pathopysiology and signs and symptoms

1. CASE PRESENTATION ON ATHEROSCLEROSIS
PRESENTED BY;
T.SAI SWAPNA
II/VI PHARM . D
Department of pharmacy
practice
Nirmala college of pharmacy
19/01/2019

2. Case summary;
• Male patient suffering from SOB , in past
having DM, HTN , and treated with , statins,
ACE inhibitors and guided to change the life
style modifications
• The case was evaluated by SOAP analysis

3. Subjective evidence;
• A male patient of age 55 years and weighs
about 80 kg suffering for fever since one week
suffering from SOB, abdominal distension ,
constipation, dry cough ,
• Past history includes DM , HTN
• His sleep and appetite was found to be normal

4. Objective data;
• Physical examination;
• Pulse- 69 b/m
• BP – 130/80 mm of hg
• Temperature – 99 degrees F
• RR – 20 b/m
• Systemic examination;
• CVS – s1 s2 +
• RS – BAE +
• P/A – soft and non tender

5. Lab tests
• RBC – 4.06c/cubic mm (4.2-5.6)
• WBC – 12,000c/cub.mm (4,000-10,000)
• Hb – 9.7g/dl (14-18)
• Heamatocrit – 30.8% (39-59)
• MCV – 75.9fi (78-98)
• MCH – 23.9pg (27-35)
• RDW – 15.4% (11.5-14.5)
• Neutrophils – 92.0 (50-81)

6. Serum electrolytes
• Sodium – 128 mmol/L(136-145)
• Potassium- 3.5 mmol/L(3.6-5.2)
• Calcium – 0.82mmol/L(2.2-2.7)
• Chloride – 96 mmol/L(98-106)
• Albumin- 2.8g/dl(3.5-5.5)
• Globulin – 4.1g/dl(2-3.5)
• A/G- 0.7(0.8-2.0)
• Iron – 11 mcg/dl(65-175)
ABG
PH- 7.4
PCO2- 32.6 mm of hg
PO2- 159 mm of hg

7. Other lab tests;
• ECHO,ECG
• COLOUR DOPPLER STUDY OF LOWER LIMB ARTERIES AND
VEINS;
• IMPRESSION; Deep facial edema , severe atherosclerotic
arterial wall disease in anterior tibial and posterior tibial
arteries
• ULTRASONOGRAPHY OF ABDOMEN;
• IMPRESSION; Bilateral pleural effusion with basal
consodilation
• Mild hepatomegaly

8. Assessment;
• Based on subjective and objective data the final diagnosis as
follows SEVERE ATHEROSCLEROTIC ARTERIAL WALL DISEASE
• DEFINITION-
• Thickening of the arterial walls – build up of plaque
• ETIOLOGY-DM & HTN
• RISK FACTORS;
• DM , HTN
• Dyslipidemia
• Tobacco smoking
• Obesity
• Stress, alcohol, sleep apnea

9. Pathophysiology;
Step 1&2
• DM,
• INCREASED LDL LEVELS
3&4
• Leucocytes adhere and migrate to BV
• Development of lipid laden macrophages
5,6,7,8
• Release of cytokines and regulation of smooth muscle
• Accumulation of lipid & narrowing of BV
• Endothelial dysfunction
• Atherosclerotic plaque

10. Signs and symptoms
• vv

11. Plan ;
• Goals;
• To decrease signs and symptoms
• To decrease disease progression
• To decrease further complications involved
• STANDARD TREATMENT;
• MEDICATIONS include antiplatelet , beta blockers
, ACE inhibitors , calcium channel blockers
• Surgical procedures like angioplasty , slent
placement , fibrinolytic therapy

12. DRUG CHAT

13. S.NO Brand name Generic name Dose RO
A
Frequency Category ADR’S
1. Inj .piptaz Piperacillin &
tazobactum
sodium
4.5g IV TID Antibioti
c
Nausea,
vomiting
2. Inj.claribid clarithromycin 500m
g
IV BD Macrolid
e
Nausea,
N2
3. Duolin neb Salbutamol &
ipatropium
bromide
1resp N 8th hourly Broncho
dilator
Nasal
congesti
on
4. Inj.pantop pantoprazole 40mg IV OD Protein
pump
inhibitor
Nausea
,electrol
yte imb
5. Tab .
tolvapton
Tolvapton
nitrase
15mg o BD Vasopres
sin
antagoni
st
Anorxeia
,urinatio
n
6. Syrup looz Lactuolse sol 30ml o OD Hyperos
motic
Hyperna
tremia
7. Inj.linezolid Linezolid 600m
g
IV BD Oxazolidi
none
Taste
alteratio
n

14. S.no Brand name Generic
name
Dose ROA Freque
ncy
Category ADR’S
8. Inj.fragmin Daltepari
n sodium
5000
IU
S/C BD Anticoagulan
t
Thrombocytopeni
a,Heamturia
9. Tab . clopilet clopidogr
el
75mg O OD Antiagrregat
ory
Hypotension ,
dizziness
10. Tab . atocor Atorvosta
tin
40mg O OD Statins Diarrhea , nausea
, UT infection
11. Tab .gemer Glimiprid
e &
metformi
n HCL
1mg
500mg
O BD Sulphonyl
urease
Hypoglycemia ,
dizziness
12. Tab. oxra Dapaglifl
ozine
10mg O OD SGCT-1
INHIBITOR
Constipation ,
extemity pain
13. Tab.lupiheme Heme
iron
polypepti
de
10mg O BD Iron
suppliment
Facial edema ,
difficulty
breathing
14. Tab. ultracet Tramadol
hcl &
acetamin
ophen
10mg O BD Analgesic Vomiting, anxiety,
sweating

15. Drug interactions;
MAJOR;
• Dalteparin - clopidogrel
• Increase the risk of bleeding
• Management ; if complications are seen then
discontinue the antiplatlet drug
• Clarithromycin - atorvostatin
• Joint pain , skin rash, fever

16. Moderate ;
• Clarithromycin – dapagliflozin
• It may lower the blood sugar levels, headache, weakness
• Management ; regular monitoring of blood sugar levels and
given
• Clopidogrel- pantoprazole
• Decreases the activity of clopidogrel
• H2 receptor antagonist is substituted if an interaction is
suspected
• Glimipride- dapagliflozin
• Lower blood sugar levels, headache, dizziness , palpatations
• Management; if interaction is seen decrease the dose of
antidiabetic drug

17. Moderate;
• Atorvostatin-clopidogrel
• May have blood clots, chest pain, SOB,
swelling
• Monitor the efficacy of clopidogrel
• Clarithromycin-tramadol
• Electrolyte imbalance

18. Patient counselling;
• About Disease :
• The patients having this disease should avoid high fat containing
food
• About drugs
• Tramadol , tolvaptan should be taken with glass full of water
• Clopidogrel , atorvostatin should be taken with or with out food
• Glimipride taken with break fast
• Antiplatelet drugs taken with plenty of water as prescribed by
physician
• Pantaprozole should be taken after meal

19. Life style modifications

20. Thank you