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A CASE STUDY ON BREAST CANCER

Prepared by

s.muzafar ahamed

Pharm-D 3rd year

15Y01T0018

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DEFINITION

  • Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body.
  • ETIOLOGY
  • Tobacco, obesity, poor diet, lack of physical activity, excessive alcohol, certain infections

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Pathophysiology

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symptoms

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DEMOGRAPHIC DATA

  • Name:MS
  • Age/Gender:52yr/Female
  • IP No:764-17
  • Department:General medicine
  • DOA:28/6/17
  • Consultant by:Dr.NIkharika
  • came for chemotherapy,she is a know case of breast cancer undergone surgery right radial mostectomy one month back and also a know case of HTNsince 5yrs.
  • HTN:Telma-40mg/OD
  • Food habits:mixed diet
  • decreased sleep

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Subjective evidence

  • came for chemotherapy,she is a know case of breast cancer undergone surgery right radial mostectomy one month back and also a know case of HTNsince 5yrs.
  • HTN:Telma-40mg/OD

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28/6/17

29/6/17

TEMP

97.8

97

BP(mmofHg)

150/100

150/80

PR/min

80

82

RR/min

24

22

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Objective evidence

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TEST VALUE

NORMAL VALUE

Hbgm/dl

8.5

12-15

TLCcumm

6700

4-11000

N

65

40-70%

L

29

20-45%

E

03

0-6%

M

03

02-10%

PLT

2.0

1.5-4L

BUN

21

10-50mg/dl

Sr.Cr

1.0

0.6-1.6mg/dl

T.bilirubin

0.5

0.2-1.2gm/dl

D.bilirubin

0.2

0.2-0.4gm/dl

SGOT

16

5.35IU/L

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SGPT

18

Upto42IU/L

ALP

290

80-90IU/L

Total proteins

6

6gm/dl

Albumin

3.4

3.2-5.0gm/dl

Globulin

2.6

2.2-4.2gm/dl

A:G ratio

1.3:1

1.2:3

RBS

84

80-160mg/dl

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SOAP NOTES

  • Subjective evidence
  • she came for chemotherapy,she is a know case of breast cancer undergone surgery right radial mostectomy one month back and also a know case of HTNsince 5yrs.
  • Objective evidence
  • In CBP she has a decreased in Hb levels(8.5gm/dl),increased in ALP(290IU/L) and remaning all are normal
  • Assessment:
  • Based on subjective and obective evidence she is diagonised as a patient of cancer and HTN

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PLANNING

So no

Brand name

Generic name

Indication

Dose

ROA

frequency

start

end

1

Tab.TELMA

Telmisartan

Anti-HTN

40mg

PO

OD

28/6/17

unknown

2

Tab.PANTACID

Pantoprazole

Proton pump inhibitor

40mg

PO

OD

28/6/17

unknown

3

Tab.EMESET

Ondansetron

Anti-emetic

4mg

PO

SOS

28/6/17

unknown

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Progressive chart

  • Progress chart
  • DAY 1: C/O: came for chemotherapy,vomitings,k/c/o HTN
  • Vitals: Rx:
  • Temperature:97.8

BP:150/100mmhg T.TELMA-40mg PO OD

PR:80bpm T.PANTOP 40mg PO/OD RR:24cpm T.ONDANZ 4mg PO SOS

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  • Name:INJ.PANTOP(PANTOPRAZOLE) Classification: Proton-pump inhibitor. Mechanism of action: Pantoprazole sodium is a proton pump inhibitor (PPI) that covalently binds to the (H(+), K(+))-ATPase enzyme system at the secretory surface of the gastric parietal cell. This action suppresses the final step in gastric acid production and leads to inhibition of both basal and stimulated acid secretion. Side effects: Proton-pump inhibitors have similar adverse events reported after therapeutic use. COMMON (2% or greater): Headache, abdominal pain, nausea, vomiting, diarrhoea, and flatulence. Monitoring parameter:Hypersecretory disorders: Acid output measurements, target level <10 mEq/hour (<5 mEq/hour if prior gastric acid-reducing surgery) Brands &Doses:PANTOP:dose:20mg,40mg

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  • Name: INJ.ONDANZ(ondensteron)
  • Classification:Anti-emetic Mechanism of action: ondansetron combined with 5-HT3 or tachykinin NK1 antagonists is also suggested for higher-level emetogenic chemotherapy and radiotherapy and for patients at high risk for PONV. Glucocorticoids may act via the following mechanisms: (1) anti-inflammatory effect; (2) direct central action at the solitary tract nucleus, (3) interaction with the neurotransmitter serotonin, and receptor proteins tachykinin NK1 and NK2, alpha-adrenaline, etc.; (4) maintaining the normal physiological functions of organs and systems; (5) regulation of the hypothalamic-pituitary-adrenal axis; and (6) reducing pain and the concomitant use of opioids, which in turn reduces opioid-related nausea and vomiting. Side effects: Muscle tightness, weakness, or limp feeling,problems with your vision,shortness of breath (even with mild exertion), swelling, rapid weight gain ,severe depression, unusual thoughts or behaviour,a seizure (convulsions) ,bloody or tarry stools, coughing up blood ,lower back pain, blood in your urine, little or no urination ,confusion, numbness or tingly feeling around your mouth ,fast or slow heart rate, weak pulse. Monitoring parameter:Electrolytes; BP; weight; 2h postprandial glucose, height (pedspts), chest x-ray if prolonged tx; ophthalmic exam if tx>6wk; BMD if prolonged tx or in pts 65 yo and older; consider upper GI x-ray if PUD hx or significant dyspepsia Brands&Dose:ADOM-O,EMESET,VOMIKIND-2mg,4mg

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  • 7.Name: Telma( telmisartan)
  • Classification: Angiotensin II Antagonists
  • Mechanism of action: Telmisartan is a nonpeptide AT1 angiotensin II receptor antagonist. It exerts antihypertensive activity by preventing angiotensin II from binding to AT1 receptors thus inhibiting the vasoconstricting and aldosterone-secreting effects of angiotensin II.
  • Side effects: Dizziness, fatigue, headache, sinusitis, upper resp tract infection, pharyngitis, UTI, back pain, myalgia, diarrhoea, abdominal pain, dyspepsia, nausea.
  • Monitoring parameters: Monitor BP, electrolytes and serum creatinine levels.
  • Brands & Doses: Adult: Initially, 40 mg once daily, may be adjusted to 20-80 mg once daily if needed.

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  • Progress chart
  • DAY 1: C/O: came for chemotherapy,vomitings,k/c/o HTN
  • Vitals: Rx:
  • Temperature:97.8

BP:150/80mmhg T.TELMA-40mg PO OD

PR:80bpm T.PANTOP 40mg PO/OD RR:22cpm T.ONDANZ 4mg PO SOS

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LIFE STYLE MODIFICATIONS

  • Regular physical activity.
  • Smoking cessation
  • Maintaining a Healthy Body Weight.
  • Limiting alcohol
  • Reducing Salt (Sodium Chloride) Intake.
  • Consuming a Diet That Emphasizes Fruits, Vegetables, and Low-Fat Dairy Products, and that is reduced in Fat and Cholesterol.

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References:

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  • http /micromedex://www.micromedexsolutions.com 2
  • www.drug.com
  • www.1mg.com

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