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Case Study Drug Allergy Present1

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  • Case studyDrug allergy

    By..

  • Patient profile 61 75

    CC:

    2

    PI: 4 day PTA diclofenac, paracetamol, serratiopeptidase, tolperisone, omeprazole

    3 day PTA , ,

  • Patient profile

    PE: 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

    U/D: Primary hypertension

    FH: DM

  • 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

    Patient profile

  • Problem lists

    Drug allergy

    Primary hypertension

  • SOAPDrug 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

  • 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

    Objective data

  • AssessmentEtiology

    Drug allergy Drug allergy Type B

  • Etiology Drug allergy

    1-2 antibodies lymphocyte (sensitized lymphocyte)

    antibodies sensitized lymphocyte

    antibodies sensitized lymphocyte

    Assessment

  • Assessment

    19/7/54

    1-2 22/7/54

  • 10-20 paracetamol

    Assessment

  • 20/6/54

    Diclofenac 25 mg 1x3 pc

    Omeprazole 20 mg 1x1 ac

    Paracetamol 500 mg 1 tab prn q 4 hr

    Dimenhydrinate 50 mg 1 tab prn q 8 hr

    Analgesic cream

    4/7/54

    Paracetamol 500 mg 1 tab prn q 4 hr

    Amlodipine 5 mg 1x1 pc

    Simvastatin 40 mg 1xhs

    Aspirin 81 mg 1x1 pc

    Amoxicillin 500 mg 1x3 pc

    CPM 4 mg 1x3 pc

    Dextromethorphan 15 mg 1x3 pc

    19/7/54

    Diclofenac 25 mg 1x3 pc

    Omeprazole 20 mg 1x1 ac

    Paracetamol 500 mg 1 tab prn q 4 hr

    Serratiopeptidase 5 mg 1x3 pc

    Tolperisone 50 mg 1x3 pc

    21/7/54

    Time lineDiclofenac

    OmeprazoleAmlodipineSimvastatin

    AspirinSerratiopeptidase

    Tolperisone

  • 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

    Assessment

    Diclofenac, Omeprazole, Amlodipine, Aspirin, Simvastatin, serratiopeptidase, tolperisone

  • 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

  • Assessment

    Drug Rash Face edemaDiclofenac - = 3

    - = 40

    - = 40

    - = 83

    - = 1

    - = 21

    - = 14

    - = 36Omeprazole - = 2

    - = 2

    face edema

    Amlodipine rash

    - = 1

    - = 1

    Spontaneous Report of Adverse Drug Reaction 2001

  • Drug Rash Face edemaAspirin - = 1

    - = 5

    - = 7

    - = 13

    - = 3

    - = 2

    - = 5

    Simvastatin rash face edema

    Tolperisone - = 3

    - = 20

    - = 16

    - = 34

    - = 8

    - = 5

    - = 13

    Serratiopeptidase - = 20

    - = 16

    - = 34

    face edema

    Assessment

    Spontaneous Report of Adverse Drug Reaction 2001

  • DiclofenacOmeprazoleAmlodipine

    AspirinSerratio peptisase

    Tolperisone

    Simvastatin

    1.

    +1 0 0 +1 0

    2.

    +2 -1 0 +2 +2

    3. (specific antagonist)

    +1 0 0 +1 +1

    4.

    +2 -1 0 0 0

    5. ()

    -1 +2 0 -1 -1

    Naranjo's algorithm Assessment

  • DiclofenacOmeprazoleAmlodipine

    Aspirinserratio peptisase

    Tolperisone

    Simvastatin

    6.

    -1 +1 0 0 0

    7. ()

    +1 0 0 0 0

    8.

    +1 0 0 0 0

    9.

    +1 0 0 0 0

    10. (objective evidence)

    +1 0 0 +1 +1

    Naranjo's algorithm Assessment

  • :

    9 (certain)

    5-8 (probable)

    1-4 (possible)

    0 (unlikely)

    Diclofenac, Omeprazole, Amlodipine, Aspirin, Serratiopeptidase, Tolperisone = 4 (Possible)

    Simvastatin = 3 (Possible)

    Assessment

  • AssessmentAssessment if therapy is indicated

    supportive treatment

  • 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

    Assessment

  • PlanGoal

    Therapeutic

    Chlorpheniramine maleate 4 mg 1x3 pc

    Calamine cream apply prn

  • Therapeutic monitoring parameter

    Patient education

    Plan

  • Future plan NSAIDs

    diclofenac aspirin COX-1 inhibitors

    Plan

  • Thank you

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