PHARMACEUTICA

L
CARE CASES
By Musonda .K. Daka
Department of Pharmacy
School of Health Sciences
University of Zambia

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Case 1
• Mr. James Banda (61 years) is admitted to the
emergence assessment unit at his local
hospital complaining of palpitations,
breathlessness and dizziness. He has a 5 day
history of some dizziness and palpitations. In
the last 24 hours he complained additionally
of shortness of breath. He collapsed at home
and was admitted to hospital via the
emergency department.

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• He experienced similar symptoms two
months ago but did not seek medical advice
at that time and seemed to recover quickly.
On examination and review by the admitting
doctor the following information is obtained:
Previous Medical History
• Hypertension (diagnosed 5 years ago), no
previous history of cardiovascular disease.
The patient is a regular smoker (> 20 per
day) and drinks 20 units of alcohol per week

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Drug History
• No known history allergies. Mr James had been
prescribed Lisinopril tablets 20mg once daily
but was poorly compliant with treatment
Signs and Symptoms on examination
• Blood Pressure 100/70 mmHg
• Heart rate 175 bpm, irregular
• Respiratory rate 25 breaths per minute
• No basal crackles in the lungs
Diagnosis
• Atrial Fibrillation
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Relevant test results
• Full blood count, liver function tests,
electrolytes and renal function were all normal
at admission and through out the admission to
discharge
Mr James is subsequently transferred to the
cardiology ward where his continuing atrial
fibrillation is later confirmed as persistent atrial
fibrillation. As the ward clinical pharmacist, you
are responsible for daily review of drug charts and
advice to medical and nursing staff on all aspects
of drug treatment for patients on the ward

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Case 2
•Mrs. Chanda Mulenga (39 years) has been referred
from George Clinic to Lusaka Teaching Hospital for
further management of a persistent headache 7/7
and episodes of irrelevant speech the past 1 week.
•On arrival at the hospital the presenting complaints
were similar
• Furthermore, she complained of pain around the
neck
•On admission the temperature was 38.1 degrees
celcius, BP 110/60 mmHg and the weight was 56kg.
•At home before admission she was on paracetamol
which she bought from a chemist

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On examination by the admitting doctor the
following information is obtained:
Previous Medical History
• Pulmonary TB (diagnosed 1 month ago)
The patient does not smoke, but drinks
occasionally
No history of diabetes, hypertension, epilepsy
and asthma
Drug History
• Mrs. Mulenga is currently on 4FDCs (3 tablets
once a day)
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Signs and Symptoms on examination
• Neck stiffness/ache
• Headache
• Fever
• Confusion
Diagnosis/Impression
• Meningitis

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Tests Requested on Admission
• Differential count
• Syphilis RPR
• HIV Rapid test
• CSF Biochemistry: Macroscopic, cell count,
gram stain and cryptococcal antigen test

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Day 2 of admission
Results
Syphilis RPR
RPR…………………………..Non-Reactive
HIV Rapid Test
HIV Determine…………..Reactive
HIV SD Bioline……………Reactive
CSF: Biochemistry
Macroscopy
Fluid…………………………..Clear
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Results Continuation
Gram stain
Organisms Seen……………..No organisms seen
Yeast Cells………………………2+
India Ink
India Ink…………………………Cryptococccus seen
Cryptococcal Antigen Test
Cryptococcal Latex…….....Reactive

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Current Medication
• Paracetamol Ibuprofen combination 1 tablet
tds po
• Fluconazole 800mg po 10/7
• Cefotaxime 1g od 14/7
Plan
• Liver Function Test
• Renal Function Test
• Full blood count

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HOW DO YOU MANAGE THIS
PATIENT?

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THANKYOU

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