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A CASE
PRESENTATION ON
CORONA VIRUS
SUBMITTED TO: SUBMITTED BY:
DR.P.SK.SUHIL AZMI R.NARESH
PHARM.D Y19PHD0317
ASSISTANT PROFEESOR
DEPARTMENT OF PHARMACY PRACTISE
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 1
INDEX:
S.NO TOPIC SLIDE NO:
1. INTRODUCTION TO
CORONA VIRUS
1-30
2. SOAP NOTES 30-44
3 REFERENCES 45
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 2
•DEFINITION:
Coronavirus disease 2019 (COVID-19) is a contagious
disease caused by a virus ,the severe acute respiratory
syndrome coronavirus 2
(SARS-CoV-2).
The first known case was identified in Wuhan ,china,in
December 2019.[7]
The disease quickly spread worldwide ,resulting in the
COVID-19 Pandemic
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 3
0RIGIN OF CORONA VIRUS:
The virus orginated in bats ,which
are host of many illness such as
Ebola,Rabies,and the Marburg
virus.
It was transferred to other animals
,specifically pangolins, which are
heavily trafficked mammals
COVID-19 first appeared on
December 12 in Wuhan, a large
city in china .
It is theorized that someone
bought contaminated
meat,became infected ,and
infected others,creating a
worldwide ripple effect.
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 4
ETIOLOGY:
•The most common cause of
corona virus is
The severe respiratory syndrome
coronavirus 2(SARS-CoV-2).
•When see under electron
microscope the virus appears like
crown shape
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 5
MODES OF TRANS MISSION:
 Prmilarly through droplets containing virus during
coughing,sneezing
(upto 1 meter) [DROPLET ROUTE]
 Also contact of droplets with eyes ,nose,and mouth
with contaminated hands /fomites[CONTACT ROUTE]
 Close contact with people
 Consuming food (Bat/snake)
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 6
TRANSMISSION:
•Rarely airborne route ,but this
done not seen an important route
•Virus is isolated in stool, but feco-
oral route does not seen important
route
•Risk of animal contact
•INCUBATION PERIOD 5-14
Days
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 7
EPIDEMIOLOGY:
In India, from 3 January 2020 to 4:54pm
CET, 23 December 2022, there have
been 44,676,678 confirmed cases of
COVID-19 with 530,690 deaths, reported to
WHO. As of 20 December 2022, a total
of 2,200,145,981 vaccine doses have been
administered.
India Situation -present
44,676,678 - Confirmed cases
530,690 Deaths -
163 - new cases in last 24hrs
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 8
EPIDEMOLOGY:
Globally, as of 4:54pm CET, 23 December
2022, there have
been 651,918,402 confirmed cases of
COVID-19, including 6,656,601 deaths,
reported to WHO. As of 21 December
2022, a total of 13,073,712,554 vaccine
doses have been administered.
Global Situation
778,897new cases in last 24 hrs
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 9
PATHOPHYSIOLOGY:
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 10
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 11
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 12
RISK FACTORS:
 Serious heart disease ,such as heart failure ,coronary
artery disease or cardiomyopathy
 Cancer
 Chronic obstructive pulmonary disease
 High blood pressure
 Preganacy
 Asthma
 Liver disease
 Down syndrome
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 13
 Weakened immune system from bone marrow
transplant ,HIV or some medications
 Brain and nervous system conditions such as strokes
 Substance use disorders
 Smoking
 Sickle cell disease
 Obesity or overweight
 Type1 and type 2 diabetes
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 14
DIAGNOSIS:
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 15
DIAGNOSIS:
 RT-PCR TEST(REVERSE TRANSCRIPTASE POLYMERASE CHAIN
REACTION):
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 16
The polymerase chain reaction (PCR) test for COVID-19 is a molecular test that
analyzes your upper respiratory specimen, looking for genetic material
(ribonucleic acid or RNA) of SARS-CoV-2, the virus that causes COVID-19.
Scientists use the PCR technology to amplify small amounts of RNA from
specimens into deoxyribonucleic acid (DNA), which is replicated until SARS-
CoV-2 is detectable if present. The PCR test has been the gold standard test for
diagnosing COVID-19 since authorized for use in February 2020. It’s accurate
and reliable.
