The patient, a 45-year-old female, presented with right-sided weakness, vomiting episodes, and left mouth deviation. She has a history of rheumatic heart disease and previous stroke. Laboratory tests revealed elevated liver enzymes and abnormalities in cell counts. She was diagnosed with cerebrovascular accident and hemiplegia due to a previous cardioembolic stroke. Her treatment plan includes anticoagulants, antiplatelets, statins, and physical therapy to manage symptoms and prevent future strokes.

1. CASE ON HEMIPLEGIA
PRESENTED BY:
M.SAI SRUTHI
II/VI PHARM-D
Y17PHD0819
DEPARTMENT OF PARMACY
PRACTICE
NIRMALA COLLEGE OF PHARMACY

2. CASE SUMMARY
•A 45 years old female patient is admitted in the hospital
on 31/10/18 with the chief complaints of right sided
generalized weakness since one month , with vomitings of
10 episodes and left side deviation of mouth. the patient
had a past history of rheumatic heart disease.
•The above case was presented in the format of SOAP
ANALYSIS.

3. SOAP ANALYSIS
SUBJECTIVE:
A 45 years old female patient is admitted in the hospital with
chief complaints of right sided generalised weakness since one
month,vomitings of 10 episodes and left sided deviation of
mouth.
PAST HISTORY:
k/c/o RHD-MVR with AF(2008)
cardio embolic stroke(R.hemiparesis-2014)

4. PERSONAL HISTORY:
• The patient is taking veg diet.
• The bowel and bladder movement is normal.
• Sleep and appetite is low.
VITALS:
Pulse:92beats/minute
Bp:120/90mm of Hg
spO2:98%
Temperature : normal
Pallor : present

5. OBJECTIVE:
BIOCHEMICAL LAB TESTS:
SNO PARAMETERS OBSERVED VALUES NORMAL VALUES
1. Bilirubin total 2.42mg/dl 0.1 to 1.2mg/dl
2. Bilirubin direct 0.87mg/dl 0.0 to 0.4mg/dl
3. Bilirubin indirect 1.55mg/dl 0.2 to 1.0mg/dl
4. ALP 134IU/L 37 to 98IU/L
5. Plasma glucose 151mg/dl 70 to 140mg/dl

6. COMPLETE BLOOD COUNT:
SNO PARAMETERS OBSERVED
VALUES
NORMAL VALUES
1. Haemoglobin 10.3g/dl 11 to16g/dl
2. MCH 25.6pg 27 to 35pg
3. Neutrophils 88% 50 to 81%
4. Lymphocytes 10% 14 to 44%
5. Monocytes 1% 2 to 6%
6. Prothrombin time 31.4sec 9.5 to 14.0sec

7. OTHER TESTS:
• CVS : mitral click+
2D Echo/colour/doppler report:
RV: Mildly dilated.
LA,RA: dilated.
Severe TR/mild PAH.
Endoscopy report:
Erosive gastritis.

8. ASSESSMENT:
Based on the sujective and objective evidence the diagnosis is that the patient is
suffering from CEREBROVASCULAR ACCIDENT with HEMIPLEGIA.
DEFINITION:Complete paralysis of one half of the body including one arm and leg.
ETIOLOGY:
NON CVA:
Neoplasm
Infections
tauma
Demyelination
CVA:
Thrombus
Embolus
Hemmorhage

9. RISK FACTORS:
NON MODIFIABLE MODIFIABLE
Age > 65 HTN
Sex: M>F Cigarette smoking.
Race : black>white> asian High cholesterole.
Family history of stroke. DM
Obesity.

10. PATHOPHYSIOLOGY:

11. SYMPTOMS:
• Difficulty in swallowing.
• Trouble in vision.
• Speech becomes difficult.
• Numbness , tingling.
• Loss of control over bladder and bowel movement.
• Feeling depressed.
• Memory poor.

12. STANDARD TREATMENT:
• Blood thinners to reduce CV blockages and decrease the chances of future
stroke.
• Antibiotics for brain infection.
• Muscle relaxants.
• Surgery to remove swelling of brain.
• Surgery for muscle contractions,spinal damage,damage to ligaments or
tendons on the unaffected area of the body.
• Exercise therapy to help you remain healthy inspite of your disability.
• Psycotherapy to deal with psycological effects of the disease.

13. PLAN:
MEDICAL:
• Anticoagulant medication-
warfarin.
• Antiplatelet medication-
aspirin.
• Statins-atorvastatin.
• Blood pressure medication.
• Medicines used to treat
depression.
SURGICAL:
• Hemorrhagic-aneurysm
clipping.
• Coil embolization.
• Arteriovenous malfunction
repair.
GOALS:

