1. Therapeutics-1 Case Presentation Ischemic Heart Disease with Hypertension and Acute BronchitisBy

2. 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.

3. 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

4. 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.

5. 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.

6. 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.

7. 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.

8. 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

9. 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. mg
0.6units
10- 40mg
5- 50mg

10. 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 7.
T. Rablet
Rabeprazole
20mg 8.
T. Calpol
Paracetamol
500mg
S-0-S 9.
T. Cetil
Cefuroxime
250mg
1-0-1

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

12. 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

13. THANK YOU