RT-PCR PROCEDURE:
 There are three key steps to the COVID-19 PCR test:
 Sample collection: A healthcare provider uses a swab to collect respiratory material
found in your nose. A swab is a soft tip on a long, flexible stick that goes into your nose.
There are different types of nose swabs, including nasal swabs that collect a sample
immediately inside your nostrils and nasopharyngeal swabs that go further into the
nasal cavity for collection. Either type of swab is sufficient for collecting material for the
COVID-19 PCR test. After collection, the swab is sealed in a tube and then sent to a
laboratory.
 Extraction: When a laboratory scientist receives the sample, they isolate (extract)
genetic material from the rest of the material in the sample.
 PCR: The PCR step then uses special chemicals and enzymes and a PCR machine
called a thermal cycler. Each heating and cooling cycle increases (amplifies) the
amount of the targeted genetic material in the test tube. After many cycles, millions of
copies of a small portion of the SARS-CoV-2 virus’s genetic material are present in the
test tube. One of the chemicals in the tube produces a fluorescent light if SARS-CoV-2
is present in the sample. Once amplified enough, the PCR machine can detect this
signal. Scientists use special software to interpret the signal as a positive test result.
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 17
RAPID COVID ANTIGEN
TEST:
•That basically means, “the point of an
antigen test is to detect the presence
of a protein—the nucleocapsid
protein—which is part of the SARS-
CoV-2 virus that is the cause of
COVID-19.”
•The way a COVID-19 Antigen test
works is similar to a PCR COVID-19
test. We will have a nurse open a new
Antigen Test packet. We will then use
a new nasal saw to collect a nasal
cavity swab. Our nurses are very
gentle and whilst the test will be over
quickly, we will do our best to make
you feel calm and safe during the
entire process.
•This swab will “then be placed into a
special solution for virus Detection.
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 18
CHEST CT SCAN:
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 19
Several chest CT findings have been reported in more than 70% of RT-PCR test–proven
COVID-19 cases, including ground-glass opacities (Figs 1, 2), vascular enlargement (Fig 2),
bilateral abnormalities, lower lobe involvement, and posterior predilection
Chest x ray
Figure 3: Characteristic chest
radiograph in a 41-year-old woman
presenting with cough and fever.
Chest radiographic findings include
bilateral patchy and confluent,
bandlike ground-glass and
consolidative opacity in a
peripheral, mid to lower lung zone
distribution (arrows).
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 20
TREATMENT:
NON-
PHARMACOLOGICAL
TREATMENT:
•Oxygen therapy
• Nebulisation
•Maintain diet protein rich
foods like meat,eggs etc,,
•Follow the treatment
prescribed by doctor
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 21
TREATMENT:
PHARMACOLOGICAL TREATMENT:
ANTIVIRAL DRUGS:
 Nirmatrelvir with Ritonavir (Paxlovid)
 Adults; children ages 12 years and older
 Start as soon as possible; must begin within 5 days of when symptoms start
 Taken at home by mouth (orally)
 MOA-Nirmatrelvir-ritonavir (Paxlovid) is an oral antiviral drug combination with activity against SARS-CoV-2.
Nirmatrelvir is a protease inhibitor, which acts to inhibit viral replication by cleaving viral polyproteins involved in
replication.
 Remdesivir (Veklury)
 Adults and children
 Start as soon as possible; must begin within 7 days of when symptoms start
 Intravenous (IV) infusions at a healthcare facility for 3 consecutive days
 MOA-VEKLURY acts to inhibit the SARS-CoV-2 RNA-dependent RNA polymerase (RdRp), which is essential for
viral replication—and thus creation of virions that circulate in the body.
 Molnupiravir (Lagevrio)
 Adults
 Start as soon as possible; must begin within 5 days of when symptoms start
 Taken at home by mouth (orally)
 MOA-Molnupiravir, sold under the brand name Lagevrio, is an antiviral medication that inhibits the replication of
certain RNA viruses. It is used to treat COVID-19 in those infected by SARS-CoV-2. It is taken by mouth.
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 22
ANTIBIOTICS:
CEPHALOSPORINS
CEFTRIAXONE:
MOA-Ceftriaxone works by inhibiting the mucopeptide synthesis in the bacterial
cell wall. The β-lactam core of ceftriaxone binds to carboxypeptidases,
endopeptidases, and transpeptidases in the bacterial cytoplasmic membrane.
