CASE PRESENTATION ON CAD-UNSTABLE

ANGINA, HYPOKALEMIA, PARONYCHIA

PRESENTED BY-
BUSHRA SABA
170715882020
PHARM D IV YEAR
 DEFINATION-
Unstable angina is a condition in which your heart
doesn’t get enough blood flow and oxygen. It may
lead to a heart attack.
Angina is a type of chest discomfort caused by poor
blood flow through the blood vessels (coronary
vessels) of the heart muscle (myocardium).
 ETIOLOGY-
The most common cause of UA is due to coronary
artery narrowing caused by a thrombus that develops
on a disrupted atherosclerotic plaque and is usually
non occlusive.
 SYMPTOMS-
 chest pain that feels crushing, pressure-like, squeezing, or sharp
 pain that radiates to your upper extremities (usually on the left
side) or back
 nausea
 shortness of breath
 dizziness
 unexplained fatigue
 RISK FACTORS-
 Men 45 years and older and women 55 years and older are more
likely to experience unstable angina.
 diabetes
 Obesity
 Smoking
 PARONYCHIA
Paronychia is an infection of the skin around your fingernails
and toenails. Bacteria or a type of yeast called Candida
typically cause this infection. Bacteria and yeast can even
combine in one infection.
ETIOLOGY-
There are multiple causes of both acute and chronic
paronychia. The underlying cause of each is bacteria,
Candida yeast, or a combination of the two agents.
SYMPTOMS-
redness of the skin around your nail, tenderness of the skin
around your nail, pus-filled blisters, changes in nail shape,
color, or texture, detachment of your nail.
SUBJECTIVE
A 50 Years old female patient was admitted in
cardiology department on 6-9-18 with chief
complaints of fever with chills, pedal edema and
shortness of breath since 3 days.
 HISTORY OF PRESENT ILLNESS-
Patient was apparently asymptomatic 3 days back
until she developed fever associated with chills,
swelling of right middle finger of hand and SOB.
 PAST HISTORY-
Known case of Hypertension, is on tablet stamlo
(Amlodipine) 5 mg since 8 years.
 OBJECTIVE

TEST FINDINGS NORMAL ECG-

VALUE
Non specific T Wave
Serum 2.6 m mol/lit 3.5-5.0 m
potassium mol/lit abnormality and QR
chloride 109 m mol/lit 95 – 105 m pattern in V1 suggests
mol/lit
potassium 3.2 m mol/lit 3.5 – 5.0 m
right ventricular
mol/lit conduction delay
 FINAL DIAGNOSIS-CAD-Unstable angina,
hypokalemia, paronychia, Bifasicular block.
ASSESSMENT
PROBLEM 1-To prevent the formation of blood clot
MEDICATION- Inj Heparin 5000u TID
 Tab Ecospirin(Aspirin)150mg TID
 Tab Clopitab (Clopidogrel)150mg OD
PROBLEM 2-To decrease the risk of GI Bleeding
MEDICATION- Inj Pan (Pantoprazole)40mg OD
PROBLEM 3- Bacterial Infection
MEDICATION- Inj taxim(Cefotaxime) BD
PROBLEM 4-fever
MEDICATION-Tab dolo(acetaminophen)650mg OD
PROBLEM 5-Decreased potassium level
MEDICATION- Syrup potkolar (potassium chloride) 2
tspn TID
PROBLEM 6-To lower cholesterol level.
MEDICATION-Tab Rosuvas (Rosuvastatin)20mg OD
PROBLEM 7- To prevent attacks of chest pain
(angina)
MEDICATION-Tab sorbitrate (Isosorbide
dinitrate)10mg TID
PROBLEM 8-Sleepliness
MEDICATION- Tab Restyl (alprazolam)0.5mg OD
TREATMENT CHART
BRAND GENERIC NAME DOSE ROU FRE D D D D D D
NAME TE Q A A A A A A
Y Y Y Y Y Y
1 2 3 4 5 6
Inj. Heparin Heparin 5000u IV TID      

