case presentation on HYPERTENSION

joshua george
2nd PharmD
T.JOHN COLLEGE OF PHARMACY
BANGLORE

1. HYPERTENSION CLASS: 2 ND PHARMD REG NO: 18Q1012 SUBJECT: PHAMACOTHERAPEUTICS-1

2. DEMOGRAPHIC DETAILS AGE : 40 GENDER : male REASON FOR ADMISSION : complaints of giddiness(since 2 days),mild chest discomfort (since 2 days) PAST MEDICAL HISTORY : Known case of hypertension PAST MEDICATION HISTORY : Tab. Chlorothiazide Tab. Telmisartan Tab. Spirinolactone

3. VITAL SIGNS DATE 5/9/19 6/9/19 TEMP N N BLOOD PRESSURE 200/100 mmHG 130/80 mmHG PULSE RATE 121 BPM 102 BPM RESPIRATORY RATE N N

4. LABORATORY INVESTIGATION TEST TEST VALUE NORMAL VALUE RBS 141 70-140 mg/dl RDW 15 11.6-14% TLC 11.2 4.5-11.0 X 10 9 /L LYMPHOCYTE 9.6 20-40% NEUTROPHILES 79.1 40-75%

5. DIAGNOSIS Accelerated hypertension U nstable angina

6. PRESCRIBED DRUGS SL.NO GENERIC NAME DOSE ROUTE OF ADMINISTRATION 1 AMLODIPIN 5mg (STAT) ORAL 2 NITROGLYCERIN 0.6mg (STAT) IV 3 TORESIMIDE 10mg (STAT) ORAL 4 AMLODIPIN 5mg 1-0-1 ORAL 5 ISOSORBIDE DINITRATE/HYDRALAZINE 20/34.5mg 1-0-1 ORAL 6 NEBIVOLOL 5mg 1-0-0 ORAL 7 BETAHISTIDINE 8mg 1-0-1 ORAL 8 TELMISARTAN 40mg 1-0-1 ORAL DATES OF TREATMENTS 5/9/19 6/9/19 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

7. PHARMACEUTICAL CARE PLAN THE TREATMENT GOAL : To reduce the chest discomfort To reduce the increased blood pressure towards normal To reduce giddiness

8. DRUG RELATED PROBLEM SL.NO DRUG- DRUG INTERACTION SEVERITY EFFECTS 1 NEBIVOLOL + AMLODIPIN MODERATE BP AND HR 2 TORESIMIDE + NEBIVOLOL MODERATE HYPERKALEMIA

9. SL.NO DRUG NAME SIDE EFFECTS 1 AMLODIPIN DIZZINESS, LIGHTHEADEDNESS 2 NITROGLYCERIN ORTHOSTATIC HYPOTENSION 3 TORESIMIDE MUSCLE CRAMPS, UNSUAL DRY MOUTH 4 ISOLAZINE LOSS OF APPETITE 5 NEBIVOLOL PEDAL EDEMA, SHORTNESS OF BREATH 6 BETAHISTIDINE STOMACH UPSET, HEADACHE 7 TELMISARTAN CHANGES OF VISION, CHANGES IN URINATION FREQUENCY

10. MONITORING PARAMETERS Monitor for blood pressure Monitor blood parameters Monitor for any further complication and comorbid diseases

11. PATIENT EDUCATION Educate on importance of patient compliance Emphasize that nitroglycerin must be kept in an dark container, away from heat or moisture Review direction on using NTG preventively that is should be taken 5 min before physical activity Warn the patient about Beta-blockers withdrawal Encourage smoking cessation for patient who smoke Proper diet, Recommend about DASH(Dietary associated to Stop Hypertension), proper exercise, weight reduction.

12. DISCHARGE MEDICATION SL.NO DRUGS DOSE AND DAYS 1 AMLODIPIN 5mg (OD) {MORNING, AFTER FOOD} 2 NEBIVOLOL 5mg (OD) 3 TELMISARTAN 40mg (OD) 4 BETAHISTIDINE 8mg (BD) {3DAYS, AFTER FOOD}