CEFEPIME SULBACTUM:
MOA-Cefepime inhibits bacterial cell wall synthesis by covalently binding
enzymes responsible for the final step in transpeptidation during
peptidoglycan wall synthesis.
CEPRAZONE SULBACTUM:
MOA-Cefepime inhibits bacterial cell wall synthesis by covalently binding
enzymes responsible for the final step in transpeptidation during
peptidoglycan wall synthesis.
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 23
PENCILLINS:
 AMOXICILLIN-CLAVULANIC ACID:
 MOA-The combination of amoxicillin and clavulanic acid is used to
treat certain infections caused by bacteria, including infections of the
ears, lungs, sinus, skin, and urinary tract. Amoxicillin is in a class of
medications called penicillin-like antibiotics. It works by stopping the
growth of bacteria.
 PIPERACILLIN AND TAZOBACTUM
 MOA-It works by killing bacteria that cause infection. Tazobactam is
in a class called beta-lactamase inhibitor. It works by preventing
bacteria from destroying piperacillin. Antibiotics such as piperacillin
and tazobactam injection will not work for colds, flu, or other viral
infections
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 24
MACROLIDE ANTIBIOTICS:
 AZITHROMYCIN:
 MOA-Azithromycin prevents bacteria from growing by interfering
with their protein synthesis. It binds to the 50S subunit of the
bacterial ribosome, thus inhibiting translation of mRNA.
 VANCOMYCIN:
 MOA-Vancomycin is an antibacterial medication in the glycopeptide class. [7] Like
penicillin, vancomycin prevents cell wall synthesis in susceptible bacteria. The
main difference in the mechanism of action between the two antibiotics is in the
binding site of each
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 25
OTHER ANTIBIOTICS
 DOXYCYCLINE:
 MOA-Doxycycline inhibits bacterial protein synthesis by binding
to the 30S ribosomal subunit. Doxycycline has bacteriostatic
activitMOAy against a broad range of Gram-positive and Gram-
negative bacteria.
 MEROPENAM:
 MOA:Meropenem exerts its action by penetrating bacterial cells
readily and interfering with the synthesis of vital cell wall
components, which leads to cell death. The bactericidal activity of
meropenem results from the inhibition of cell wall synthesis.
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 26
Chloroquine and hydroxychloroquine:
 MOA-Chloroquine and hydroxychloroquine increase pH
within intracellular vacuoles and alter processes such
as protein degradation by acidic hydrolases in the
lysosome, assembly of macromolecules in the
endosomes, and posttranslation modification of
proteins in the Golgi apparatus.
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 27
MULTIVITAMINS
 LINCEE(VIT-C)
 MOA-Absorption is through an energy-dependent process that has
two mechanisms: simple diffusion and active transport. Two
transporters are involved: SVCTs (sodium-dependent vitamin C
transporters) and hexose transporters.
 ZINCOVIT:
 MOA-Zincovit tablet is used to treat and prevent vitamin and mineral deficiency.
Supports body with essential micronutrients to improve overall well-being. It has
antioxidant properties that protect the body from oxidative damage. Improves
energy levels to meet daily demand and keeps fatigue and tiredness.
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 28
PREVENTION:
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 29
VACCINES:
COVAXIN:
MOA:The vaccine works by stimulating the
immune system to produce antibodies against
the inactivated SARS-CoV-2 strain. The vaccine
is used, along with immune stimulants commonly
known as vaccine adjuvants (Alhydroxiquim-II), to
improve the immune response and provide
longer-lasting immunity.
COVISHIELD:
MOA:COVISHIELD™ is a monovalent vaccine
composed of a single recombinant, replication-
deficient chimpanzee adenovirus (ChAdOx1)
vector encoding the S glycoprotein of SARS-CoV-
2. Following administration, the S
glycoprotein of SARS-CoV-2 is expressed
locally stimulating neutralizing antibody and
cellular immune responses.
