1. Management Course in the Wards Discharge Plans

2. Management: Course in the Wards Hospital Day 1: Admission Day – Requested to be started on: Ceftriaxone 2g/IV OD Azithromycin 500mg/tab 1tab OD for 3days Erdosteine 300mg/cap 1cap BID Paracetamol 500mg/tab 1tab q4 prn for T> 38C Amlodipine 5mg/tab 1tab OD Note: Medications were not started due to financial constraints Furosemide 40mg/IV 1dose and Salbutamol neblization q4 were requested

3. Management: Course in the Wards Hospital Day 2 – Patient was hypertensive at 180/100mmHg was given Amlodipine 10mg/tab – Ceftriaxone was started

4. Management: Course in the Wards Hospital Day 3 – Salbutamol was shifted to Combivent nebulization q12, with gentle chest physiotherapy after each nebulization – Patient had a BP of 140/90mmHg Was started on Metoprolol 50mg/tab 1tab BID

5. Management: Course in the Wards Hospital Day 4 – Ceftriaxone was shifted to Cefuroxime 500mg/tab 1tab BID to complete 7days Was not done due to financial constraints Hospital Day 5 – Azithromycin, FeSO4 + FA, Metoprolol, as previously ordered, were started

6. Management: Course in the Wards Hospital Day 6 – Cefuroxime, as previously ordered, was started Hospital Day 7 – Patient’s condition improved and was stable discharge

7. Management: Discharge Plans Pharmacologic Non-Pharmacologic Check-Up

8. Discharge Plans: Pharmacologic Azithromycin – MOA: blocks transpeptidation by binding to 50s ribosomal subunit of susceptible organisms and disrupting RNA- dependent protein synthesis at the chain elongation step. – AE: Mild to moderate nausea, vomiting, abdominal pain, dyspepsia, flatulence, diarrhoea, cramping; angioedema, cholestatic jaundice; dizziness, headache, vertigo, somnolence; transient elevations of liver enzyme values. – Dosage: 500mg/tab, 1 tablet OD for 3 days – SRP: Php 150.00

9. Discharge Plans: Pharmacologic Cefuroxime – MOA: binds to one or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death. – AE: Large doses can cause cerebral irritation and convulsions; nausea, vomiting, diarrhoea, GI disturbances; erythema multiforme, Stevens-Johnson syndrome, epidermal necrolysis, anaphylaxis, nephrotoxicity, pseudomembranous colitis. – Dosage: 500mg/tab, 1 tablet BID for 7 days – SRP: Php 75.00

10. Discharge Plans: Pharmacologic Amlodipine – MOA: relaxes peripheral and coronary vascular smooth muscle. It produces coronary vasodilation by inhibiting the entry of Ca ions into the voltage-sensitive channels of the vascular smooth muscle and myocardium during depolarisation. It also increases myocardial O 2 delivery in patients with vasospastic angina. – AE: Headache, peripheral oedema, fatigue, somnolence, nausea, abdominal pain, flushing, dyspepsia, palpitations, dizziness. Rarely pruritus, rash, dyspnoea, asthenia, muscle cramps. Potentially Fatal: Hypotension, bradycardia, conductive system delay and CCF. – Dosage: 10mg/tab, 1 tablet BID – SRP: Php 22.00

11. Discharge Plans: Pharmacologic Metoprolol – MOA:Metoprolol selectively inhibits β-adrenergic receptors but has little or no effect on β 2 -receptors except in high doses. It has no membrane-stabilising nor intrinsic sympathomimetic activity. – AE:Bradycardia, hypotension, arterial insufficiency, chest pain, CHF, oedema, palpitation, syncope, gangrene; dizziness, fatigue, depression, confusion, headache, insomnia, short-term memory loss, nightmares, somnolence; pruritus, rash, increased psoriasis, reversible alopecia, Heart failure, heart block, bronchospasm. – Dosage: 50mg/tab, 1 tablet BID – SRP: Php 4.00

12. Discharge Plans: Pharmacologic Erdosteine – MOA:contains two sulfhydryl groups, which are freed after metabolic transformation in the liver. The liberated sulfhydryl groups break the disulphide bonds, which hold the glycoprotein fibres of mucus together. This makes the bronchial secretions more fluid and enhances elimination. – AE:Epigastralgia, nausea, vomiting, loose stools, spasmodic colitis, headache. – Dosage: 300mg/cap, 1 capsule BID – SRP: Php 19.00

13. Discharge Plans: Pharmacologic Ferrous Sulfate + FA – MOA:Ferrous sulfate facilitates O 2 transport via haemoglobin. It is used as iron source as it replaces iron found in haemoglobin, myoglobin and other enzymes. – AE: GI irritation, abdominal pain and cramps, nausea, vomiting, constipation, diarrhoea, dark stool and discoloration of urine; heartburn. – Dosage: 500mg/tablet, 1tablet BID – SRP: Php 20.00

14. Getting plenty of rest and drinking of lots of fluids Active lifestyle (e.g. Daily exercise) Preventive measures –Flu shot —for people at high risk, particularly the elderly, because pneumonia may be a complication of the flu –Pneumococcal vaccine —recommended for: People over aged 65, or those who have a chronic illness, such as diabetes or sickle-cell disease Children under two years old Discharge Plans: Non-Pharmacologic

15. Lifestyle interventions: – Reduction of dietary salt intake (<6g NaCl/day) – Moderate alcohol consumption Men: </= 2 drinks per day Women: </= 1 drink per day – Adapt DASH dietary plan Diet high in fruits and low-fat dairy products, reduced saturated and total fat – Physical activity Regular aerobic activity (e.g. brisk walking for 30 mins/day) Discharge Plans: Non-Pharmacologic

16. Discharge Plans: Check-up Return to UST Hospital for Check-up after 1 week or immediately when condition worsens.