Case No.

:
Date:
SUBJECTIVE
PROBLEM

OBJECTIVE
1.VITAL SIGNS
2.LAB TESTS
3.MED.LIST

ASSESSMENT
ETIOLOGY OF
PROBLEM

1.EVALUATE
CURRENT
THERAPY FOR
PROBLEM

PLAN
GOALS FOR
TREATMENT
OF PROBLEM

RECOMMEND
1. DRUG TREATMENT FOR
PROBLEM
2. MONITORING PARAMETERS
FOR EACH DRUG LISTED
3. FURTHER TESTS FOR PROBLEM
IF NEEDED
4. DRUGS TO BE AVOIDED AND
WHY

2.EVALUATE NEED
FOR THERAPY

JAUNDICE
60 yrs male, was

Vitals:

Jaundice is caused by a

1. Current

To reduce the

1. Urso deoxy cholic acid-150 mg

1. Ask the patient

P.R :86/min

build-up of bilirubin in

treatment with

Total bilirubin

Pantoprazole-40mg

to consume plenty

the blood and body

following drugs

levels

Paracetmol-500mg

of fluids and

B.P :130/80 mm of Hg

admitted on 24/08/2014

RR : 26 / min

tissue. That build-up is

provides quick

with c/o

Body temperature : 101 F

often due to conditions

recovery of patient

To reduce the

* Fever, Yellowish

Labs:

affecting the liver, such

from jaundice.

fever &

as cirrhosis, hepatitis or

a) Urso deoxy

coloration of eyes since

22/08/14.
* Vomiting
* Abdominal Pain
PMH:
Recently affected with
bacterial infection and

DAY
Hemoglobin
ESR
RBC
Total count
Serum Creatinine
Total Protein
SGOT
SGPT
ALP
Bilirubin total

1
10.39 g/dl
23mm/hr
1.5 m/dl
13700/cum
3.5g/dl
6.4mg/dl
69u/l
80u/l
30.7mu/ml
3.2mg/dl

fever and treated with

1.T. Amoxycillin+

Current medication:

Clavulanic acid 625mg

Urso deoxy cholic acid-150 mg

Pantoprazole-40mg
Paracetmol-500mg
Chloroquine-500mg
Ceftriaxone-1g
Cefixim-200mg
Baclofen-10mg

2.T. Ibuprofen 400mg

SH: Alcoholic

PATIENT
EDUCATION

gallstones.
Certain individuals with
hereditary conditions
(for example,
thalassemia or
hereditary
spherocytosis) are at an
increased risk of
developing jaundice

abdominal pain

cholic acid -

2. Monitor Live Enzymes with

Cephalosporin therapy

that is low in fat,

rich in fruits,

3. Liver Function Test Can be

vegetables and

repeated.

whole grains can

Naturally Occurring

To stop the

Abdominal ultrasonography is usually

help treat

Bile Acids helps in

vomiting

done first; usually, it is highly

jaundice.

reduction of

accurate in detecting extrahepatic

Jaundice.

obstruction. CT and MRI are

b) Paracetamol

alternatives.

antipyretic to

Unexplained cholestatic jaundice

control the fever.

warrants laparoscopy occasionally

c) Pantoprazole
Proton pump

4. The cephalosporins in general

inhibitor as the

have been associated with little

Individuals who

patient c/o

hepatotoxicity and only rare

consume alcohol heavily

abdominal pain.

instances of drug induced liver injury

from hemolysis.

following a diet

due to these agents have been

are at an increased risk

of developing alcoholic

Need for therapy:

published. A special exception is

hepatitis, pancreatitis,

No change to

ceftriaxone, a third generation

Department of Pharmacy Practice, Sri Venkateswara College of Pharmacy, RVS Nagar, Chittoor-517127 (AP), INDIA

Case No.:
Date:
and cirrhosis leading to

current therapy is

cephalosporin which, when given

jaundice. Here the

required except

parenterally, can cause biliary sludge

patient is alcoholic

stopping the Use of

with symptoms of cholecystitis and

Baclofen (Anti

cholestatic jaundice.

Spastic)
Key Points

Suspect acute viral hepatitis in patients, particularly young and healthy patients, who have acute jaundice, particularly with a viral prodrome.

Suspect biliary obstruction due to cancer in elderly patients with painless jaundice, weight loss, an abdominal mass, and minimal pruritus.

Suspect hepatocellular dysfunction if aminotransferase levels are > 500 U/L and alkaline phosphatase elevation is < 3 times normal.

Suspect cholestasis if aminotransferase levels are < 200 U/L and alkaline phosphatase elevation is > 3 times normal.

Hepatic dysfunction is significant if mental status is altered and coagulopathy is present.

Department of Pharmacy Practice, Sri Venkateswara College of Pharmacy, RVS Nagar, Chittoor-517127 (AP), INDIA