introduction To The Clinical Pharmacy.pptVIP

Introduction To The Clinical Pharmacy By Amgad A. Ragab, Pharm D, CCP New York University Medical College New York University Cancer Center New York USA Human Body $ 44,701,295 VS $ 17.00 1000 gm of Bone Marrow ($23,ooo/gm) Total: $ 23,000,000 7.5 gm of DNA ($1.300,000/gm) Total: $9.700,000 109.2 gm of Immune globulin IgG ($67,000/gm) Total: $ 7,316,400 210 units of erythropoietin hormone ($5/u) Total : $ 1050.00 Human Body Organs The Heart : $ 57,000 The Liver : $ 54,110 The Lung : $ 58,200 X 2 = $ 116,400 The Kidney : $ 45,700 X 2 = $ 194,000 The Pancrease : $ 43,900 The Cornea : $ 4,000 X 2 = $ 8,000 The Egg = $ 7,000 each The Sperm = $ 75.00 each ejaculation Human Chemistry Iron $ 0.30 Potassium $ 5.95 Carbon $ 1.98 Calcium $ 0.18 Chloride $ 0.17 Phosphours $ 7.12 Iodide $ 0.01 Sulphur $ 1.60 Zinc $ 0.03 Sodium $ 0.11 TOTAL $ 17.00 CASE STUDY A 52-year-old male was admitted to the hospital with fever and fatigue. Lab tests revealed that he was pancytopenic WBC 1000, ANC 300, HGB 5.7, HCT 17% Platelets 97,000, BUN 63, Creatinine 2.2 PMS: Orthotopic heart transplant 14 months before this event Medications: Cyclosporine 100mg PO BID Azathioprine 150mg PO BID Prednisone 10mg PO QD CASE MANAGEMENT Pt. was admitted to ICU with precautions related to neutropenia He received a blood transfusion (4 units) for anemia Broad-spectrum AB for neutropenia Fluconazole and Ganciclovir for possible fungal or viral infections BM biopsy for possible CMV infection MEDICAL PROBLEM DISCOVERY Clinical pharmacist interviewed the pt. It was discovered that pt. was being treated with allopurinol 300mg PO QD for hyperuricemia (disorder associated with cyclosporin therapy) 2 months before the hospitalization Drug-drug interaction between allopurinol and azathioprine causes pancytopenia Naranjo score is 7 MECHANISM OF ACTION Azathioprine is metabolized to 6 mercaptopurine 6-MP and then to inactive products by xanthine oxida