322024 acute ischemic strokjtyjgjye.pptx

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1. CASE PRESENTATION ON ACUTE ISCHEMIC STROKE Presented by : Shaik.Jareena Jasmine 322024 II/VI Pharm -D

2. INTRODUTION Ischemic strokes are caused either due to local thrombus formation or emboli that occlude a cerebral artery. The final result of both thrombus formation and embolism is arterial occlusion, decreasing cerebral blood flow and causing ischemia and ultimately infarction distal to the occlusion.

3. DEMOGRAPHICS: Name: X Gender: Male Age: 48 Department: Neurology

4. CHIEF COMPLAINTS: Sudden onset of weakness of left leg 2 days back. Slurred speech. Deviation at angle of mouth. ON EXAMINATION: Patient is conscious and coherent. PR: 86bpm BP: 130/90mmHg CVS : S 1 S 2

5. PATIENT PROFILE: Past medical history : Seizures 8 yrs back, HTN. Past medication history : Unknown. Past surgical history : Nil. SOCIAL HISTORY: Marital status : Married. Smoking : Smoker. Alcohol : Alcoholic. Diet : Mixed .

6. PHYSICAL EXAMINATION: Parameters DAY- 1 DAY- 2 BP (mmHg) 130/90 130/90 RR (Breaths/min) 21 22 PR (bpm) 86 87 Temp (°F) 98.6°F 98.6°F

7. LABORATORY PARAMETERS: PARAMETERS NORMAL RANGE DAY- 1 Hb 11.6-16.5 g/dl 14.6 g/dl RBC 4.7-6.1 millions/ cmm 5.1millions/ cmm PCV 35-45 % 43% WBC* 4,500-11,000 cells/ cmm 12,700 cells/ cmm RBS 70-150 mg/dl 125 mg/dl Platelets 1.5-4.0 lakh/ cmm 3.5 lakh/ cmm Total Cholesterol* Below 200 mg/ dL 263 mg/ dL

8. CORE : CONDITION OF THE PATIENT : Sudden onset of weakness of left leg 2 days back. Slurred speech. Deviation at angle of mouth. OUTCOMES : To attain symptomatic relief to the patient. To reduce ongoing neurologic injury and long-term disability. To prevent complications secondary to immobility and neurologic dysfunction. To prevent stroke recurrence.

9. REGIMEN : Tab. Clopidogrel (75mg) - Antiplatelet aggregating agent. Tab. Atorvastatin (80mg) - HMG- CoA reductase inhibitor. Tab. Citicoline (500mg) - Choline donor. Tab. Pantoprazole(40mg) - Proton pump inhibitor. Tab. Zincovit - Multivitamin supplement. Inj.   Mecobalamin (1ml) -Vitamin B12.

10. DRUG CHART: BRAND NAME GENERIC NAME FREQUENCY ROUTE D-1 D-2 Tab. Pantop Pantoprazole OD PO ✓ ✓ Inj. Meaxon Plus  Mecobalamin OD IV ✓ ✓ Tab. Clopitab Clopidogrel OD PO ✓ ✓ Tab. A tocar Atorvastatin OD PO ✓ ✓ Tab. Zincovit Multivitamin OD PO ✓ ✓ Tab. Citicoline Citicoline BD PO ✓ ✓

11. EVALUATION : Cholesterol levels should be monitored. Vitals should be monitored. Neurological complications should be monitored.

12. PRIME: PHARMACEUTICAL RELATED PROBLEMS: NIL RISK FACTORS : Age. Gender. Race (African American, Asian, Hispanic). Hereditary. Hypertension. Cardiac disease. S moking.

13. DRUG RELATED RISK FACTORS : Clopidogrel : Hepatotoxicity, Colitis. Atorvastatin : Liver failure, Diarrhea, UTI. Citicoline : Headache, Insomnia, Fatigue. Pantoprazole : Constipation, Diarrhea, Headache. Zincovit : Nausea, Vomiting. Mecobalamin : Itching, Rashes, Anxiety.

14. INTERACTIONS: Clopidogrel + Atorvastatin : The metabolism of atorvastatin can be decreased when combined with Clopidogrel. Pantoprazole + Clopidogrel : The serum concentration of the active metabolites of clopidogrel can be reduced. Pantoprazole + Atorvastatin : The excretion of Atorvastatin can be decreased when combined with Pantoprazole.

15. MISMATCH : NIL. EFFICACY RELATED PROBLEMS : NIL.

16. NON-PHARMACOLOGICAL THERAPY : Limit alcohol consumption. Avoid smoking. Follow regular physical activity. Maintain healthy weight. Limit daily fat intake. Pantoprazole should be taken 30 mins before breakfast.

17. Thank you