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 30
 SOAP NOTES
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 31
PATIENT DETAILS:
 NAME: 38 years
 SEX : Male
 IP.NO: 221402189
 WEIGHT: 70kgs
 HEIGHT: 160 cm
 DOA:16-11 2021
 DOD:20-11-2021
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 32
SUBJECTIVE EVIDENCE:
 A 38yrs male patient was admitted in a hospital with
chief complaints of :
 Shortness of breath
 Cough with soutum
 Generalized weakness
 Burning sensation of abdomen since morning
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 33
PRESENT MEDIACL HISTORY:
 Patient was apparently asymptomatic 10days back
then he developed sudden onset of fever with chills
,generalized body pains for which he got admitted in
another hospital and treated as viral fever and got
discharged 2 days back,later now patient develop
shortness of breath ,cough with sputum ,generalized
weakness ,burning sensation in abdomen .
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 34
OBJECTIVE EVIDENCE
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 35
DATE 16/2 17/2 18/2 19/2
TEMP 99F AFEBRILE AFEBRILE AFEBRILE
BP 130/90 130/90 140/80 130/80
RR 22 24 16 20
SPO2 99% 93% 92% 98%
LABORATORY DATA
DAY-1 DAY-2 DAY-4 NORMAL
RANGE
HB 16.4 15.7 15.7 13.5-17.5g/dl
PCV 46 46.4 46.9 40-52%
WBC 7560 7570 5920 4500-
1100cells/mm
NEUTROPHILS 83 83 81 55-70%
LYMPHOCYTES 14 11 13 20-40%
ESINOPHILS 01 0 0 1-4%
SR.CREATININE 1.2 1.1 1.0 0.6-1.5mg/dl
NA+ 138 138 141 136-150meq/l
K+ 4.2 4.2 4.2 3.3-5.5meq/l
CA+ 9.4 9.4 9.5 8.5-11meq/l
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 36
ASSESSMENT
Based upon the subjective evidence and objective
evidence the patient was diagnosed with COVID-19
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 37
PLAN
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 38
S.NO
111
BRAND NAME GENERIC NAME CATEGORY DOSE ROUT
E
FREQ
1. INJ REMEDESVIR Remedesvir Antiviral 200mg IV Stat
2. INJ.AUGMENTIN Amoxicillin+
clavlanate
Antibiotic 1.25g IV TID
3. INJ DECADRON Dexamethasone Corticosteriod 6mg IV OD
4. INJ PAN Pantoprazole PPI 40mg IV OD
5. INJ CLEXANE Enoxaparin Anticoagulant 10mg SC OD
6. T.ZINCOVIT multivitamin Multivitamin 1 tab PO OD
7. T.CALCIQUICKD3 Calcium +vitD3 Vitamin 1tab PO Once
weekly
8. INJ.OPTINEURON vitB6+B12+B2+D
panthenol
vitamin 1 amp IV OD
9. T.BILASURE Bilastine
+montelukast
Antihistamine
+leukotrienean
tagonist
1 tab PO BID
10. SYP.RESWAS Levodropropizine&
chlorpheneiramine
maleate syrup
Antihistamnine
+antitussasive
15ml PO TID
11. T.LIMCEE Vitamin c vitamin 1 tab PO TID
DISHAREGE MEDICATION:
S.NO DRUG NAME DOSE FREQUENCY DURATION
1. T.MOX.CV 625mg TID 7days
2. T.PANTOCID 40mg OD 15days
3. T ZINCOVIT OD 15days
4. T LIMCEE 500mg BID 15days
5. T.LUMIA 60k Once weekly 8 weeks
6. T.MONTEX FX 60mg OD 5 days
7 T.IFAXA 10mg OD 10 days
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 40
PATIENT COUNSELLING:
 Wash your hands often with soap and water for 20sec
 If soap and water are not available use an alcohol-
based hand sanitizer
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 41
 Wear a mask in crowded areas
 Avoid touching your eyes,nose ,and mouth with
unwashed hands
 Avoid close contact with the people who are sick
 Cover your cough or sneeze with a tissue ,then throw the
tissue in the trash
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 42
 Take balanced nutritious diet
 Have adequate sleep and rest
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 43
 Take regular mediacations as advise
Self monitoring at home –temp,blood plessure, blood
sugar, pulse oximetry .
