CASE PRESENTATION

1. PRESENTED BY
KAVIYA AP
DOCTOR OF PHARMACY
DEPARTMENT OF PHARMACY PRACTICE
SRM COLLEGE OF PHARMACY, SRM INSTITUTE OF SCIENCE & TECHNOLOGY, KATTANKULATHUR
CASE PRESENTATION ON
DIABETES CARDIOMYOPATHY

2. SUBJECTIVE EVIDENCE
2
NAME Mr.X
AGE 55 Years
GENDER Male
WEIGHT / HEIGHT 68 kg / 168 cm
BMI 24
MARITAL STATUS Married
OCCUPATION Engineer
DEPARTMENT Cardiology
D.O.A / D.O.D 07.06.19 /16.06.19
TOATL NO.OF STAY 9 Days

3. REASON FOR ADMISSION Breathlessness
Squeezing
Heartburn
Coldsweat Since morning
HOPI Nausea, indigestion
PAST MEDICAL HISTORY Hypertension x 5 years
Diabetes mellitus type II x 5 years
PAST MEDICATION HISTORY T.Glycomet 500mg
T.Propanolol 20mg
PERSONAL HISTORY Mixed diet
Occasional drinks
Non- smoker
Psychological – normal
FAMILY HISTORY PARENTS - Hypertension
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4. 4
GENERAL EXAMINATION PHYSICAL EXAMINATION
Temperature : 98.6 F
BP : 120/80 mm Hg
PR : 68 beats/min
RR : 22 cycle/min
SYSTEMIC EXAMINATION
CVS : S1S2 +
CNS : NFND
RS : NVBS
P/A : soft , no bowel sounds
INVESTIGATIONS DONE •Complete blood count
•Liver function test
•Renal function test
•Urine test
•ECG

5. HEMATOLOGICAL TEST
Hb 14 13-17 g/dl
PCV 42 40-50 %
MCV 83 83-101 fl
MCH 27 27-32 pg
Total RBC 3.9 3.8-4.8 millions/cmm
WBC 7360 4000-10000 cells/cumm
Neutrophil 65.4 40-80%
Platelet count 2.0 2.0-4.0 lakhs/cumm
ESR 18 0-20 mm/hr
RBS 207 70-140 mg/dl
FBS 170 70-110 mg/dl
HbA1C 5.9 4.5-6.0 mg/dl
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OBJECTIVE EVIDENCE

6. 6
RENAL FUNCTION TEST
Creatinine 1.4 0.6-1.2 mg/dl
Urea 31 7-20 mg/dl
Sodium 139 135 -145 mEq/L
Chlorine 108 97 -107 mEq/L
LIPID PROFILE TEST
Cholesterol 220 200 –239 mg/dl
HDL 44 40- 60 mg/dl
LDL 167 130-159 mg/dl
Triglycerides 205 150-199 mg/dl

7. 7
08/06/19
12/06/19
ECG
ECHO
PAIN ASSESSMENT :
PROCEDURE :
CORONARY
ANGIOGRAM
Left axis deviation
Incomplete RBBB
Global hypokinesia
Severe LV dysfunction
MR mild
No pain - 0
The study reveled distal left main with multi
vessel disease and advised patient and
attenders to do CABG.

8. ASSESSMENT
FINAL DIAGNOSIS :
DIABETES CARDIOMYOPATHY
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9. PLAN
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THERAPEUTIC GOALS
• To maintain the normal blood sugar levels.
• To enable the patient symptoms free.
• To prevent the progression of the disease and its complications.
• To improve the quality of life of the patient.

10. 1. Inj. LASIX
FUROSEMIDE
20mg IV BD DAY 1-9
2. T. CLOPILET
CLOPIDOGREL
75mg oral OD DAY 1-9
3. T.FLAVEDON
TRIMETAZIDINE
35mg oral BD DAY 1-9
4. T. ATORVASTATIN 20mg oral HS DAY 1-9
5. T.NITROCONTIN
NITRO GLYCERIN
2.6mg oral BD DAY 6-9
6. T.CARDIVAS
CARVEDILOL
3.125mg oral BD DAY 6-9
7. T.RANTAC
RANITIDINE
150mg oral BD DAY 6-9
8. T.ANXIT
ALPRAZOLAM
0.25mg oral HS DAY 8-9
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MEDICATION CHART

11. PHARMACIST INTERVENTION
S.NO DRUG NAME DOSE ROA FREQ DAYS
1. T. ATORVASTATIN 20mg Oral HS DAY 1-9
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 PRESCRIPTION ERROR :
Statins will increase the sugar level in blood. Therefore it is better to
administer other class of lipid lowering drug to the patient.
Eg. Niacin 50-100mg PO
 MISSED DRUG :
Pt had a complaint of nausea and vomiting sensation.
Addition of ondansetron-4mg may relieve from his symptoms.

