A 65-year-old man with heart failure and DKA is admitted to hospital with a potassium level of 7.1 mmol/L. HE was started with Rx lisinopril 20 mg daily, spironolactone 25 mg daily. Insulin Infusion + 5% Dextrose

1. CASE DISCUSSION
SESSION-2
#PharmD
Dr. S P Srinivas Nayak,
PharmD, Rph, (MSc), (Dip.D)
Assistant Professor,
Dept of Pharmacy Practice

2. HYPERKALAEMIA
• Hyperkalaemia(K+ more than 5.5 mEq/L)
CAUSES
• digitalis, beta-2 antagonists, potassium sparing diuretics,
NSAIDs, fluoride, heparin, succinylcholine, drugs producing
acidosis and (ACEI + PSD), DKA, AKI, CKD etc
Manifestations
• abdominal pain, diarrhoea, myalgia, and weakness. ECG
changes, tall peaked T waves, ST segment depression,
prolonged PR interval, and QRS prolongation. In severe
cases there is ventricular fibrillation.
Treatment:
• Glucose, insulin infusion, sodium bicarbonate, and calcium
gluconate. Haemodialysis and exchange resins may be
required.

3. HYPOKALAEMIA
Hypokalaemia (K+ less than 3.5 mEq/L)
CAUSES
• beta2 agonists, theophylline, insulin, chloroquine, caffeine,
dextrose, loop diuretics, thiazide diuretics, oral
hypoglycaemics, salicylates, sympathomimetics, drug-
induced gastroenteritis, and metabolic acidosis.
MANIFESTATIONS
• muscle weakness, paralytic ileus, and ECG changes—flat or
inverted T waves, prominent U waves, ST segment
depression.
• In severe cases there is
A-V block and ventricular fibrillation.
TREATMENT:
Oral or IV potassium.

4. CASE DISCUSSION - 1
• A 65-year-old man with heart failure and DKA
is admitted to hospital with a potassium level
of 7.1 mmol/L.
HE was started with
Rx
• lisinopril 20 mg daily,
• spironolactone 25 mg daily.
• Insulin Infusion + 5% Dextrose
QUESTION:
• Find the possible intervension here

5. Case 2
• A 55-year-old woman who was on warfarin
attends an out-patient clinic with a raised INR.
On questioning it is discovered that she has
recently started taking glucosamine for muscle
and Joint aches for the last 2 weeks.
QUESTIONS
1. Give possible interactions with Warfarin and
patient Counselling.
2. What may be the reason for elevated INR?

7. ANSWER.1
1. Oral anticoagulants × CRAP GPS increase metabolic
clearance of oral anticoagulants and hence decrease the
anticoagulant effect.
2. Warfarin × salicylates/sulphonamides: Warfarin is highly
protein bound. These drugs displace warfarin from
plasma protein binding site, increase the free plasma
concentration and results in bleeding.
3. Warfarin × SICK FACES. COM decrease metabolic
clearance of warfarin and increase anticoagulant effect.
4. Warfarin × tetracyclines: Tetracyclines suppress the
bacterial flora and decrease vitamin K production, hence
potentiate warfarin effect
5. Liver Failure × Warfarin - Bleeding

8. ANSWER.2
• Glucosamine is a popular supplement
purchased for ‘joint health’. It is commonly
used by older patients. Spontaneous reports
of interactions between warfarin and
glucosamine have been submitted.
• Advice patient to use alternative drug for joint
Health.

9. CASE 3
• A 43-year-old lady K/c/o DM2, HTN and dyslepidemia who comes
to GP with sudden sycopial symptoms whose past medication
history was
💊simvastatin 10 mg at night
💊Metoprolol 40mg
💊Tab. Glimepride 2mg BD
💊metformin 500mg TID and
💊aspirin 75 mg daily for the past 4weeks
A week ago her GP added tab. Prazosin 5mg for uncontrolled HTN.
Now, A routine blood test revealed an increase in ALT.
she had no other drug abuse.
Questions
1) what may be reason for elevated ALT
2) Why she might developed syncope