 For persistent dry cough/sore throat do saline gargles
and take steam inhalation
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 44
REFERENCES:
 Clinical pharmacy and therauptics-Roger and Walker
 Pharmacotherapy :A pathophysiological approach –
joseph T.Dipiro et al .Applenton &lange
 https//www. Myoclinic .com
 https//www.Wikipedia.com
 https//www.drugs.com
 https//www.Medscape.com
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 45
DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 44

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COVID PPT.pptx

  • 1. A CASE PRESENTATION ON CORONA VIRUS SUBMITTED TO: SUBMITTED BY: DR.P.SK.SUHIL AZMI R.NARESH PHARM.D Y19PHD0317 ASSISTANT PROFEESOR DEPARTMENT OF PHARMACY PRACTISE DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 1
  • 2. INDEX: S.NO TOPIC SLIDE NO: 1. INTRODUCTION TO CORONA VIRUS 1-30 2. SOAP NOTES 30-44 3 REFERENCES 45 DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 2
  • 3. •DEFINITION: Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus ,the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan ,china,in December 2019.[7] The disease quickly spread worldwide ,resulting in the COVID-19 Pandemic DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 3
  • 4. 0RIGIN OF CORONA VIRUS: The virus orginated in bats ,which are host of many illness such as Ebola,Rabies,and the Marburg virus. It was transferred to other animals ,specifically pangolins, which are heavily trafficked mammals COVID-19 first appeared on December 12 in Wuhan, a large city in china . It is theorized that someone bought contaminated meat,became infected ,and infected others,creating a worldwide ripple effect. DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 4
  • 5. ETIOLOGY: •The most common cause of corona virus is The severe respiratory syndrome coronavirus 2(SARS-CoV-2). •When see under electron microscope the virus appears like crown shape DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 5
  • 6. MODES OF TRANS MISSION:  Prmilarly through droplets containing virus during coughing,sneezing (upto 1 meter) [DROPLET ROUTE]  Also contact of droplets with eyes ,nose,and mouth with contaminated hands /fomites[CONTACT ROUTE]  Close contact with people  Consuming food (Bat/snake) DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 6
  • 7. TRANSMISSION: •Rarely airborne route ,but this done not seen an important route •Virus is isolated in stool, but feco- oral route does not seen important route •Risk of animal contact •INCUBATION PERIOD 5-14 Days DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 7
  • 8. EPIDEMIOLOGY: In India, from 3 January 2020 to 4:54pm CET, 23 December 2022, there have been 44,676,678 confirmed cases of COVID-19 with 530,690 deaths, reported to WHO. As of 20 December 2022, a total of 2,200,145,981 vaccine doses have been administered. India Situation -present 44,676,678 - Confirmed cases 530,690 Deaths - 163 - new cases in last 24hrs DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 8
  • 9. EPIDEMOLOGY: Globally, as of 4:54pm CET, 23 December 2022, there have been 651,918,402 confirmed cases of COVID-19, including 6,656,601 deaths, reported to WHO. As of 21 December 2022, a total of 13,073,712,554 vaccine doses have been administered. Global Situation 778,897new cases in last 24 hrs DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 9
  • 10. PATHOPHYSIOLOGY: DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 10
  • 11. DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 11
  • 12. DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 12
  • 13. RISK FACTORS:  Serious heart disease ,such as heart failure ,coronary artery disease or cardiomyopathy  Cancer  Chronic obstructive pulmonary disease  High blood pressure  Preganacy  Asthma  Liver disease  Down syndrome DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 13
  • 14.  Weakened immune system from bone marrow transplant ,HIV or some medications  Brain and nervous system conditions such as strokes  Substance use disorders  Smoking  Sickle cell disease  Obesity or overweight  Type1 and type 2 diabetes DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 14
  • 15. DIAGNOSIS: DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 15
  • 16. DIAGNOSIS:  RT-PCR TEST(REVERSE TRANSCRIPTASE POLYMERASE CHAIN REACTION): DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 16 The polymerase chain reaction (PCR) test for COVID-19 is a molecular test that analyzes your upper respiratory specimen, looking for genetic material (ribonucleic acid or RNA) of SARS-CoV-2, the virus that causes COVID-19. Scientists use the PCR technology to amplify small amounts of RNA from specimens into deoxyribonucleic acid (DNA), which is replicated until SARS- CoV-2 is detectable if present. The PCR test has been the gold standard test for diagnosing COVID-19 since authorized for use in February 2020. It’s accurate and reliable.
