hepatic impairment Omeprazole dose
should not exceed 20
mg daily
Drug interaction Omeprazole-clarithromycin 1
David S.Tatro.2004
SIGNIFICANT SEVERITY/ MANAGEMENT
RATING/ONSET DOCUMENTATION Based on available data no special action is
3/delayed Minor/suspected needed. Co-administration of theses agents
may be beneficial in treatment of h pylori
eradication.
Cost related problem (Neshat MQ. 2007-08)
GENERIC BRANDS MANUFACTURER RETAIL PRICE
Cap Omeprazole 40mg Risek (prescribed here) Getz pharma 259Rs
lozal Novartis 200Rs
Omega Ferozsons 180Rs
Inj metoclopramide 10mg Maxolon(prescribed here) GSK 118Rs
Metoclon Indus pharma 80Rs
Maxaclor polyfine 50Rs
Cap Clarithromycin 500 Klaricid (prescribed here) Abbott 648Rs
mg Claritek Getz pharma 370Rs
Clarion Ferozsons 297Rs
Miscellaneous problems (Reference: David S.Tatro.2004) 1
counselling Not done in case of clarithromycin because it Management: proper counselling for
has interaction with food(significant rating2,delayed drug intake.
onset, moderate severity, suspected documentation) Give antimicrobial before one hour of
proper monitoring of LFT’s required in cirrhotic patient meal 63
that is not done Take with liquids other than grape fruit
juice
Regular check up of LFT’s should be
done in order to check the progress.
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Table 3.3e:
CASE NUMBER : 05
PATIENT DEMOGRAPHICS
• NAME Zahid khan
• AGE/GENDER 40y/male
• ADDRESS Malakand
DIAGNOSIS: PUD NSAID induced (HCV cirrhotic)
CHIEF PRESCRIBED STANDARD COMPARISO
COMPLIANTS TREATMENT TREATMENT N
(Berardi RR,
Welage LS.
2005)
Abdominal pain –last Hospital treatment
10days Tab spironolactone 100mg Esomeprazole in cirrhotic
Anorexia OD(continue) 40 mg daily patient dose of
Vomiting Tab Domperidone TDS Stop the NSAID Omeprazole
before meal Use
(chronic user of should not
Inj Ranitidine 50mg I/V
NSAID) exceed 20mg
BD(stopped)
daily
Syp Lactulose 30m 2TSF
TDS
Tab frusemide 20mg 1× BD
Discharge medicine
Tab Esomeprazole 40mg
1OD(one month)
Syp cyproheptadine 2TSF
TDS
tab propranolol 10mg
TDS(continue)
DRUG RELATED PROBLEM FREQUENCY
Dose adjustment and excessive dose reference:
Martin J, Cloase LA, Jordan B et al.,2009
Excessive dose Esomeprazole should not exceed 20mg daily 1
Dose adjustment in Esomeprazole Management: In cirrhotic
hepatic impairment 40mg patient Esomeprazole dose
should not exceed 20 mg
daily
Cost related problem (Neshat MQ.2007-08) 2
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

65
Table 3.3 f: CASE NUMBER : 06
PATIENT DEMOGRAPHICS
• NAME Khawar Ali
• AGE/GENDER 47y/male
• ADDRESS Peshawar
DIAGNOSIS: PUD(NSAID induced)
CHIEF PRESCRIBED TREATMENT STANDARD COMPARISON
COMPLIANTS TREATMENT
(Berardi RR,
Welage
LS.2005)
Abdominal distention Hospital treatment
&discomfort -1week Inj Omeprazole 40mg 1 OD Omeprazole 20 Pharmacotherapy
Vomiting -2days Inj metoclopramide I/V STAT mg BD given I hospital is
Constipation-few days then OD according to
(chronic use of Syp Lactulose 30ml 2TSF TDS
NSAIDs for joint Dexamethasone topical ointment
STG(standard
pain) Multivitamins treatment
Inf ciprofloxacin 100mg I/V guidelines)
BD(stopped)
Tab Allupurinol 300mg BD
(stopped)
Discharge medicine
Tab Omeprazole 20mg
BD(14days)
DRUG RELATED PROBLEM FREQUENCY
Improper drug Allupurinol was prescribed for joint pain that is not 1
selection the right choice because it is indicated for gout.
Management: Nimusilde or Celecoxib is the drug
of choice for joint pain.
Cost related problem (Neshat MQ.2007-08) 4
GENERIC BRANDS MANUFACTURER RETAIL PRICE
Cap Omeprazole 40mg Risek (prescribed here) Getz pharma 259Rs
lozal Novartis 200Rs
Omega Ferozsons 180Rs
Inj metoclopramide 10mg Maxolon(prescribed here) GSK 118Rs
Metoclon Indus pharma 80Rs
Maxaclor polyfine 50Rs
Syp Lactulose 120ml Duphalac (prescribed High Noon 148Rs
here) Getz pharma 124R s
Lilac Werrick 93Rs
Werilax
Tab ciprofloxacin 250mg Novidate(prescribed here) Sami 151Rs
Ciproquine Macter 120Rs
Cp zaf Zafa 35Rs
Miscellaneous problems 1
Reference: David S.Tatro.2004
Counselling in case of quinolone administration no Management: avoid milk intake but if milk
counselling has been done abt milk intake along with can not be avoided lengthen the intake of
ciprofloxacin intake because it has interaction with milk and drug as much as possible
milk of significant rating-2(onset rapid, severity
moderate and suspected documentation)

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