THERAPEUTICS Case presentation - PowerPoint Presentation

Slide1

THERAPEUTICS

Case presentation B.Manoj Kumar Pharm.DV Year

ASTHMA WITH HYPERTENSION

Scenario: Here is a 72 year old male patient hospitalised for 6 days. Patient demograpics

:

Name:

siddamayya

Age: 60y

Sex: male

I.P.no:

28185

Medicine Unit : I

Dr

treated : Dr.

Honnutagi

D.O.A:

04/1/2014

D.O.D:

09/1/2014

Chief complaints:

c/o cough since 2 days. c/o breathlessness since 2 days.History of present illness: Patient was apparently normal 2 days back but developed breathlessness sudden in onset and progressive in nature associated with wheezing and cough with expectoration yellowish in colour.

Past medical history:

k/c/o hypertension since 3 years.

Personal history:

Patient is a smoker since 20 years.General physical examination: On auscultation- inspiratory and expiratory wheezing. Pallor- positive Tachycardia- positiveLaboratory data:

DATE

4|1

5|1

6|1

7|1

8|1

9|1

BP

165/100

160/100

140/80

130/80

120/90

130/80

PULSE

100

125

80

90

80

76

CBC:

Hb

9.2

ESR

30

Neutrophils

80

Eosinophils

8

MCH

23

MCHC

29.1

RBC

4.71

SOAP NOTE:

Subjective: Here is a 72 years old male patient presenting with complaints of cough and breathlessness since 2 days. Objective:

BP

is increased – hypertension.

Pulse- 100 bpm-tachycardia

yellow sputum – asthma

/ pneumonia

(

H

utchison’s clinical medicine

pg

53)

Pallor – skin paleness (

D

orland’s medical dictionary )

Hb decreased- anemia (Comprehensive pharmacy review by

L.Shargel

)

MCH AND MCHC decreased - hypochromic

normocyric

anemia. (“)

ESR increased- infection.(“)

Neutrophils increased- bacterial

infection(“)

Eosinophils

increased-

asthma

.(“)

DIAGNOSIS

By the above subjective and objective data the patient was diagnosed with ASTHMA WITH HYPERTENSION

Assesment:

Problems:1.Cough: Protective reflex against infections, by activation of mechano and chemoreceptors.2. Breathlessness: Mucous gland hypertrophy due to inflammation excessive mucous production and airway plugging

.

3.Bronchial asthma:

Epithelial damage and mucosal inflammation due to irritants that trigger the mast cells- Esinophils and neutrophils

accumilate

broncho constriction and cause airway plugging

4. Hypertension:

It may be age related.

Standard

theraphy

Problem

Goals

of treatment

Drugs and MOA

Dosage

Asthma

Hypertension

To maintain

normal activity levels.

maintain normal pulmonary function.

Prevent symptoms like cough and breathlessness.

Provide therapy with minimal or no adverse effects.

Bp

of 140/90mmHg

To reduce morbidity and mortality

To prevent further complications.

Short acting beta agonists:

salbutamol

- bronchodilator.

Long acting beta agonist:

Deriphylline- bronchodilator.

ACE inhibitors:

a)They block conversion of

AT1 to

AT2, thereby prevents vasocon -striction.

CCB:

a)They block voltage

gated calcium channels and prevent vasoconstriction.

100µg

150mg

Ramipril-

2.5mg/day

Enalapril- 5mg/day

Amlodipine

5mg/day

Drugs

Dosage

DAYS OF

TREATMENT

4|1

5|1

6|1

7|1

8|1

9|1

Tab.Amilokind

5mg(1-0-0)

*

*

*

*

-

-

Inj.

Lasix

2amp(1-1-0)

*

*

-

-

-

-

Inj.Rablet

20mg(0-0-1)

*

*

-

-

-

-

Duolin nebulizer

100µg(4

th

hourly)

*

*

*

*

*

*

Inj.Levoflox

100ml(1-0-0)

*

*

-

-

-

-

Inj.Deriphylline

2ml(1-0-0)

*

*

*

*

*

*

Tab.Rablet

20mg(0-0-1)

-

-

*

*

*

*

PLAN OF CARE: 1.Cough

:

Duolin nebulizer – Salbutamol+ipratropium bromide. Class-Bronchodilator.

Indication-Used to reduce cough.

MOA: Adrenergic drugs causes bronchodilatation through

β

receptor stimulation ―›increased cAMP formation in bronchial muscle cell―›relaxation.

2.Breathlessness

:

Inj.Deriphylline

-

Etophylline+Theophylline

.

Class-

Bronchodilators.xanthane

derivatives

Indication- Used to reduce breathlessness. MOA: Theophylline competitively blocks phosphodiesterase which increases cAMP tissue concentrations causing bronchodilatation.

3.Hypertension

:

Tab.Amlokind

– Vasodilator Amlodipine.

Class – Calcium channel blocker. MOA: Amlodipine 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.

Inj.Lasix- Furosemide. Class– anti hypertensive Loop Diuretic.

Indication – Used to reduce BP. MOA: Furosemide inhibits reabsorption of Na and chloride mainly in the medullary portion of the ascending Loop of Henle. Excretion of potassium and ammonia is also increased while uric acid excretion is reduced. Furosemide reduces BP in hypertensives .

DISCHARGE DRUGS: 1.Tab.Amlokind – 5mg - 1-0-0 2.Tab.Deriphylline – 150mg - 1-0-1 3.Asthaline Nebulizer – 100µg – 1-1-1

PATIENT COUNSELLING: 1.The correct use of drugs and the education of patients are counseled for asthma management.

2.The patient may experience sudden dizziness due to amlodipine so the patient should be informed about this.

3.Exercise.

4. Healthy lifestyle.

THANK YOU