  • 17. RT-PCR PROCEDURE:  There are three key steps to the COVID-19 PCR test:  Sample collection: A healthcare provider uses a swab to collect respiratory material found in your nose. A swab is a soft tip on a long, flexible stick that goes into your nose. There are different types of nose swabs, including nasal swabs that collect a sample immediately inside your nostrils and nasopharyngeal swabs that go further into the nasal cavity for collection. Either type of swab is sufficient for collecting material for the COVID-19 PCR test. After collection, the swab is sealed in a tube and then sent to a laboratory.  Extraction: When a laboratory scientist receives the sample, they isolate (extract) genetic material from the rest of the material in the sample.  PCR: The PCR step then uses special chemicals and enzymes and a PCR machine called a thermal cycler. Each heating and cooling cycle increases (amplifies) the amount of the targeted genetic material in the test tube. After many cycles, millions of copies of a small portion of the SARS-CoV-2 virus’s genetic material are present in the test tube. One of the chemicals in the tube produces a fluorescent light if SARS-CoV-2 is present in the sample. Once amplified enough, the PCR machine can detect this signal. Scientists use special software to interpret the signal as a positive test result. DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 17
  • 18. RAPID COVID ANTIGEN TEST: •That basically means, “the point of an antigen test is to detect the presence of a protein—the nucleocapsid protein—which is part of the SARS- CoV-2 virus that is the cause of COVID-19.” •The way a COVID-19 Antigen test works is similar to a PCR COVID-19 test. We will have a nurse open a new Antigen Test packet. We will then use a new nasal saw to collect a nasal cavity swab. Our nurses are very gentle and whilst the test will be over quickly, we will do our best to make you feel calm and safe during the entire process. •This swab will “then be placed into a special solution for virus Detection. DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 18
  • 19. CHEST CT SCAN: DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 19 Several chest CT findings have been reported in more than 70% of RT-PCR test–proven COVID-19 cases, including ground-glass opacities (Figs 1, 2), vascular enlargement (Fig 2), bilateral abnormalities, lower lobe involvement, and posterior predilection
  • 20. Chest x ray Figure 3: Characteristic chest radiograph in a 41-year-old woman presenting with cough and fever. Chest radiographic findings include bilateral patchy and confluent, bandlike ground-glass and consolidative opacity in a peripheral, mid to lower lung zone distribution (arrows). DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 20
  • 21. TREATMENT: NON- PHARMACOLOGICAL TREATMENT: •Oxygen therapy • Nebulisation •Maintain diet protein rich foods like meat,eggs etc,, •Follow the treatment prescribed by doctor DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 21
  • 22. TREATMENT: PHARMACOLOGICAL TREATMENT: ANTIVIRAL DRUGS:  Nirmatrelvir with Ritonavir (Paxlovid)  Adults; children ages 12 years and older  Start as soon as possible; must begin within 5 days of when symptoms start  Taken at home by mouth (orally)  MOA-Nirmatrelvir-ritonavir (Paxlovid) is an oral antiviral drug combination with activity against SARS-CoV-2. Nirmatrelvir is a protease inhibitor, which acts to inhibit viral replication by cleaving viral polyproteins involved in replication.  Remdesivir (Veklury)  Adults and children  Start as soon as possible; must begin within 7 days of when symptoms start  Intravenous (IV) infusions at a healthcare facility for 3 consecutive days  MOA-VEKLURY acts to inhibit the SARS-CoV-2 RNA-dependent RNA polymerase (RdRp), which is essential for viral replication—and thus creation of virions that circulate in the body.  Molnupiravir (Lagevrio)  Adults  Start as soon as possible; must begin within 5 days of when symptoms start  Taken at home by mouth (orally)  MOA-Molnupiravir, sold under the brand name Lagevrio, is an antiviral medication that inhibits the replication of certain RNA viruses. It is used to treat COVID-19 in those infected by SARS-CoV-2. It is taken by mouth. DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 22
