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Case studies 5~7 of ADR events

The 5th case is a 21-year-old female with Urinary tract infection received ciprofloxacin 400 mg IV stat on 2016/10/13. Allergic reaction, such as skin rash was observed. Her urine culture grew E. coli. On 2016/10/13, Her creatinine was 0.93 which was normal. Her C-Reactive Protein was high up to 5.32 and WBC was a little bit high 12000 and neutrophil count around 83.5%, it is highly suspected with bacteria infection. The assessment was to rule out ciprofloxacin related allergic reaction (skin rash). The incidence was about 1%. The plan was to prescribed hydrocortisone 100 mg IV stat and shift to Cefuroxime 1.5 g IV every 8 hours from 10/13-10/18. Next case was a 52-year-old female with Adenocarcinoma of pancreas neck and body under FOLFIRINOX regimen.
They are including 5-FU 100 mg, irinotecan 21 mg, oxaliplatin 21 mg IV plus erlotinib on 2016/11/8 which is the third cycle. Patient developed Neutropenia (grade 4) was observed on 2016/11/28. Her WBC was gradually decreased to 2100 and neutrophil count was consisted of 18% and calculated ANC was down to 529. The assessment was to rule out 5-FU, irinotecan, oxaliplatin related neutropenia. The incidence rate of neutropenia compare oxaliplatin to gemcitabine in treating late stage pancreas cancer is 45.7% versus 21.0%. But oxaliplatin could significant extend patients’ survival time to 11.1 month versus 6.8 month. The plan was to hold current therapy. Unfortunately, re-challenge of oxaliplatin from Cycle 4 through Cycle 7,neutropenia was observed again.
On 2017/3/13 we finally change to paclitaxel, gemcitabine plus erlotinib. Case number 7 is a 58-year-old male with poorly differentiated carcinoma of right lung, with spine metastasis,T4N2M1b stage IV under cisplatin 80 mg IV stat on 2016/10/7. He developed allergic reaction (pruritus), flushing were observed during infusion of cisplatin On 2016/10/7, his creatinine was 0.68, ALT was 19, Sodium was 141, potassium was a bit low 3.2. The assessment was to rule out cisplatin related allergic reaction. The plan was to prescribed chlorpheniramine 5 mg IV Stat and hydrocortisone 100 mg IVA Stat. But unfortunately, while we Re-challenge cisplatin on 2016/10/28, a similar Adverse Drug Reaction was observed. Finally, We shift to docetaxel on 2016/11/29.

Ms Chao will explain 3 more examples in SOAP format in this video. Please observe each case and ponder why the plan, suggestion, and adjustment being given.

The fifth case

A 21-year-old female displayed allergic reactions after receiving ciprofloxacin 400 mg IV stat for her UTI. Urine culture grew E.coli. WBC count was 12000 (slightly high), C-Reactive Protein count was 5.32 (high), neutrophil count was 83.5%.

Below are some of the relevant information:

Ciprofloxacin related allergic reaction (skin rash) has an incidence rate of about 1%.

The TVGH pharmacists prescribed hydrocortisone 100 mg IV stat and shifted to Cefuroxime 1.5 g IV every 8 hours for the next 5 days.

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Good Pharmacy Practice: Introduction to Clinical Pharmacy Services

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