Case 1 - Eczema & Diabetes

8/12/2019 Case 1 - Eczema & Diabetes

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Case 1Eczema & Diabetes


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Patient Demographics

Name : Mrs. L

Gender : Female

Race : Chinese

Age : 45 years old

Weight : 60 kg


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Chief Complaint/Presenting Complain

I have rashes on my leg, around my thigh areas and at my feet.


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History of Presenting Complaint

She says that it is very itchy. She scratches until there are minor woun

There are patches of redness on the itchy areas. The redness and itch

subside after a few days but a relapse occurs.


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Past Medical History

Rhinitis


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Past Medications

Rhinocort aqua (budenoside) 64mcg

Dosage : 2 puffs into each nostril in the morning

OR 1 puff into each nostril twice daily


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Present Medical Conditions

Eczema based on the factors and symptoms below :

- rashes on the leg, thigh areas and at the feet

- history of rhinitis


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Present Medications

Glucophage 850mg (metformin hydrochloride)

Dosage : 1 tablet (850mg) twice daily


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Current Problems & Medications

Problems Medications

Eczema

Diabetes Glucophage 850mg

List of Drug Related Problems Needs additional drug therapy : No medication is taken for ecz Inappropriate compliance : Lack of compliance to lifestyl

modification + oral anti-diabetic agent (OAD) therapy

Need for monitoring


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Desired Therapeutic OutcomesMedical Condition Desired Therapeutic O

Eczema To treat eczema by contitching, reduce skininf

(redness and swelling) an

lesionsfrom forming.

Diabetes To arrest disease prog

diabetes.To reduce risk of diabe

complicationssuch as

nephropathy, neuropath

heard disease (CHD), di


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Pharmaceutical Issues & PlansMedical condition : EczemaMedications : Corticosteroid (Elomet cream 0.1%) + Antihistamine (

Indication

Relief of theinflammatory

& pruriticmanifestations

How touse

Apply twice daily

Preferrably aftermorning shower &before sleep

Keynotes Continue to applyfor 48 hours after

symptoms subside

Indication

Sympttreatm

Of all

How totake

1

Tw

Keynotes

Non-s

Can be

combiRhino

mometasonefuroate

cetirizinedihydrochloride


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Possible dietary supplements :

Probioticsboost the immune system and control allergies

Borage oilanti-inflammatory and reduce eczema symptoms

Evening primrose oilreduce itching of eczema


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Patient Counselling Points Identify trigger factors for eczema and avoid these triggers. Possible trigg

Possible

triggerfactors

Soap &detergents

Inhaled/

contactallergens

Foodallergy

Stress

Non-pharmacological

intervention

Mild soap &moisturizer

Avoid/reducefood causes

allergy

Exercise


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Pharmaceutical Issues & Plan

Medical condition : Diabetes

Medication : Continue on

with Glucophage 850mg.

Patients value : 8.0mmol/L


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Exercise atleast150mins/week

High fibre diet Balanced diet : 50-

60% carbohydrate,15-20% protein,25-30% fats

Total carbohydrateintake

Regular timings

Medicatimin after

Lifestyle Modification


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Pharmaceutical Issues & Plan

- Pre-obese

Patients value : 23.4

In obese patients with weight loss of 510%

weight improves insu

reduces blood pressu

improves dyslipidaem

The optimal rate of wekg/month.


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Monitoring Plan


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SBGM = Self Blood Glucose Monitoring

Self-care : Blood glucose monitoring

Keeping a log of your test results is vital. It will give a good picture of your body's response to your d

Hence, changes can be done by you and your doctor to achieve effective treatment.


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The warning signs of trouble:Vision problems (blurriness, spots).

Tiredness or pale skin colour.

Obesity (more than 20 pounds overweight).

Numbness or tingling feelings in hands or feet.

Repeated infections or slow healing of wounds.

Chest pain.

Vaginal itching.

Constant headaches (This may be a symptom of

high blood pressure.)


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References American Academy of Dermatology. How Is Eczema Diagnosed and Treated? [Online]. Availab

http://www.webmd.com/skin-problems-and-treatments/eczema/understanding-eczema-t21 April 2014].

American Academy of Dermatology.Atopic dermatitis: Diagnosis, treatment, and outcome [Online

http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/a---d/atopic-dermatitis/[Accessed : 21 April 2014].

Astrazeneca. Rhinocort Aqua [Online]. Available at : http://www1.astrazeneca-us.com/pi/R[Accessed : 21 April 2014]

Drugs.com.Mometasone cream [Online]. Available at : http://www.drugs.com/pro/mometa[Accessed : 21 April 2014].

Datapharm Communications Ltd. Cetirizine 10mg Film-coated Tablets [Online]. Available https://www.medicines.org.uk/EMC/medicine/26858/PIL/Cetirizine+10+mg+Film-Co[Accessed : 21 April 2014].


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National Jewish Health.Atopic Dermatitis or Eczema [Online]. Available at :http://health.usnews.com/health-conditions/allergy-asthma-respiratory/adermatitis-or-eczema/treatment [Accessed : 21 April 2014]

NHS choices. Rhinitis, allergic-Treatment [Online]. Available at :

http://www.nhs.uk/Conditions/Rhinitis---allergic/Pages/Treatment.aspx 21 April 2014].

NHS choices. Side effects of corticosteroids [Online]. Available at :http://www.nhs.uk/Conditions/Corticosteroid-%28drugs%29/Pages/Sid[Accessed : 21 April 2014]

Univeristy of Maryland Medical Center.Eczema [Online]. Available at :http://umm.edu/health/medical/altmed/condition/eczema [Accessed : 2


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Drugs in use : clinical case studies for pharmacists / edited by Linda J. D

London : Pharmaceutical Press, c2010.

Mims

Malaysia Clinical Practice Guidelines www.acamed.org.my

Case 1 - Eczema & Diabetes

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