Case study

Drug allergy
By..

Patient profile
61 75
CC:
2
PI:
4 day PTA
diclofenac,
paracetamol, serratiopeptidase, tolperisone,
omeprazole
3 day PTA , ,

Patient profile
PE:

U/D:
FH:

BP 141/106 mmHg, BT 36.5 C, PR 103/min, RR 20/min

Papule 0.3 cm distribute at both cheeks, no angioedema,
multiple small papule at back and limbs
Lung: clear
Heart, Addomen: normal
Primary hypertension
DM

Patient profile
Med-PTA:
Diclofenac 25 mg 1x3 pc
Paracetamol 500 mg 1 tab prn q 4 hr
Serratiopeptidase 5 mg 1x3 pc
Tolperisone 50 mg 1x3 pc
Omeprazole 20 mg 1x1 ac
BALM analgesic cream apply prn

Patient profile
Imp: R/O drug allergy
Home medication:
Chlorpheniramine maleate 4 mg 1x3 pc
Calamine cream apply prn

Patient profile

19/7/54
1-2
22/7/54

Patient profile

10-20


paracetamol

Problem lists
Drug allergy
Primary hypertension

SOAP
Drug Allergy
(22/7/2554)

Subjective data
61 75
CC:
2
PI:
4 day PTA
diclofenac,
paracetamol, serratiopeptidase, tolperisone,
omeprazole
3 day PTA , ,

Objective data
PE:

Papule 0.3 cm distribute at both cheeks,

no angioedema, multiple small papule at back and limbs
Lung: clear
Heart, Addomen: normal

Objective data
Med-PTA:
Diclofenac 25 mg 1x3 pc
Paracetamol 500 mg 1 tab prn q 4 hr
Serratiopeptidase 5 mg 1x3 pc
Tolperisone 50 mg 1x3 pc
Omeprazole 20 mg 1x1 ac
BALM analgesic cream apply prn

Objective data
Imp: R/O drug allergy
Home medication:
Chlorpheniramine maleate 4 mg 1x3 pc
Calamine cream apply prn

Assessment
Etiology
Drug allergy
Drug allergy
Type B

Assessment
Etiology
Drug allergy
1-2 antibodies lymphocyte
(sensitized lymphocyte)
antibodies sensitized
lymphocyte
antibodies sensitized lymphocyte

Assessment

19/7/54
1-2

22/7/54

Assessment

10-20


paracetamol

Time line

4/7/54
Paracetamol 500 mg 1 tab prn q 4 hr

Diclofenac
Omeprazole
Amlodipine
Simvastatin
Aspirin
Serratiopeptidase
Tolperisone

Amlodipine 5 mg 1x1 pc
Simvastatin 40 mg 1xhs
Aspirin 81 mg 1x1 pc

21/7/54

Amoxicillin 500 mg 1x3 pc

CPM 4 mg 1x3 pc
Dextromethorphan 15 mg 1x3 pc

20/6/54

19/7/54

Diclofenac 25 mg 1x3 pc

Diclofenac 25 mg 1x3 pc

Omeprazole 20 mg 1x1 ac

Omeprazole 20 mg 1x1 ac

Paracetamol 500 mg 1 tab prn q 4 hr

Paracetamol 500 mg 1 tab prn q 4 hr

Dimenhydrinate 50 mg 1 tab prn q 8 hr

Serratiopeptidase 5 mg 1x3 pc

Analgesic cream

Tolperisone 50 mg 1x3 pc

Assessment
Etiology
Type III (immune complex)
antibody
antibody antibody
antigen-antibody complex
complement
1-3 ( Diclofenac, Omeprazole, Amlodipine,
Aspirin simvastatin) Tolperisone, Serraatiopeptidase
1-2
non-immunological type mast cells
histamine

Diclofenac, Omeprazole, Amlodipine, Aspirin,

Simvastatin, serratiopeptidase, tolperisone

Assessment
Etiology

Diclofenac, Omeprazole, Amlodipine, Aspirin

simvastatin, Tolperisone, Serraatiopeptidase
Amlodipine, Aspirin simvastatin 17
antibodies sensitized lymphocyte

omeprazole 32

Assessment
Etiology
diclofenac antibodies
sensitized lymphocyte

diclofenac 1-2
paracetamol,
CPM, dextromethorphan, dimenhydrinate
amoxicillin 6-7
penicillins
10-14

Assessment

Drug
Diclofenac

Omeprazole
Amlodipine

Rash
- = 3

Face edema
- = 1

- = 40

- = 21

- = 40

- = 14

- = 83
- = 2

- = 36

face edema

- = 2

rash

- = 1
- = 1

Spontaneous Report of Adverse Drug

Reaction 2001

Assessment
Drug
Aspirin

Rash
- = 1

Face edema
- = 3

- = 5

- = 2

- = 7

- = 5

Simvastatin

- = 13
rash

Tolperisone

- = 3

face
edema
- = 8

- = 20

- = 5

- = 16

- = 13

Serratiopeptidase

- = 34
- = 20
- = 16

face
edema

- = 34
Spontaneous Report of Adverse Drug Reaction 2001

Naranjo's algorithm

Assessment

1.

2.

3.

(specific antagonist)
4.

5.
()

+1

Diclofenac
Omeprazole
Amlodipine
Aspirin
Serratio peptisase
Tolperisone
+1

+2

-1

+2

+2

+1

+1

+1

+2

-1

-1

+2

-1

-1

Simvastatin

Naranjo's algorithm

Assessment

6.

7.
()

-1

+1

Diclofenac
Omeprazole
Amlodipine
Aspirin
serratio peptisase
Tolperisone
0

+1

+1

+1

+1

+1

+1

8.

9.


10.
(objective
evidence)

Simvastatin

Assessment

:
9
5-8
1-4
0

(certain)
(probable)
(possible)
(unlikely)

Diclofenac, Omeprazole, Amlodipine, Aspirin,

Serratiopeptidase, Tolperisone = 4 (Possible)
Simvastatin = 3 (Possible)

Assessment
Assessment if therapy is indicated



supportive
treatment

Assessment
Assessment of current therapy :
Drug Allergy
1. Specific treatment

2. Supportive & symptomatic treatment

antihistamine, corticosteroid

Diclofenac, Omeprazole, Amlodipine, Aspirin
Simvastatin, Tolperisone, Serratiopeptidase CPM
4 mg 1x3 pc calamide cream apply prn

Plan
Goal

Therapeutic

Chlorpheniramine maleate 4 mg 1x3 pc
Calamine cream apply prn

Plan
Therapeutic monitoring parameter

Patient education

Plan
Future plan
NSAIDs
diclofenac aspirin
COX-1 inhibitors

Thank you