Transcript urosepsis - Komuniti Farmasi Malaysia

GROUP CASE
PRESENTATION
SATELLITE PHARMACY
CLERKSHIP
2010/2011
GROUP B
CASE: UROSEPSIS
PATIENT’ S CMR
PATIENT PARTICULARS
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NAME: MISS ABC
BED/WARD: C1/17
AGE: 70
DIAGNOSIS : UROSEPSIS
DATE OF ADMISSION: 12/7/2010
DATE OF DISCHARGE : 8/8/2010
Brief overview : UROSEPSIS
 Definition: sepsis (septicaemia syndrome) caused by urinary
tract infection
 Urosepsis in adults comprises approximately 25% of all sepsis
cases and in most cases is due to complicated urinary tract
infections (UTIs)
 Classic presentation: fever, chills, hypotension in some
patient
 Patients who are more likely to develop urosepsis include:
infant,elderly patients, diabetics, immunosuppressed
patients (such as transplant recipients), patients receiving
cancer chemotherapy or corticosteroids and patients
with acquired immunodeficiency syndrome(HIV)
Clinical diagnostic criteria of sepsis
Associated with Systemic Inflammatory
Response Syndrome(SIRS):
i) Temperature > 38 C or < 36 C
ii) Heart rate > 90 beats per minute
iii)Respiratory rate > 20 breaths or PaC02 < 32
mmHg
iv) White blood cells > 12 x 10^9/L
 For therapeutic purposes, the diagnostic criteria
of sepsis should identify patients at an early stage
of the syndrome, prompting urologists and
intensive care specialists to search for and treat
infection, initiate appropriate therapy, and
monitor for organ failure and other complications
In the case of urosepsis the clinical evidence of
UTI is based on symptoms, physical examination,
sonographic and radiological features, and
laboratory data, such as bacteriuria and
leucocyturia.
Pathophysiology of urosepsis
• Micro-organisms reach the urinary tract by way
of the ascending, haematogenous or lymphatic
routes. For urosepsis to be established, from the
urinary tract the pathogens have to reach the
bloodstream. The risk of bacteraemia is increased
in severe urogenital infections such as
pyelonephritis and acute bacterial prostatitis, and
is facilitated by obstruction.systemic
inflammatory response syndrome (SIRS) is then
triggered
General Management of Urosepsis
• Effective treatment eliminates the infectious sources, and
improves organ perfusion. Treatment of urosepsis
comprises four basic strategies:
i) supportive therapy (fluid replacement therapy for
stabilisation and maintaining blood pressure, manage fluid
and electrolyte balance)
ii) antimicrobial therapy (initiate with broad spectrum
antibiotic within in the first hour)
iii) control or manage of the complicating factor, &
iv) specific sepsis therapy(eg.corticosteroid, insulin, etc)
All four strategies need to be started as early as possible.
• Appropriate and early diagnosis of sepsis is
important to enable commencement of
treatment without delay-if left untreated it
can cause severe sepsis & septic shock
• According to Kumar et al.’s data [7],we have 1
h to administer broad-spectrum antibiotics.
We have 6 h to stabilise haemodynamics
according to early goal-directed therapy. We
have 24 h to apply adjunctive therapy
Severe Sepsis association with organ
dysfunction, hypoperfusion or hypotensionmay include but are not limited to lactic
acidosis, oliguria or an acute alteration of
mental status
Septic shock- Sepsis with hypotension
despite adequate fluid resuscitation
DRUG THERAPY GIVEN(based on CMR)
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HYDROCHLOROTHIAZIDE
NIFEDIPINE
AMLODIPINE
PCM
LOVASTATION
TAZOCIN
OMEPRAZOLE
UNASYN
RANITIDINE
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MAXOLON(
COLCHICINE
TICLIDOPINE
PREDNISOLONE
METOPROLOL
MIST KCL
NEUPOGEN
ALBUMIN
SYPLACTULOSE
Hydrochlorothiazide( HCTZ)
• INDICATION: Management of mild to
moderate hypertension, treatment of edema
in congestive heart failure, corticosteroid
therapy and nephrotic syndrome
• ACTION: Inhibits sodium reabsorption in the
distal tubules causing increased excretion of
sodium(&chloride) and water
• Half life: 5.6-14.8 hour
• Onset of action ~ 2hours (duration 6-12hours)
DOSAGE
IN ADULT
EDEMA(25-100mg/day , max 200mg/day)
HTN(12.5-50mg/day)
In elderly patient : 12.5-25 mg once daily
(from the prescription dose given is 25mg po od)
Warning /Precaution
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Should avoid in renal disease(ineffective)
Electrolyte disturbance(hypokalemia, hyponatremia etc) can occur
May precipitate gout(cause hyperuricemia)
Use in caution with diabetes patient(may alter glucose control)
Use in caution in patient with high cholesterol
ADR: 1-10% :orthostatic hypotension, photosensitivity,
hypokalemia, hyponatremia, anorexia, epigastric distress
• Contraindications Hypersensitivity to thiazides, related diuretics, or
sulfonamide-derived drugs; anuria; renal decompensation
• Hepatic impairment: Minor alterations of fluid and electrolyte
balance may precipitate hepatic coma; use drug with caution
DRP detected: Drug-drug interactions
1) Hydrochlorothiazide + prednisolone
Levels/effect of hydrochlorothiazide may be
increased by corticosteroid (prednisolone)
still can be used together
2) Hydrochlorothiazide + amlodipine
The antihypertensive effect of amlodipine and
thiazide diuretics may be additive. Management
consists of monitoring blood pressure during
coadministration, especially during the first 1 to 3
weeks of therapy.
PATIENT CARE CONSIDERATIONS
Administration/Storage
• If drug is administered as single dose, give in
morning.
• Administer drug with food or milk to minimize
GI irritation.
• Store tablets in tightly closed container at
room temperature
Assessment/Interventions
• Monitor patient's BP with patient lying down and standing.
• Monitor serum potassium, calcium, magnesium, sodium, ABGs, uric
acid.
• Monitor renal ( BUN, creatinine) and liver (ALT, AST) function tests.
• Monitor blood glucose levels in diabetic patients.
• Observe closely for anaphylaxis (shortness of breath, rash, edema)
after first dose.
• Report muscle weakness, cramps, nausea, blurred vision, or
dizziness to health care provider
• Advise patient to limit sodium intake for optimal drug effect
• Caution patient to avoid sudden position changes to prevent
orthostatic hypotension
• Advise patient that drug may cause drowsiness and to use caution
while driving or performing other tasks requiring mental alertness