1. PHARMACOTHERAPEUTICS-1 Major ACUTE CORONARY SYNDROME WITH ESSENTIAL HYPERTENSION

2. PATIENT DEMOGRAPHICS:-
IP NO : Age:- 72 yrs
Gender:- Male
CHIEF COMPLAINTS:-
c/o, chest pain radiating to neck since 1 day.
HISTORY OF PRESENT ILLNESS:-
The patients was apparently normal 1 day back but developed pain in the chest, radiating type .

3. PAST MEDICAL HISTORY:-
The patient is a known case of hypertension since 8 yrs.
PAST MEDICATON HISTORY:-
Tab. Amlong 5mg OD
Tab. Ranitidine 150 mg
LABORATORY INVESTIGATIONS:-
DATE
Day 1 2 3 4 5 6 7
BLOOD PRESSURE
mm/hg
150/80
160/84
140/80
130/78
140/76
144/80
130/84
PULSE RATE
bpm 86 78 72 94 82 80

4. Troponin- T test :- positive
ECG:- shows ST- segment elevation in leads 2, v1 and aVr.
ECHOCARDIOGRAPHY:-
Aortic valve – thickened.
Type-1 diastolic dysfunction.
Mild sclerotic aortic valve disease.
DATE
values
Result
HEMOGLOBIN gm%
8.9
decreased
ESR mm/hr 45
increased
PCV
35.6
MCH
19.1
CPK-MB U/L 50

5. SOAP ANALYSIS
SUBJECTIVE:- here is a 72 yrs old male patient hospitalized with complaints of chest pain since 1 day.
OBJECTIVE:-
The BP values are increased this indicates hypertension.
The troponin T is positive – this indicates myocardial infarction.
The hemoglobin values are decreased- this indicates anemia.
The ESR values are increased – this indicates tissue necrosis- myocardial infarction.

6. The PCV values are decreased – this indicates anemia/ over hydration.
The MCH values are decreased- this indicates hypochromia.
The CPK-MB values are increased – this indicates tissue necrosis/ infarction.
ECG shows ST- segment elevation myocardial infarction.
Echocardiography shows type-1 diastolic dysfunction , thickening of aortic valve.
DIAGNOSIS:- By observing the subjective and objective evidence the patient was diagnosed with ACUTE CORONARY SYNDROME WITH ESSENTIAL HYPERTENSION.

7. ASSESSMENT:-
PROBLEM LIST-
1. Chest pain
2. Myocardial infarction
3.Essential hypertension
Chest pain- during ischemia there will be reduced oxygen supply to tissues leading to release of necrotic factors and substance P which modulates pain.
Myocardial infarction – It occurs due to the ischemia of heart muscles due to coronary artery blockade, leading to necrosis and finally myocardial infarction.
Hypertension- it may be age related.

8. PROBLEM
GOALS OF THERAPY
DRUGS AND MOA
DOSAGE
ACUTE CORONARY SYNDROME
Early restoration of blood flow to the occluded artery
Prevention of complications and death
Prevention of coronary artery re-occlusion
Relief of ischemic chest discomfort
1.Aspirin- It inhibits release of ADP and prevent sticking of platelets.
2.Clopidogrel- inhibits ADP activation of platelets and prevents platelet aggregation.
3.Enoxaparin- it activates plasma antithrombin. Enoxaparin binds to the clotting factors (except vii a) and inactivates them.
4.Streptokinase- they activate the plasminogen which in turn helps in the dissolution of clots.
5.Nitrates- they cause venous dilation and decrease the venous return to the heart thereby decreasing the preload.
Intial 375 mg mg
 75mg
  ml
1.5 mill Units
5-10mg

9. PROBLEM
GOALS OF THERAPY
STANDARD TREATMENT
DOSE AND REGIMEN
HYPERTENSION
Treatment for patients post MYOCARDIAL INFARCTION
To attain goal blood pressure values of 140/80 mm/hg in patients.
To reduce morbidity and mortality
To prevent further complications
ACE inhibitor- they prevent conversion of angiotensin 1 to angiotensin2,prevents vasoconstriction.
Beta Blockers- they act on the beta adrenergic receptors and reduce the heart rate and cardiac output, thereby causes reduction in blood pressure.
Ramipril mg OD
Enalapril 5mg OD
Metoprolol mg

10. Aspirin+ clopidogrel+atorvastatin 10mg
BRAND NAME
GENERIC NAME
DOSE
REGIMEN
Day 1 2 3 4 5 6 7
T. Disprin
aspirin
375mg
1-0-1 Y
T. Clopitab
clopidogrel
75mg
0-1-0
T. Tonact
atorvastatin
40mg
0-0-1
I. Streptokinase
streptokinase
1.5 mill.U
T. Ecosprin gold
Aspirin+ clopidogrel+atorvastatin
10mg
I. Faciloc
enoxaparin
0.4ml
T. Roseday
rosuvastatin
20mg
T. Anxit
alprazolam
0.5mg
T. Betaloc
metoprolol
25mg
T. Ramace
Ramipril
2.5mg
1-0-0
T. Sorbitrate
Isosorbide
dinitrate
5mg
1-1-1
T. Pantop
pantoprazole
Syp. Looz
lactulose
10ml

11. DRUG INTERACTIONS:-
1. enoxaparin- clopidogrel :Major interaction
Effect : Increased risk of bleeding.
THERAPEUTIC DUPLICATION :
Atorvastatin and Rosuvastatin given together on 3rd day.
Intervention done- drug Rosuvastatin was removed.
NOTE:
Pantoprazole should had been given with the discharge drugs as patient is on Ecosprin therapy .

12. PATIENT COUNSELLING:-
Avoid stress and anxiety.
Avoid foods rich in fats.
Avoid high salt containing foods.
Regular exercise and brisk walking.
Aspirin- take the drug with food.
Nitrates- do not stand up immediately after taking nitrates.
Maintain normal BMI .