1. Case presentation B.Manoj Kumar Pharm.D V Year
THERAPEUTICS
ASTHMA WITH HYPERTENSION
Case presentation
B.Manoj Kumar
Pharm.D
V Year

2. Scenario:
Medicine Unit : I
Here is a 72 year old male patient hospitalised for 6 days.
Dr treated : Dr. Honnutagi
D.O.A: 04/1/2014
Patient demograpics :
D.O.D: 09/1/2014
Name: siddamayya
Age: 60y
Sex: male
I.P.no:

3. 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.

4. Patient is a smoker since 20 years. General physical examination:
Personal history:
Patient is a smoker since 20 years.
General physical examination:
On auscultation- inspiratory and expiratory wheezing.
Pallor- positive
Tachycardia- positive
Laboratory 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
PULSE
100
125 80 90 76

5. CBC: Hb 9.2 ESR 30 Neutrophils 80 Eosinophils 8 MCH 23 MCHC 29.1 RBC
4.71

6. SOAP NOTE: Subjective: Objective:
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 (Hutchison’s clinical medicine pg 53)
Pallor – skin paleness (Dorland’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.(“)

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

8. 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.

9. 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

10. * - 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(4th hourly)
Inj.Levoflox
100ml(1-0-0)
Inj.Deriphylline
2ml(1-0-0)
Tab.Rablet

11. Indication-Used to reduce cough.
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.

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

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

14. THANK YOU