  • 23. ANTIBIOTICS: CEPHALOSPORINS CEFTRIAXONE: MOA-Ceftriaxone works by inhibiting the mucopeptide synthesis in the bacterial cell wall. The β-lactam core of ceftriaxone binds to carboxypeptidases, endopeptidases, and transpeptidases in the bacterial cytoplasmic membrane. CEFEPIME SULBACTUM: MOA-Cefepime inhibits bacterial cell wall synthesis by covalently binding enzymes responsible for the final step in transpeptidation during peptidoglycan wall synthesis. CEPRAZONE SULBACTUM: MOA-Cefepime inhibits bacterial cell wall synthesis by covalently binding enzymes responsible for the final step in transpeptidation during peptidoglycan wall synthesis. DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 23
  • 24. PENCILLINS:  AMOXICILLIN-CLAVULANIC ACID:  MOA-The combination of amoxicillin and clavulanic acid is used to treat certain infections caused by bacteria, including infections of the ears, lungs, sinus, skin, and urinary tract. Amoxicillin is in a class of medications called penicillin-like antibiotics. It works by stopping the growth of bacteria.  PIPERACILLIN AND TAZOBACTUM  MOA-It works by killing bacteria that cause infection. Tazobactam is in a class called beta-lactamase inhibitor. It works by preventing bacteria from destroying piperacillin. Antibiotics such as piperacillin and tazobactam injection will not work for colds, flu, or other viral infections DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 24
  • 25. MACROLIDE ANTIBIOTICS:  AZITHROMYCIN:  MOA-Azithromycin prevents bacteria from growing by interfering with their protein synthesis. It binds to the 50S subunit of the bacterial ribosome, thus inhibiting translation of mRNA.  VANCOMYCIN:  MOA-Vancomycin is an antibacterial medication in the glycopeptide class. [7] Like penicillin, vancomycin prevents cell wall synthesis in susceptible bacteria. The main difference in the mechanism of action between the two antibiotics is in the binding site of each DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 25
  • 26. OTHER ANTIBIOTICS  DOXYCYCLINE:  MOA-Doxycycline inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit. Doxycycline has bacteriostatic activitMOAy against a broad range of Gram-positive and Gram- negative bacteria.  MEROPENAM:  MOA:Meropenem exerts its action by penetrating bacterial cells readily and interfering with the synthesis of vital cell wall components, which leads to cell death. The bactericidal activity of meropenem results from the inhibition of cell wall synthesis. DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 26
  • 27. Chloroquine and hydroxychloroquine:  MOA-Chloroquine and hydroxychloroquine increase pH within intracellular vacuoles and alter processes such as protein degradation by acidic hydrolases in the lysosome, assembly of macromolecules in the endosomes, and posttranslation modification of proteins in the Golgi apparatus. DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 27
  • 28. MULTIVITAMINS  LINCEE(VIT-C)  MOA-Absorption is through an energy-dependent process that has two mechanisms: simple diffusion and active transport. Two transporters are involved: SVCTs (sodium-dependent vitamin C transporters) and hexose transporters.  ZINCOVIT:  MOA-Zincovit tablet is used to treat and prevent vitamin and mineral deficiency. Supports body with essential micronutrients to improve overall well-being. It has antioxidant properties that protect the body from oxidative damage. Improves energy levels to meet daily demand and keeps fatigue and tiredness. DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 28
  • 29. PREVENTION: DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 29
  • 30. VACCINES: COVAXIN: MOA:The vaccine works by stimulating the immune system to produce antibodies against the inactivated SARS-CoV-2 strain. The vaccine is used, along with immune stimulants commonly known as vaccine adjuvants (Alhydroxiquim-II), to improve the immune response and provide longer-lasting immunity. COVISHIELD: MOA:COVISHIELD™ is a monovalent vaccine composed of a single recombinant, replication- deficient chimpanzee adenovirus (ChAdOx1) vector encoding the S glycoprotein of SARS-CoV- 2. Following administration, the S glycoprotein of SARS-CoV-2 is expressed locally stimulating neutralizing antibody and cellular immune responses. DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 30
