The document summarizes the medical history and hospital course of a 52-year-old male patient admitted with weakness on the left side of his body and loss of speech. He was diagnosed with a cerebrovascular accident (CVA) or stroke in the right side of the brain based on his symptoms and a CT scan showing an infarct in the right occipital region. He had a history of hypertension. Over five days in the hospital, he was given treatments including mannitol, phenytoin, antibiotics, amlodipine, and aspirin to control his blood pressure, prevent seizures and infection, and reduce stroke risk. His vital signs and lab results improved before being discharged.

1. BY
RUMANA HAMEED
170310820021
PHARMD 5TH YEAR
MESCO COLLEGE OF PHARMACY

2. NAME: XYZ AGE: 52YRS
SEX:MALE IP NO: 22120
OCCUPATION: Daily wage earner
ADDRESS:KARIMNAGAR
DOA: 05-05-2015

3.  COMPLAINS:
c/o weakness of left upper and lower limb assosiated
with loss of speech.
 HISTORY OF PRESENT ILLNESS:
Patient was apparently asymptomatic 5 days back,
patient experienced focal seizure of left upper limb
since 5 days. And developed unconsciousness, weakness
of left upper limb and deviation of face on right side.
Patient was hypertensive (since 2 months).

4. H/O Hypertension since 2months on Amlodipine
5mg BD.
No h/o siezures/head injury/fever.
Personal History:
Smoker since 20 years.
Family History:
Nil significant

5. VITALS
Day1 Day 2 Day 3 Day 4 Day 5
PULSE RATE
(PER MIN)
82 82 84 88 72
BLOOD PRESSURE
(MMHG)
110/70 120/70 120/80 130/80 130/70
TEMPERATURE N N N N N

6.  PROVISIONAL DIAGNOSIS:
CVA with Right Hemiplegia with HTN.
LABORATORY INVESTIGATIONS
Biochemical: Hematological:
RBS : 120 mg/dl WBC Count: 6,400
S. urea: 30 mg/dl N: 67
S. Cr: 1.0mg/dl M: 1
Na+: 135 meq/L E: 2
K+: 4.1 meq/L Hemoglobin: 12.5 mg/dl

7.  CT Scan of Brain :
ill defined hypodensity noted in right
occipital region, right caudate, right
centrum semiovale--- chronic infarct.

8. FINAL DIAGNOSIS
CVA with Right Hemiplegia.
CLINICAL PHARMACIST ASSESMENT
Based on CT SCAN of BRAIN and Physical
examination the disease was diagonised
as
CVA with Right Hemiplegia with HTN.

9.  In the management of patient condition, firstly
patient mental condition, and HTN is controlled,
which is followed by Antibiotics to prevent the
secondary infection and ultimately normalizing
of all elevated or decreased biochemical and
hematological parameters till the patient is
stable and all parameters return to normal
limits.

10. Formula
tion
Drugs Generics Dose Route frequen
cy
Day
1
Day
2
Day
3
Inj 20%Mannitol mannitol 100ml Iv TID Y Y Y
INJ EPTOIN PHENYTOIN 100MG IV TID Y Y Y
INJ MONOCEF CEFTRIAXONE 1GM IV BD Y Y Y
TAB AMLODIPINE AMLODIPINE 5mg PO BD Y Y Y
TAB ATORVAS ATORVASTATIN 20MG PO OD Y Y Y
INJ RANTAC RANITIDINE 50MG IV BD Y Y Y
INJ BC B COMPLEX 1TAB PO OD Y Y Y
INJ CITICOLINE CITICOLINE 500MG IV BD Y Y Y
TAB ASPIRIN ASPIRIN 150MG PO OD Y Y Y

11. Disease State:
CVA: It is characterized by sudden loss of blood circulation to an area
of brain, resulting in a corresponding loss of neurologic function.
Life Style Modifications:
Quit Smoking
Take medication regularly.
Do not discontinue medication abruptly.
Reduce salt intake
Do not take stress
Maintain Hygienic conditions
Mild aerobic exercise
Regular monitoring of BP and frequent check ups.

12.  Mannitol:osmotic diuretic,decreases the intra
cranial pressure.
 Phenytoin:Antiepileptic
 Monocef:Antibiotic
 Amlodipine:AntiHTN
 Citicoline:Neuroprotective
 Aspirin:Antiplatelet
 Atorvastatin:Anti hyperlipidemic

13. There are no serious/ harmful interactions
in the plan.
Minor interaction is seen with Ranitidine-
Phenytoin.
Ranitidine increases the levels of phenytoin
by decreasing its metabolism.

14. Why statins are given at night?
They act by inhibiting the enzyme HMG CoA
reductase, which controls synthesis of
cholesterol in the liver.
Cholesterol synthesis appears to occur mostly
at night, so statins are usually taken at night
to maximize their effect