The document discusses COPD, corpulmonale, and PAH. It defines each condition and describes symptoms, causes, and standard treatment protocols. COPD is a progressive lung disease causing shortness of breath. Corpulmonale occurs when the right side of the heart fails due to long-term high blood pressure in the lungs. PAH means high blood pressure in the lungs causing the heart to work harder over time. Standard treatments include medications, oxygen therapy, and lung transplantation to control symptoms and reduce risks. The document also includes a case study of a patient with COPD, corpulmonale and PAH who was admitted and discharged with a treatment plan.

1. COPD, CORPULMONALE,
PAH
PRESENTED BY:
HASHIM SYED ALI ABBAS H
HT NO: 170312882029
Pharm-D 6TH Year
MESCO COLLEGE OF PHARMACY. .

2. .
, .COPD, or chronic
obstructive pulmonary
disease, is a progressive
disease that makes it hard
to breathe.
SYMPTOMS:
 Shortness of breath
 Cough
 Sputum production
 chest tightness

3. .
CORPULMONALE:
 Corpulmonale is a
condition that causes
the right side of the
heart to fail.
 Long-term high blood
pressure in the
arteries of the lung
and right ventricle of
the heart can lead to
corpulmonale.

4. .
CAUSES:
 Chronic obstructive pulmonary disease
 Chronic blood clots in the lungs
 Cystic fibrosis
 Scarring of the lung tissue (interstitial lung disease)
 Severe curving of the upper part of the spine (kyphoscoliosis)
 Obstructive sleep apnea, which causes stops in breathing because
of airway inflammation
SYMPTOMS:
 Fainting spells during activity
 Chest discomfort, usually in the front of the chest
 Chest pain
 Swelling of the feet or ankles
 Symptoms of lung disorders, such as wheezing or coughing
 Lips and fingers that turn blue (cyanosis)

5. .
PULMONARY HYPERTENSION(PAH):
 Pulmonary hypertension (PH) is high blood pressure in the arteries to
lungs.
 It is a serious condition.
 The blood vessels that carry blood from heart to lungs become hard
and narrow.
 Heart has to work harder to pump the blood through.
 Over time, heart weakens and cannot do its job and can
develop heart failure.
SYMPTOMS:
 Shortness of breath during routine activity, such as climbing two
flights of stairs
 Tiredness
 Chest pain
 A racing heartbeat
 Pain on the upper right side of the abdomen
 Decreased appetite

7. .
SUBJECTIVEDATA:
Name Of The Patient: Md. Mahboob
Age: 68.
Occupation: Shopkeeper
IP NO: 15868l15
Address With Ph. NO: kishanbagh, 9352277867.
Date Of Admission: 29-04-2015.
Date Of Discharge: 05-05-2015.
COMPLAINTS:
 SOB:since 4 days(Grade2 dyspnoea)
 Cough with sputum
 Pedal edema:since 6 months
 Loss of appetite
 General weakness

8. .
PAST HISTORY:
 HYPERTENSION SINCE 30 YEARS
 RV DYSFUNCTION SINCE 1 YEAR
 COPD SINCE 5 YEARS
FAMILY HISTORY:INSIGNIFICANT

9. ,
OBJECTIVE DATA:
ROUTINE
BIOCHEMICAL
INVESTIGATIONS
HAEMATOLOGICAL
INVESTIGATIONS
B.Urea:32 WBC:14800 B:02%
S.creatinine:1.1 N:80% PLT:Adequate
Na:144meq/L L:16% Hb:11%
K:4.4meq/L M:01%

10. .
2D ECHO REPORT:
o Good LV systolic function
o Grade 2 diastolic dysfunction
o RV dysfunction
o Severe TR/moderate PAH
o Dilated RA,RV
o EF%-37%

11. .
CT SAN OF CHEST:
Bilateral minimal pleural effusion.
Dilated main pulmonary
artery(33mm).
Cardiomegaly.
Few cystic lesions noted in right
upper lobe.

12. .
ASSESMENT
COPD : known case
CORPULMONALE:
2D ECHO:
o Grade 2 diastolic dysfunction
o RV dysfunction
o Severe TR/moderate PAH
o Dilated RA,RV
o EF%-37%
PAH:
CT SCAN OF CHEST:
• Bilateral minimal pleural effusion
• Dilated main pulmonary artery(33mm)
• Cardiomegaly
• Few cystic lesions noted in right upper lobe

13. .
PLANNING
DAY1:
Pulse rate:80beats/min
B.P:130/90
Respiratory rate:18
Temperature:98.5F
TREATMENT CHART:
FORMULA
TION
DRUGS GENERIC DOSE ROUTE FREQUENCY
CAP AMOXYCILLIN CLAV AMOXICILLIN CLAVULANIC
ACID
620mg P/O TID
TAB AZITHRAL AZETHROMYCIN 500mg P/O B.D
INJ PAN PANTAPRAZOLE 40mg IV O.D
TAB LASIX FUROSIMIDE 40mg P/O O.D
TAB ASPIRIN ASPIRIN 75mg P/O O.D
TAB ATORVAS ATORVASTATIN 20mg P/O O.D
OXYGEN INHALATION
WITH PROPPED UP
POSITION