  • 31.  SOAP NOTES DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 31
  • 32. PATIENT DETAILS:  NAME: 38 years  SEX : Male  IP.NO: 221402189  WEIGHT: 70kgs  HEIGHT: 160 cm  DOA:16-11 2021  DOD:20-11-2021 DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 32
  • 33. SUBJECTIVE EVIDENCE:  A 38yrs male patient was admitted in a hospital with chief complaints of :  Shortness of breath  Cough with soutum  Generalized weakness  Burning sensation of abdomen since morning DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 33
  • 34. PRESENT MEDIACL HISTORY:  Patient was apparently asymptomatic 10days back then he developed sudden onset of fever with chills ,generalized body pains for which he got admitted in another hospital and treated as viral fever and got discharged 2 days back,later now patient develop shortness of breath ,cough with sputum ,generalized weakness ,burning sensation in abdomen . DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 34
  • 35. OBJECTIVE EVIDENCE DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 35 DATE 16/2 17/2 18/2 19/2 TEMP 99F AFEBRILE AFEBRILE AFEBRILE BP 130/90 130/90 140/80 130/80 RR 22 24 16 20 SPO2 99% 93% 92% 98%
  • 36. LABORATORY DATA DAY-1 DAY-2 DAY-4 NORMAL RANGE HB 16.4 15.7 15.7 13.5-17.5g/dl PCV 46 46.4 46.9 40-52% WBC 7560 7570 5920 4500- 1100cells/mm NEUTROPHILS 83 83 81 55-70% LYMPHOCYTES 14 11 13 20-40% ESINOPHILS 01 0 0 1-4% SR.CREATININE 1.2 1.1 1.0 0.6-1.5mg/dl NA+ 138 138 141 136-150meq/l K+ 4.2 4.2 4.2 3.3-5.5meq/l CA+ 9.4 9.4 9.5 8.5-11meq/l DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 36
  • 37. ASSESSMENT Based upon the subjective evidence and objective evidence the patient was diagnosed with COVID-19 DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 37
  • 38. PLAN DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 38
  • 39. S.NO 111 BRAND NAME GENERIC NAME CATEGORY DOSE ROUT E FREQ 1. INJ REMEDESVIR Remedesvir Antiviral 200mg IV Stat 2. INJ.AUGMENTIN Amoxicillin+ clavlanate Antibiotic 1.25g IV TID 3. INJ DECADRON Dexamethasone Corticosteriod 6mg IV OD 4. INJ PAN Pantoprazole PPI 40mg IV OD 5. INJ CLEXANE Enoxaparin Anticoagulant 10mg SC OD 6. T.ZINCOVIT multivitamin Multivitamin 1 tab PO OD 7. T.CALCIQUICKD3 Calcium +vitD3 Vitamin 1tab PO Once weekly 8. INJ.OPTINEURON vitB6+B12+B2+D panthenol vitamin 1 amp IV OD 9. T.BILASURE Bilastine +montelukast Antihistamine +leukotrienean tagonist 1 tab PO BID 10. SYP.RESWAS Levodropropizine& chlorpheneiramine maleate syrup Antihistamnine +antitussasive 15ml PO TID 11. T.LIMCEE Vitamin c vitamin 1 tab PO TID
  • 40. DISHAREGE MEDICATION: S.NO DRUG NAME DOSE FREQUENCY DURATION 1. T.MOX.CV 625mg TID 7days 2. T.PANTOCID 40mg OD 15days 3. T ZINCOVIT OD 15days 4. T LIMCEE 500mg BID 15days 5. T.LUMIA 60k Once weekly 8 weeks 6. T.MONTEX FX 60mg OD 5 days 7 T.IFAXA 10mg OD 10 days DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 40
  • 41. PATIENT COUNSELLING:  Wash your hands often with soap and water for 20sec  If soap and water are not available use an alcohol- based hand sanitizer DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 41
  • 42.  Wear a mask in crowded areas  Avoid touching your eyes,nose ,and mouth with unwashed hands  Avoid close contact with the people who are sick  Cover your cough or sneeze with a tissue ,then throw the tissue in the trash DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 42
  • 43.  Take balanced nutritious diet  Have adequate sleep and rest DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 43
  • 44.  Take regular mediacations as advise Self monitoring at home –temp,blood plessure, blood sugar, pulse oximetry .  For persistent dry cough/sore throat do saline gargles and take steam inhalation DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 44
  • 45. REFERENCES:  Clinical pharmacy and therauptics-Roger and Walker  Pharmacotherapy :A pathophysiological approach – joseph T.Dipiro et al .Applenton &lange  https//www. Myoclinic .com  https//www.Wikipedia.com  https//www.drugs.com  https//www.Medscape.com DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 45
  • 46. DEPARTMENT OF PHARMACY PRACTISE,AMRMCP SLIDE NO 44