12.  DRUG - DRUG INTERACTIONS :
Moderate
Furosemide + Carvedilol
Carvedilol increase the effect of furosemide and decrease the
potassium level in the blood. Monitor closely serum potassium level.
 DRUG – DISEASE INTERACTIONS:
HMG CoA REDUCTASE ENZYME INHBITORS + DIABETES
Increase in HbA1c and fasting serum glucose levels.Alternate drug
must be used.
 DRUG – FOOD INTERACTION :
Carvedilol + caffeine
Avoid taking coffee along with T.Carvedilol
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13. DISCHARGE SUMMARY
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1. T. CLOPILET 75mg oral OD
2. T.FLAVEDON 35mg oral BD
3. T. ATORVASTATIN 20mg oral HS
4. T.NITROCONTIN 2.6mg oral BD
5. T.CARDIVAS 3.125mg oral BD
6. T.RANTAC 150mg oral BD
7. T.ANXIT 0.25mg oral HS
The patient and attender wanted to get discharged and come again
later. The patient was discharged with following medications.

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15. DISEASE COUNSELING
 Diabetes cardiomyopathy is a disorder of the heart muscle in the
people with diabetes.
 It can lead to inability of the heart to circulate blood throughout the
body effectively.
 Treating the initial problem early can prevent the complication of the
disease.
 Following a healthy diet with low glycemic index can lower the blood
sugar level.
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16. DRUG COUNSELING
 Follow 4S in drug meditation : Do not share,stop, skip and sum the doses
of the prescribed drugs.
 A pill organizer or pill container is best way for medication adherence
and keeping alarm can help patient to take medications at correct time.
 Do not take T.Furosemide more than it is recommended.
 T.Nitrocontin can cause dizziness. Do not drive or operate heavy machinery
while taking this drug.
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17. DIET COUNSELING
 To combat the dawn phenomenon, eat high fiber and low fat snack before
going to bed like wheat crackers or an apple.
 Diabetes can lead to low hemoglobin concentration. Therefore eat foods
rich in Iron content- dates,greens,broccoli and dry fruits.
 Eat foods with heart healthy fats : olive oil and tuna fish(soorai) and salmon
fish(sankara)
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18.  Limit foods and drinks that includes saturated fats,high in sodium,
beverages with added sugars.
 Make every meal well balanced :The key for eating diabetes is to eat a
variety of heathy foods from all food groups,
 Vegetables – Starchy : potatoes , corn.
 Non starchy : carrot ,greens, peppers.
 Fruits : orange, lemon , berries, bananas.
 Grains : wheat , rice ,oats.
 Protein : fish , eggs , dried peas.
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19. Plate method
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• Use a nine inch plate.
• Fill half of the plate with non-starchy foods.
• Fill one quarter of plate with whole grain or starchy foods and
remaining quarter with lean protein foods.
• Patient can also have one glass of milk and few parts of fruits in bowl.

20.  Lower high blood pressure- limit salt intake in diet
 Be physically active everyday- exercise 15 mins a day.
Walk at least 10 mins a day.
 Aim for healthy weight – do not eat food that increase
your weight.
 Manage diabetes – follow sugar controlled diet
 Reduce stress – do meditation to relieve from stress.
 Limit alcohol – cessation of alcohol is good for heart.
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LIFESTYLE MODIFICATION

21. TO CONTROL SUGAR
 Sleep at right time : If amount of sleep decreases, blood sugar level
increases. So sleep for 8-10 hours for normal functioning of body and
also for the production of RBCs.
 Coconut a week : It maintains blood sugar and A1c and its a good
source of magnesium which may increase insulin sensitivity and
reduce blood sugar level.
 Get body hydrated : Drink enough water to keep body hydrated and
it helps body in eliminating excess of glucose from the body.
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22. TO PREVENT FURTHER COMPLICATIONS :
 Candy in a pocket : Whenever there is giddiness , eat a candy to
overcome it.
 Vision test : A comprehensive eye exam should be taken to check
the functioning of eyes and to avoid cataract and other vision
problems.
 Regular checkup : get regular checkup in hospital for every three
months.
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23. For drug dose , drug interactions and patient counseling :
Secondary source:
Pharmacotherapy handbook – 9th edition by Joseph.T.Dipiro
BNF 76
Teritary source :
 www.mayoclinic.org
 www.micromedex.com
 www.wemmd.com
 www.healthline.com
 www.medscape.com
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REFERENCE

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