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College of Pharmacy & Nursing

School of Pharmacy

PHARMACOTHERAPY-1 LAB (PHCY310L)

Clinical Lab Manual

Spring Semester 2016/2017

Faculty: Dr. Sabin Thomas

Assistant Professor in Pharmacy Practice

Name:

Student ID:

Table of Contents

| | | |

|Sl.No |Particulars |Page Numbers |

|1 |Cardiovascular Disorders |Hypertension |3 |

| | |Heart Failure |6 |

| | |Angina Pectoris Case-1 |10 |

| | |Angina Pectoris Case-2 |12 |

| | |Myocardial Infarction |15 |

|2 |Respiratory Disorders |Asthma Case-1 |19 |

| | |Asthma Case-2 |21 |

| | |Chronic Obstructive Pulmonary Disease |23 |

|3 |Central Nervous System Disorders |Insomnia |26 |

| | |Transient Ischemic Attack/Stroke |28 |

| | |Epilepsy |30 |

| | |Depression |32 |

|4 |Headache |Migraine Headache |34 |

|5 |Renal Disorders |Acute Renal Failure |36 |

CARDIOVASCULAR DISORDERS

Topic: Hypertension

A 52-year-old man complains of a throbbing headache in the morning for the past week. He was diagnosed with hypertension 6 years ago and was initially treated with lifestyle modifications, and then with antihypertensive medication (amlodipine). He took this medication for 2 years and then discontinued because he did not think it was needed. Past medical history is unremarkable. His father had hypertension and died of an MI at age 54. His mother had diabetes and hypertension and died of a stroke at age 68. He smokes 1 pack per day of cigarettes (for 35 years) and thinks that his BP is high because of job-related stress. He does not engage in any regular form of exercise and does not restrict his diet in any way including salt intake.

Physical examination shows he is 69” tall, weighs 108 kg (body mass index, 35.2 kg/m2), BP is 148/88 mm Hg (left arm) and 150/86 mm Hg (right arm) while sitting, heart rate is 82 beats/min and regular. One month ago, his BP values were 152/88 mm Hg and 154/84 mm Hg. Funduscopic examination reveals mild arterial narrowing, arteriovenous nicking, with no exudates or hemorrhages. The remainder of the physical examination is essentially normal.

Laboratory examination reveals the following values: blood urea nitrogen (BUN), 24 mg/dL (normal, 7 to 20 mg/dL); serum creatinine (SrCr), 1.3 mg/dL (normal, 0.5 to 1.2 mg/dL); fasting glucose, 95 mg/dL (normal, 60 to 110 mg/dL); potassium (K), 4.0 mEq/L (normal, 3.5 to 5.2 mEq/L); uric acid, 8.0 mg/dL (normal, 2.0 to 8.0 mg/dL); low-density lipoprotein (LDL) cholesterol, 140 mg/dL (normal, 40 mg/dL), and triglycerides 230 mg/dL (normal, 30 per day) and drinks approximately 35 units of alcohol per week.

Family history

No family history of cardiovascular disease.

Drug history on admission

No known allergies.

Prescribed drugs are listed in Table

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Signs and symptoms on examination

• Patient was pale on examination.

• Temperature 36.8°C

• Blood pressure 105/60 mmHg

• Heart rate 90 bpm, irregular

• Swelling of ankles (SOA) – pitting to the knees

• JVP +4 cm

• Weight 97 kg (usually 85 kg)

• CXR – cardiomegaly

• Basal crackles in both lungs

• ECG – normal.

Biochemistry results at admission

• Na + 132 mmol/L (135–145 mmol/L)

• K + 4.3 mmol/L (3.5–5.0 mmol/L)

• Urea 17 mmol/L (0–7.5 mmol/L)

• Creatinine 169 micromol/L (35–125 micromol/L)

• Total cholesterol 3.9 mmol/L (40 per day) and drinks approximately 10 units of alcohol per week. He has osteoarthritis of the knee.

Family history

Father died following a myocardial infarction at 60 years of age. No maternal history of cardiovascular disease.

Drug history

Allergies: Trimethoprim. Mr FG has been taking diclofenac MR tablets 75 mg (twice daily) and nifedipine (Adalat Retard) MR tablets 20 mg (twice daily). Both were stopped on admission.Signs and symptoms on examination

[pic] Temperature 36.4°C

[pic] Blood pressure 160/80 mmHg

[pic] Heart rate 75 bpm, regular

[pic] Respiratory rate 15 breaths per minute

[pic] No basal crackles in the lungs.

An ECG taken immediately on arrival reveals ST elevation of 3 mm in the inferior leads.

Diagnosis

A preliminary diagnosis of myocardial infarction is made.

Relevant test results

Full blood counts, liver function tests, electrolytes and renal function, CXR, total cholesterol, full blood count and blood glucose were taken at admission.

1 What further diagnostic and biochemical tests should be ordered to help confirm

the diagnosis?

2 What is myocardial infarction and what are the classic symptoms?

Initial treatment

About 45 minutes after the onset of chest pain the patient received the following treatment in the emergency department:

[pic] heparin 5000 units stat

[pic] reteplase 10 units i.v. bolus followed by a further 10 unit i.v. bolus after 30 minutes

[pic] diamorphine 2.5 mg IV stat

[pic] metoclopramide 10 mg stat.

A sliding scale insulin infusion of Actrapid 50 units made up to 50 mL with sodium chloride 0.9% was initiated and titrated against blood glucose.

3- Explain the mechanism of action of thrombolytics such as reteplase in acute myocardial infarction.

The patient is subsequently transferred 2 hours later to the coronary care unit as he is pain-free. As the ward clinical pharmacist, you are responsible for daily review of drug charts and advice to medical and nursing staff on all aspects of drug treatment for patients on the ward.

The following tests taken at admission are reported:

Na + 134 mmol/L (135–145 mmol/L)

K + 4.3 mmol/L (3.5–4.0 mmol/L)

Urea 5.2 mmol/L (0–7.5 mmol/L)

Creatinine 81 micromol/L (35–125 micromol/L)

Total cholesterol 5.9 mmol/L ( ................
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