14. .
FORMULATIO
N
DRUGS GENERIC DOSE ROUTE FREQUENCY
NEBULISATI
ON
ASTHALIN SORBUTAMO
L
5mg/2.5ml INTRANASAL EVERY 4TH
HOURLY
TAB LOAL-HL LOSARTAN+
HYDROCHLO
ROTHIAZIDE
50mg P/O O.D

15. .
DAY2:
PULSE RATE:120
B.P:149/90
RESPIRATORY RATE:28
TEMPERATURE:98.5F
STOP OXYGEN INHALATION
CST
DAY3:
PULSE RATE:90
B.P:100/70
RESPIRATORY RATE:22
TEMPERATURE:98.5F
CST

16. .
DAY4:
PULSE RATE:90
B.P:100/70
RESPIRATORY RATE:22
TEMPERATURE:98.5F
CST
DAY5:
PULSE RATE:90
B.P:100/70
RESPIRATORY RATE:22
TEMPERATURE:98.5F
 ADD TAB PANTAPRRAZOLE 40mg O.D
 ADD TAB B COMPLEX O.D
 TAB SALBUTAMOL 2mg B.D
 TAB DIGOXIN 0.25mg O.D
 TAB CIFRAN(CIPROFLOXACIN) 500mg O.D
STOP CAP AMOXYCLAV,TAB AZITHRAL,INJ PAN
CST

17. .
DAY6:
PULSE RATE:80
B.P:110/80
RESPIRATORY RATE:22
TEMPERATURE:98.5F
CST

18. .
DISCHARGE SUMMARY:
 TAB ASPIRIN-75mg O.D(2P.M)
 TAB DIGOXIN-0.25mg O.D(AT NIGHT)
 TAB ATORVAS-40mg O.D(AT NIGHT)
 TAB SALBUTAMOL-2mg B.D
 INHALER BUDECORT(BUDESONIDE)-2PUFFS B.D
 TAB CIFRAN(CIPROFLOXACIN)-500mg B.D
 TAB LOSARTAN+HYDROCHLOROTHIAZIDE-50mg
O.D(MORNING)
 REVIEW AFTER 15 DAYS IN OPD

19. .
INDICATIONS:
 TAB ASPIRIN-antiplatelet given for corpulmonale
& PAH
 TAB DIGOXIN-Ionotropic agent given for
corpulmonale
 TAB ATORVAS-Statin given as prophylaxis for
corpulmonale & PAH
 TAB SALBUTAMOL-BETA2 agonist given for COPD
 INHALER BUDECORT(BUDESONIDE)-
corticosteriod given for COPD
 TAB CIFRAN(CIPROFLOXACIN)-antibiotic
indicated for copd
 TAB LOSARTAN+HYDROCHLOROTHIAZIDE-ARB
THAIZE DIURETIC indicated for corpulmonale

20. .
STANDARD TREATMENT PROTOCOL FOR
CORPULMONALE:
The goal of treatment is to control symptoms.
 Blood thinners to reduce the risk of blood clots
 Ionotropic agents to increase force of contraction
of heart
 Oxygen therapy at home
 A lung or heart-lung transplant, if medicine does
not work

21. .
Standard treatment for PAH:
 There is no cure for PH.
 Treatments can control symptoms.
 They involve treating the heart or lung disease,
medicines,(ARB ,ACEI ,DIURETICS) oxygen, and
sometimes lung transplantation.

22. .
DRUG INTERACTIONS:
HYDROCHLOROTHIAZIDE+DIGOXIN:HCT increases
effects of digoxin by pharmacodynamic
synergism.Significant interaction possible,monitor
closely.
ASPIRIN+LOSARTAN:Aspirin decreases effect of
losartan by pharmacodynamic antagonism.potential for
significant interaction, monitor closely.
ASPIRIN+DIGOXIN:Both increases serum potassium
LOSARTAN+ASPIRIN:Both increases serum potassium
ASPIRIN+CIPROFLOXACIN:Aspirin decreases levels of
ciprofloxacin by inhibiting its absorption
PHARMACIST INTERVENTION:
THE PRESCRIPTION IS FOUND TO BE RATIONAL

23. .
PATIENT COUNSELLING
LIFE STYLE MODIFICATIONS:
 Avoid strenuous activities and heavy lifting.
 Avoid traveling to high altitudes.
 Get a yearly flu vaccine, as well as other
vaccines, such as the pneumonia vaccine.
 If you smoke, stop.
DRUGS:
 Take medicines on time.
 Do not stop any medicine without consulting
your doctor

24. ,
To use an MDI:
 Shake the inhaler well before use (3
or 4 shakes)
 Remove the cap
 Breathe out, away from your inhaler
 Bring the inhaler to your mouth. Place
it in your mouth between your teeth
and close your mouth around it.
 Start to breathe in slowly. Press the
top of your inhaler once and keep
breathing in slowly until you have
taken a full breath.
 Remove the inhaler from your mouth,
and hold your breath for about 10
seconds, then breathe out.
 If you need a second puff, wait 30
seconds, shake your inhaler again,
and repeat steps 3-6. After you've
used your MDI, rinse out your mouth
and record the number of doses
taken.
 Store all puffers at room temperature

25. .
THANK YOU!
For being good audience