Patient Demographics Name : Mrs. L Gender : Female Race : Chinese Age : 45 years old Weight : 60 kg Height : 160 cm Body Mass Index (BMI) : 23.44 (pre-obese) Chief Complaint/Presenting Complaint I have rashes on my leg, around my thigh areas and at my feet. History of Presenting Complaint She says that it is very itchy. She scratches until there are minor wounds. There are patches of redness on the itchy areas. The redness and itchiness subside after a few days but a relapse occurs. Past Medical History Rhinitis Past Medications Rhinocort aqua (budenoside) 64mcg Dosage : 2 puffs into each nostril in the morning OR 1 puff into each nostril twice daily Family History & Social History Family History : Mother has eczema. Social History : Married with two children. Physical Examinations & Other Relevant Findings Weight : 60 kg Non-fasting blood glucose level : 8.0mmol/L (Target control : 4.4-8.0mmol/L)
Present Medical Conditions Eczema based on the factors and symptoms below : - rashes on the leg, thigh areas and at the feet - history of rhinitis Present Medications Glucophage 850mg (metformin hydrochloride) Dosage : 1 tablet (850mg) twice daily Current Problems & Medications Problems Medications Eczema Diabetes Glucophage 850mg List of Drug Related Problems Needs additional drug therapy : No medication is taken for eczema Inappropriate compliance : Lack of compliance to lifestyle modification + oral anti-diabetic agent (OAD) therapy Need for monitoring Desired Therapeutic Outcomes Medical Condition Desired Therapeutic Outcomes Eczema To treat eczema by controlling itching, reduce skin inflammation (redness and swelling) and reduce new lesions from forming. Diabetes To arrest disease progression of diabetes. To reduce risk of diabetes complications such as retinopathy, nephropathy, neuropathy, coronary heard disease (CHD), diabetic foot, erectile dysfunction (ED). Pharmaceutical Issues & Plans Medical condition : Eczema Medications : Corticosteroid (Elomet cream 0.1%) + Antihistamine (Zyrtec 10mg)
Indication Relief of the inflammatory & pruritic manifestations How to use Apply twice daily Preferrably after morning shower & before sleep Keynotes
Continue to apply for 48 hours after symptoms subside Indication Symptomatic treatment Of allergic origin How to take 1 tablet (10mg) Twice daily Keynotes Non-sedating Can be taken in combination with Rhinocort aqua mometasone furoate cetirizine dihydrochloride
Possible dietary supplements : Probiotics boost the immune system and control allergies Borage oil anti-inflammatory and reduce eczema symptoms Evening primrose oil reduce itching of eczema Patient Counselling Points Identify trigger factors for eczema and avoid these triggers. Possible trigger factors : Possible trigger factors Soap & detergents Inhaled/ contact allergens Food allergy Stress Non- pharmacological intervention Mild soap & moisturizer Short, warm showers Avoid/reduce food causes allergy Exercise Current Problems & Medications Problems Medications Eczema Diabetes Glucophage 850mg List of Drug Related Problems Needs additional drug therapy : No medication is taken for eczema Inappropriate compliance : Lack of compliance to lifestyle modification + oral anti-diabetic agent (OAD) therapy Need for monitoring Desired Therapeutic Outcomes Medical Condition Desired Therapeutic Outcomes Eczema To treat eczema by controlling itching, reduce skin inflammation (redness and swelling) and reduce new lesions from forming. Diabetes To arrest disease progression of diabetes. To reduce risk of diabetes complications such as retinopathy, nephropathy, neuropathy, coronary heard disease (CHD), diabetic foot, erectile dysfunction (ED). Pharmaceutical Issues & Plan Medical condition : Diabetes Medication : Continue on with Glucophage 850mg. Patients value : 8.0mmol/L Exercise at least 150mins/week
High fibre diet Balanced diet : 50- 60% carbohydrate, 15-20% protein, 25-30% fats Total carbohydrate intake Regular meal timings Medication : 15-30 min after food
Lifestyle Modification Pharmaceutical Issues & Plan - Pre-obese Patients value : 23.44 (pre-obese) In obese patients with diabetes, a weight loss of 5 10% of initial body weight improves insulin sensitivity, reduces blood pressure and improves dyslipidaemia. The optimal rate of weight loss : 1 2 kg/month.
Monitoring Plan SBGM = Self Blood Glucose Monitoring Self-care : Blood glucose monitoring Keeping a log of your test results is vital. It will give a good picture of your body's response to your diabetes care plan. Hence, changes can be done by you and your doctor to achieve effective treatment. The warning signs of trouble: Vision problems (blurriness, spots). Tiredness or pale skin colour. Obesity (more than 20 pounds overweight). Numbness or tingling feelings in hands or feet. Repeated infections or slow healing of wounds. Chest pain. Vaginal itching. Constant headaches (This may be a symptom of high blood pressure.) References American Academy of Dermatology. How Is Eczema Diagnosed and Treated? [Online]. Available at : http://www.webmd.com/skin-problems-and-treatments/eczema/understanding-eczema-treatment [Accessed : 21 April 2014]. American Academy of Dermatology. Atopic dermatitis: Diagnosis, treatment, and outcome [Online]. Available at : http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/a---d/atopic-dermatitis/diagnosis-treatment [Accessed : 21 April 2014]. Astrazeneca. Rhinocort Aqua [Online]. Available at : http://www1.astrazeneca-us.com/pi/Rhinocort_Aqua.pdf [Accessed : 21 April 2014] Drugs.com. Mometasone cream [Online]. Available at : http://www.drugs.com/pro/mometasone-cream.html [Accessed : 21 April 2014]. Datapharm Communications Ltd. Cetirizine 10mg Film-coated Tablets [Online]. Available at : https://www.medicines.org.uk/EMC/medicine/26858/PIL/Cetirizine+10+mg+Film-Coated+Tablets/ [Accessed : 21 April 2014]. National Jewish Health. Atopic Dermatitis or Eczema [Online]. Available at : http://health.usnews.com/health-conditions/allergy-asthma-respiratory/atopic- dermatitis-or-eczema/treatment [Accessed : 21 April 2014] NHS choices. Rhinitis, allergic-Treatment [Online]. Available at : http://www.nhs.uk/Conditions/Rhinitis---allergic/Pages/Treatment.aspx [Accessed : 21 April 2014]. NHS choices. Side effects of corticosteroids [Online]. Available at : http://www.nhs.uk/Conditions/Corticosteroid-%28drugs%29/Pages/Sideeffects.aspx [Accessed : 21 April 2014] Univeristy of Maryland Medical Center. Eczema [Online]. Available at : http://umm.edu/health/medical/altmed/condition/eczema [Accessed : 21 April 2014]
Drugs in use : clinical case studies for pharmacists / edited by Linda J. Dodds. London : Pharmaceutical Press, c2010. Mims Malaysia Clinical Practice Guidelines www.acamed.org.my