Inj pantocid Pantoprazole 40mg IV OD      

Inj. Taxim Cefotaxime 1gm IV BD      

Tab. Aspirin 150mg PO TID      

Ecospirin

Tab. Clopitab Clopidogrel 150mg PO OD      

BRAND NAME GENERIC NAME DOSE ROU FR D D D D D D
TE EQ A A A A A A
Y Y Y Y Y Y
1 2 3 4 5 6

Tab. Sorbitrate Isosorbide dinitrate 10 mg PO TID      

Tab. Rosuvas Rosuvastatin 20 mg PO OD      

Tab. Dolo Paracetamol 650 mg PO SOS      

Syrup. Potkolar Potassium chloride 2 tbsp PO TID      

Tab. Restyl Alprazolam 0.5 mg PO OD      

 DAY 01
O/E- pt is c/c/c.
C/O-Fever with chills, SOB,Pedal edema
DAY 02
O/E- pt is c/c/c.

DAY NOTES-

VITALS DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6

TEMP 101 99 98.6 98.6 98.6 98.6

BP(mm/hg 100/70 110/70 110/80 120/80 120/80 110/70

)
DAY NOTES
PR(b/min) 82 90 82 84 88 89

RR(/min) 18 18 15 18 18 19
DAY 01-
O/E-patient is c/c/c,oriented.
C/O-fever with chills, pedal edema, SOB
DAY 02-
O/E-patient is c/c/c, oriented
C/O-mild chest pain
DAY 03-
O/E- Patient is c/c/c, oriented, vitals are stable
C/O- Headache, giddiness, sleepless night.
DAY 04-
O/E- Patient is c/c/c, oriented, vitals are stable
No chest pain, No headache, Symptoms are
better
DAY 05-
O/E- patient is conscious, coherent, vitals are
stable
No fresh complaints, decreased SOB
DAY 06-
O/E- Vitals are stable, no fresh complaints
 pt. can be discharged
PLAN
Tab. Clopitab (Clopidogrel)----------150mg OD
Tab. Sorbitrate (Isosorbide dinitrate)--5mg TID
Tab Rosuvas(Rosuvastatin)-----------20mg OD
Tab Ecospirin (Aspirin)----------150mg OD
Tab Restyl (Alprazolam)---------------0.5mg OD
 PHARMACIST INTERVENTIONS
BENEFICIAL EFFECTS
 Heparin + Aspirin
 heparin and aspirin both increase anticoagulation. Modify
Therapy/Monitor Closely.
 Aspirin + Potassium chloride
 aspirin and potassium chloride both increase serum potassium.
Modify Therapy/Monitor Closely.
 Heparin + Clopidogrel
 heparin, clopidogrel. Either increases effects of the other by
pharmacodynamic synergism. Modify Therapy/Monitor Closely.
MINOR
 Acetaminophen + Heparin
 acetaminophen increases effects of heparin by unknown
mechanism. Minor/Significance Unknown.
 PATIENT COUNSELLING
 REGARDING DISEASE-
 Unstable Angina is a type of chest discomfort and usually occurs
while resting ,caused by poor blood flow to the heart muscle.
 Paronychia is a skin infection around the fingernails or toenails. It
usually affects the skin at the base (cuticle) or up the sides of the nail.
 REGARDING MEDICATIONS-
 The patient was explained about the medication adherence for
effective treatment of disease.
 If the dose is missed take as soon as u remember.
 Do not take extra dose to makeup for a missed dose.
 Avoid skipping dose when feeling better.
 Ecospirin should be taken immediately after a meal to reduce the risk
of acid reflux and gastric bleeding.
 LIFE STYLE MODIFICATIONS
 Keep your infected finger clean and dry at all times.
 Rub lotion into your nail folds.
 Keep your nails short. Do not bite your nails, pick at your
hangnails or suck your fingers.
 Eat a heart-healthy diet to lower your blood pressure and
cholesterol levels.
 Eat mainly fruits and vegetables, whole grains, fish, lean meat,
and fat-free or low-fat dairy. Limit salt, fat, and sugar.
 Keeping yourself active by doing exercise.
 You should stop if you feel pain / severe breathlessness.
 Managing stress levels by doing meditation, deep breathing, or
yoga to relax.