14. DRUG CHART:
S
n
o
Drug
name
Dose RO
A
Freq Duration Indication Category MOA Side effects Monitoring
parameters
1. T.Lesuri
de
[levosulp
iride]
25
mg
oral OD D2 D3 To relieve GI
complication
Substituted
benzamide
selective antagonist
of dopamine
D2 receptor activity
on both central and
peripheral levels.
Fever , excessive
sweating,gynaco
mastia.
Monitoring
dehydration.
2. Inj.Zofer
[ondanse
tron]
1
amp
Iv 12th hr D2 Antiemetic Serotonin
5-HT3
receptor
antagonist
blocks serotonin. Headache,fatigu
e,constipation,pa
inful urination.
ECG ; K
,Mg,serotonin
syndrome;
decreased bowel
activity.
3. Inj.panto
cid(panto
prazole)
40mg Iv OD D2 To relieve GI
complication
PPI suppresses gastric
acid secretion by
inhibiting the
parietal cell
H+/K+ ATP pump
Headache,skin
rash,nausea,vom
iting,runny nose
,cough.
Bone loss and
fractures,
CDAD,
Mg,serum
gastrin levels
4. T.Torvas
[atorvast
atin]
10mg oral OD D1 D2 Decrease bad
cholesterol
and TG in
blood
HMG CO
A
reductase
inhibitor
HMG-CoA
Reductase Inhibitor
Diarrhea
,cough,runny
nose muscle
pain,joint pain.
Lipid
profile,hepatic,tr
ansaminase,CPK

15. S
n
o
Drug name Dos
e
RO
A
Fre
q
Duration Indication Category MOA Side effects Monitoring
parameters
5. Cap.becela
c forte
[vit
supplement
]
1ca
p
oral BD D1 D2 Gastrointest
inal
disorders,d
ecrease
cholesterol
Vit supplement - Confusion,nausea,
allergic reactions.
Skin reactions
6. T.Fruselac
[spironolact
one(50mg),
Furosemide(
20mg)]
½
tab
oral OD D2 D3 Chronic
cardiac
failure.
Antihypertensiv
e
Diuretic( Loop)
Competes with
aldosterone for
receptor sites
Inhibits Na and
Cl
Irregular heart
beat,headache,wea
kness,skin rash.
serum
electrolytes ,Bp
Monitor I & O ,
serum electrolytes,
renal function
7. T.digoxin.(d
igoxin)
0.25
mg
oral OD D2 Congestive
heart
failure,AF
Antiarrhythmic
Agent
Inhibition of
the
sodium/potassi
um ATPase
pump in
myocardial
cells
Dizziness,
rash,nausea,vomoti
ng.
Heart rate and
rhythm

16. S
no
Drug name Dose ROA Freq Duration Indication Category MOA Side effects Monitori
ng
paramete
rs
8. Tab.rudimin 1tab oral OD D2 Multivitamin,
mulitmineral
Vit
supplement
- Depression,nau
sea,flatulence,al
lergic reactions.
-
9. T.Calaptin
(verapamil)
120m
g
oral OD D2 D3 Arrhythmia,a
ngina.
Calcium
Channel
Blocker
Inhibits calcium ion
from entering the
“slow channels”
Headache ,
constipation ,
dizziness,
nausea,muscle
or joint pain.
Bp,heart
rate
10. T.Acitrom
(acenocoum
arol)
1mg oral OD D1 D2 Anticoagulan
t
Vitamin K
Antagonist
Hepatic synthesis of
coagulation factors
II, VII, IX, and X,
proteins C and S
Dizziness, head
ache, bleeding,
hepatotoxicity.
CBC
11. T.Zolfresh
(zolpidem)
5mg oral OD D3 Hypnotic enhances the activity
of the inhibitory
neurotransmitter
Headache
,dizziness,drow
siness.
Fall risk
,abuse.

17. DRUG INTERACTION:
S
no
Title Interaction severity Risk rating Patient management
1. Levosulpiride /
Loop Diuretics
LD enhance the toxic
effect of Levosulpiride.
moderate Avoid combination Do not combine
2. Verapamil /
AtorvaSTATin
Increase conc moderate Consider therapy
modification
monitor HMG-CoA
reductase inhibitor
toxicity
3. Digoxin /
AtorvaSTATin
AtorvaSTATin may
increase the serum
concentration of Digoxin.
moderate Monitor therapy digoxin toxicity
4. Digoxin /
Spironolactone
Increase conc moderate Monitor therapy Monitor signs digoxin
toxicity

18. S no Title Interaction severity Risk rating Patient management
5. Spironolactone /
AtorvaSTATin
Statin
increase toxic
effect
Moderate Monitor therapy Use with caution.
6. Verapamil/digoxin.
Bradycardia-Causing
Agents
enhance moderate Monitor therapy worsening bradycardia
7. Cardiac Glycosides /
Loop Diuretics
Enhance toxic
effects
moderate Monitor therapy Monitor for increased
cardiac glycoside toxicity
8. Cardiac Glycosides /
Levosulpiride
Levosulpiride
enhance
moderate Monitor therapy nausea, vomiting

19. PATIENT COUNSELLING
• ABOUT DISEASE:
• Plegia -weakness,hemi –one side complete
paralysis of one half of the body ,including one
arm and leg.
• It is caused due to
stroke,thrombus,embolus,hemorrhage,head
injury,infections,migraine syndrome.

20. ABOUT LIFESTYLE:
• Reduce saturated fat and cholesterol.
• Stop smoking and drinking alcohol.
• Maintain healthy weight.
• Eat food rich in veg and fruits.
• Get regular exercise.
• Balance training.
• Electrical stimulation to strengthen muscle.