ACUTE CORONARY SYNDROME WITH ESSENTIAL HYPERTENSION PATIENT DEMOGRAPHICS IP NO 2885 Age 72 yrs ID: 1047136
Download Presentation The PPT/PDF document "PHARMACOTHERAPEUTICS-1 Major" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1. PHARMACOTHERAPEUTICS-1 MajorACUTE CORONARY SYNDROME WITH ESSENTIAL HYPERTENSION
2. PATIENT DEMOGRAPHICS:- IP NO : 2885 Age:- 72 yrsGender:- MaleCHIEF COMPLAINTS:- c/o, chest pain radiating to neck since 1 day.HISTORY OF PRESENT ILLNESS:- The patients was apparently normal 1 day back but developed pain in the chest, radiating type .
3. PAST MEDICAL HISTORY:- The patient is a known case of hypertension since 8 yrs.PAST MEDICATON HISTORY:- Tab. Amlong 5mg OD Tab. Ranitidine 150 mg 1-0-0LABORATORY INVESTIGATIONS:-DATEDay 1234567BLOOD PRESSURE mm/hg150/80160/84140/80130/78140/76144/80130/84PULSE RATEbpm86787294828080
4. Troponin- T test :- positiveECG:- shows ST- segment elevation in leads 2, v1 and aVr.ECHOCARDIOGRAPHY:- Aortic valve – thickened. Type-1 diastolic dysfunction. Mild sclerotic aortic valve disease.DATE values ResultHEMOGLOBIN gm% 8.9decreasedESR mm/hr 45increasedPCV 35.6decreasedMCH 19.1decreasedCPK-MB U/L 50increased
5. SOAP ANALYSIS SUBJECTIVE:- here is a 72 yrs old male patient hospitalized with complaints of chest pain since 1 day.OBJECTIVE:- The BP values are increased this indicates hypertension.The troponin T is positive – this indicates myocardial infarction.The hemoglobin values are decreased- this indicates anemia.The ESR values are increased – this indicates tissue necrosis- myocardial infarction.
6. The PCV values are decreased – this indicates anemia/ over hydration.The MCH values are decreased- this indicates hypochromia.The CPK-MB values are increased – this indicates tissue necrosis/ infarction.ECG shows ST- segment elevation myocardial infarction.Echocardiography shows type-1 diastolic dysfunction , thickening of aortic valve.DIAGNOSIS:- By observing the subjective and objective evidence the patient was diagnosed with ACUTE CORONARY SYNDROME WITH ESSENTIAL HYPERTENSION.
7. ASSESSMENT:-PROBLEM LIST-1. Chest pain2. Myocardial infarction3.Essential hypertensionChest pain- during ischemia there will be reduced oxygen supply to tissues leading to release of necrotic factors and substance P which modulates pain. Myocardial infarction – It occurs due to the ischemia of heart muscles due to coronary artery blockade, leading to necrosis and finally myocardial infarction. Hypertension- it may be age related.
8. PROBLEMGOALS OF THERAPYDRUGS AND MOA DOSAGE ACUTE CORONARY SYNDROMEEarly restoration of blood flow to the occluded arteryPrevention of complications and deathPrevention of coronary artery re-occlusion Relief of ischemic chest discomfort1.Aspirin- It inhibits release of ADP and prevent sticking of platelets.2.Clopidogrel- inhibits ADP activation of platelets and prevents platelet aggregation.3.Enoxaparin- it activates plasma antithrombin. Enoxaparin binds to the clotting factors (except vii a) and inactivates them.4.Streptokinase- they activate the plasminogen which in turn helps in the dissolution of clots.5.Nitrates- they cause venous dilation and decrease the venous return to the heart thereby decreasing the preload.Intial 375 mg 75- 150mg 75mg 0.4- 0.6ml 1.5 mill Units 5-10mg
9. PROBLEMGOALS OF THERAPYSTANDARD TREATMENTDOSE AND REGIMENHYPERTENSION Treatment for patients post MYOCARDIAL INFARCTIONTo attain goal blood pressure values of 140/80 mm/hg in patients.To reduce morbidity and mortalityTo prevent further complications ACE inhibitor- they prevent conversion of angiotensin 1 to angiotensin2,prevents vasoconstriction.Beta Blockers- they act on the beta adrenergic receptors and reduce the heart rate and cardiac output, thereby causes reduction in blood pressure.Ramipril 2.5-10mg ODEnalapril 5mg ODMetoprolol 25- 50mg
10. BRAND NAMEGENERIC NAMEDOSE REGIMENDay 1234567T. Disprinaspirin375mg1-0-1YYT. Clopitabclopidogrel75mg0-1-0YYT. Tonactatorvastatin40mg0-0-1YYYI. Streptokinasestreptokinase1.5 mill.UYT. Ecosprin goldAspirin+ clopidogrel+atorvastatin10mg0-0-1YYYYYI. Facilocenoxaparin0.4ml1-0-1YYYYT. Rosedayrosuvastatin20mg0-0-1YT. Anxitalprazolam0.5mg0-0-1YYYYYT. Betalocmetoprolol25mg1-0-1YYYYYT. RamaceRamipril2.5mg1-0-0YYYT. SorbitrateIsosorbidedinitrate5mg1-1-1YYYT. Pantoppantoprazole40mg1-0-0YYYSyp. Loozlactulose10ml0-0-1YYY
11. DRUG INTERACTIONS:-1. enoxaparin- clopidogrel :Major interaction Effect : Increased risk of bleeding.THERAPEUTIC DUPLICATION : Atorvastatin and Rosuvastatin given together on 3rd day.Intervention done- drug Rosuvastatin was removed. NOTE: Pantoprazole should had been given with the discharge drugs as patient is on Ecosprin therapy .
12. PATIENT COUNSELLING:-Avoid stress and anxiety.Avoid foods rich in fats.Avoid high salt containing foods.Regular exercise and brisk walking.Aspirin- take the drug with food.Nitrates- do not stand up immediately after taking nitrates.Maintain normal BMI .