Therapeutics-1 Case Presentation Ischemic Heart Disease with Hypertension and Acute Bronchitis By

Here is a 74yrs old female hospitalized for 6 days. SENARIO: Here is a 74yrs old female hospitalized for 6 days. CHIEF COMPLAINTS: Breathlessness since 15 days Fever and cough with expectoration since 15 days HISTORY OF PRESENT ILLNESS: Patient was apparently normal 15days back but developed Fever of moderate Grade and intermittent type associated with Chills & rigors. Patient also complains of cough with expectoration and breathlessness on exertion. Sputum was yellowish and thick.

PAST MEDICAL HISTORY:- k/c/o IHD with hypertension. SURGICAL HISTORY:- Angiography 4 years back. LABORATORY INVESTIGATIONS:- CBC 1 2 3 4 5 6 Neutrophils 87 Hb 10gm% ESR 105mm/hr Blood pressure mm/hg 160/ 90 108/ 72 110/ 70 120/ 124/ 64 76 Pulse rate bpm 84 92 80

GENERAL PHYSICAL EXAMINATION:- Pallor + Auscultation- crepts+ over left axillary and infra scapular region Percussion- b/l resonance over all areas NVBS+ SOAP NOTE Subjective:- here is a 74 yrs old female patient presenting with complaints of breathlessness, fever, cough with expectoration since 15 days. Objective:- BP on the day of admission was 160/90 mmhg increase in BP indicates Hypertension.

CBC: Neutrophils-87 – increased due to bacterial infections ESR-105mm/hr-increased due to infection and inflammation Hb-10gm%-decreased due to anaemia Echocardiography:- Type-1 Diastolic dysfunction LVEF-50% IHD-RWMA (+) Concentric left ventricle hypertrophy. DIAGNOSIS:- IHD with Hypertension and Acute Bronchitis.

Breathlessness: It is due to the inflammation of PROBLEM LISTS: Breathlessness: It is due to the inflammation of bronchi, due to which narrowing of bronchial tubes occur. There will also be mucous hypersecretion due to which airway plugging and breathlessness occurs. Cough with expectoration: cough consists of sputum due to secretions from inflammatory cells. By coughing the body attempts to expel sputum. Fever: due to release of pyrogens by infection causing microbes, there will be release of prostaglandins which causes rise in temperature.

bronchi and is associated with infection. Acute Bronchitis: there will be inflammation of bronchi and is associated with infection. Hypertension: it may be age related. Ischemic Heart Disease: it occurs due to the decrease in the blood flow to myocardium due to coronary artery narrowing or obstruction.

PROBLEM GOALS OF THERAPY DRUGS AND MOA DOSE Bronchitis Hypertension Provide comfort to the patient Relief of symptoms. Goal BP of less than 140/80 mmhg To reduce or prevent complications acetaminophen- it is a cox-1 inhibitor and reduces synthesis of prostaglandins. Erythromycin- inhibits bacterial protein synthesis by binding to 50s ribosome. ACEI:- they prevent conversion of AT-1 to AT-2 and prevents vasoconstriction. CCB:- they block voltage gated ca+2 channels and prevents vasoconstriction. 650mg 500mg 2.5- 5mg 5mg

PROBLEM GOALS OF THERAPY DRUGS AND MOA DOSE Ischemic Heart Disease Early restoration of blood flow to occluded coronary artery. Relief of ischemic chest discomfort. aspirin- it inhibits release of ADP and prevents sticking of platelets. Heparin- it inactivates clotting factors. Nitrates – it decreases pre and afterload by causing arterial and venous dilation. Beta- blockers- they reduce afterload and prevent forceful contraction. 75- 150mg 0.6units 10- 40mg 5- 50mg

S. NO BRAND NAME GENERIC NAME DOSE 1 2 3 4 5 6 1. T. Tonact-asp Atorvastatin 75mg 0-0-1 Y 2. T. Telsartan telmisartan+ aspirin 3. T. Betaone- xl Metoprolol 25mg 1-0-0 4. INJ. Taxim Ceftriaxone 1gm 1-1-1 5. INJ. Deriphyllin Theophylline+ etophylline 6. Duolin neb Salbutamol+ Ipratropium 1-1-1-1 7. T. Rablet Rabeprazole 20mg 8. T. Calpol Paracetamol 500mg S-0-S 9. T. Cetil Cefuroxime 250mg 1-0-1

DISCHARGE DRUGS :- T.Tonact-asp 0-0-1 x 30 days T.Telsartan 0-0-1 x 30 days T.Rablet-20 1-0-0 x 30 days T.Deriphylline-R 150 1-0-1 x 5 days Duolin nebulizer 1-1-1-1 T.Cetil 250mg 1-0-1 x 5 days. PROGNOSIS: condition improved Follow up after 30 days

DRUG INTERACTIONS:- Interaction between cefuroxime- rabeprazole Its a Moderate interaction Rabeprazole decreases absorption of cefuroxime PATIENT COUNSELLING:- Take rabeprazole every morning before breakfast. Take aspirin with or immediately after food. Avoid high fat containing foods. Exercise regularly Patient is suggested to eat fresh green leafy vegetables

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