A 45-year-old male patient presented with a chief complaint of chest pain for one week along with giddiness and palpitations. On examination, he was found to have pedal edema, elevated blood pressure, and abnormal echocardiogram and ECG results. Lab work showed anemia, elevated CK-MB, and abnormal lipid levels. He was diagnosed with inferior wall myocardial infarction, dyslipidemia, hypertension, depression, and anemia. His treatment plan included medications to treat these conditions like aspirin, clopidogrel, atorvastatin, enalapril, ferrous sulfate, alprazolam, and cefotaxime. Counseling was provided on medication

1. CASE PRESENTATION
BY
NIKHIL PETER
PHARM.D .

2. CHIEF COMPLAINTS:
A 45year old male patient got admitted to the hospital with
complaints of chest pain for the past 1 week
H/O giddiness
H/O palpitation
PRESENT ILLNESS :
Cough and expectoration, sputum white in color
Loss of appetite
Insomnia
constipation

3. PERSONAL HISTORY:
Mixed diet
Bowel and bladder normal.
Patient is known smoker and alcoholic for the past 30 years
He take 25 bedi per day
Not A tobacco chewer
Married ,

4. Patient is taking drugs for hypertension for past 2 years
Not a k/c/o DM/PTB/EPILLEPSY
PAST MEDICATION HISTORY
Treated in private hospital and following
drug where prescribed
T.Aspirin 75 mg
T.Clopilet 75 mg
T. Storvas 80 mg
T.Atenolol 50 mg

5. ON EXAMINATION:
Conscious and oriented, A febrile
Pedal edema- present.
Blood pressure- 140/90 mm of Hg
Pulse rate - 78/min
Respiratory rate - 16/min
Spo2 - 98%

6. LAB DATA :
Hemoglobin - 9.8 mg/dl 13-18 mg/dl
Serum sodium – 139 mmol/l 135-145mmol/l
Blood sugar – 88 mg/dl 70-140 mg/dl
Serum chloride- 100mmol/l 96-106mmol/l
Serum urea - 25 mg/dl 15- 40 mg/dl
Serum potassium- 3.8 mmol/l 3.5-5.0mmol/l
Serum creatinine -1.0 mg/dl 0.6- 1.2mg/dl
CK-MB - 34 U/L < 25

7. LIPID PROFILE:
Total cholesterol - 149 mg/dl <200mg/dl
Serum TGL - 165mg/dl <150mg/dl
Serum HDL - 35 mg/dl >30mg/dl
Serum LDL - 142mg/dl <100mg/
Echo report- Grade-II diastolic dysfunction
coronary artery disease

8. THERAPEUTIC MANAGEMENT:
 Inj.Rabeprazole IV OD
 Inj.Cefotaxime IV Bd
 Inj.Enoxaparin 40 Mg S/C Bd
 Tab .Aspirin 150 Mg 0-1-0
 Tab. Storvastatin 40mg BD
 Tab. Multi Vitamin
 Tab. Alprazolam 0.25 Mg 0-0-1
 Syp. Cremaffin 10 ML HS
 Tab. Enalapril 2.5 Mg OD

9. PROBLEMS IDENTIFIED:
 Problem -1 : Anemia
 Problem -2 : inferior wall myocardial infraction
 Problem -3 : dyslipidemia
 Problem -4 : depression
 Problem -5 : hypertension
 Problem -6 :cough and expectoration

10. PROBLEM – 1 : ANAEMIA
S: Anemia
O: From the lab data patient hemoglobin level was found to
be 9.8 g/dl
A: Treatment with Ferrous sulphate can be initiated to
increase hemoglobin levels.
P: Ferrous sulphate 250mg two times a day for 6 months.
INSTRUCTIONS:
Ferrous sulphate should be taken after food.
Tell the patient that Ferrous sulphate causes blackening of
stools.

11. PROBLEM- 2: Inferior wall myocardial
infraction
S: chest pain, giddiness, perspiration
O: From Echo report grade-
II diastolic dysfunction.
Coronary artery disease
ECG report –
ST segment elevation of > I mm above the base line
A: From the lab data patient had been diagnosed with inferior
wall myocardial infraction, smoking is the most likely
causative factor. ACE inhibitors can be initiated to decrease
the Preload and post load of the heart.

12. T. Aspirin 150 mg 0-1-0
T. Clopidogrel 75 mg 0-1-0
T. Ranitidine 150 mg BD
Oxygen supplementation
Newly acquired problem is constipation it may
due to side effect of clopidogrel or
atorvastatin or due to immobility of patient
during hospitalisation
SYP. Cremaffin 10 ml hs

13. PROBLEM-3 : dyslipidemia.
S : Patient had increased lipid levels.
O : From the lab data patient had increased serum
TGL, LDL and Cholesterol levels.
A : Patient needs treatment with antilipidemic
agents like statins
P : Atorvastatin 40mg one times a day.

14. S – patient is known case of hypertension
for past 2 years
O- Elevated blood pressure than the normal
B.P- 140/90 mmHg
A-patient have hypertension, patient discontinued
treatment may lead to elevation of blood pressure,
patient is taking Atenolol 50 mg for past 2 years and
stopped 3 months back
P- Patient should be initiated with Enalapril
2.5 mg two times a day.

15. (1). weight reduction if overweight,
(2). adoption of the Dietary Approaches to Stop
Hypertension eating plan,
(3) dietary sodium restriction ideally to 1.5 g/day
(3.8 g/day sodium chloride),
(4) regular aerobic physical activity,
(5) moderate alcohol consumption (two or fewer
drinks per day),
(6) smoking cessation

16. S- patient is feeling depressed he having the
complaints of lack of energy, loss of appetite and
problems of insomnia
O-none
A-the patient was much anxious about his disease
alprazolam is effective for his anxiety problems
P- Alparazolam O.5 Mg at night
Should monitor changes in appetite, patient
counselling is needed to strengthen his
confidence

17. S- Patient have cough with sputum, whitish in
colour
O- None
A– Culture sensitivity test was not performed
but cefotaxime was given as empirical therapy
Advice to do the culture test
P- SYP AMBROXOL 10 ML SOS

18. Needing pharmacotherapy but not receiving : Yes
Taking or receiving the wrong drug: No
Taking or receiving too little of the correct dose: Yes
Taking or receiving too much of the correct drug: NO
Experiencing an adverse drug reaction: YES
Experiencing a drug-drug or drug-food interaction: YES
Not receiving or taking the drug prescribed: No
Taking or receiving the drug for no valid indication: YES
Indication of therapy not noticed - yes

19. THANKS