Case Presentation on

Hypertension with stroke

MODERATOR
DR.MANGALA LAKHAR
CHIEF ACADEMIC COORDINATOR
NIPER GUWAHATI

PRESENTED BY
MUDASIR MAQBOOL
DEPARTMENT OF PHARMACY
PRACTICE
NIPER-GUWAHATI 1
 Demography

Name of Patient – R.P.

Age - 70 yrs
Sex – Male
Ward- Trauma
Bed Number-11
Hospital Number-546743/15
DOA - 22/04/15
DOD - 24/04/15

2
Present complaints:

 Weakness

 Numbness in both upper and lower limb

 Restlessness

 Slurred speech

3
Social History :
Non alcoholic
Non smoker
Vegetarian

Family History: None

4
Past medical history -
Hypertension from last 2-3 years.

Past medication history-

Oral antihypertensive medication (Tab. Nicardia
retard 20) o.d. from last 2-3 years but not taking
from last 2 months.

5
Examination findings
 CNS EXAMINATION
 Consciousness along with slurred speech.
 Weakness and numbness on right side of the
body.
Date Pulse BP
22/04/15 70/min 210/90 mmHg

23/04/15 80/min 110/70 mmHg

24/04/15 80/min 140/80 mmHg

6
 Lab Investigation
 Random blood sugar – 77.92 mg/dl (normal: 70-140
mg/dl)

 Serum creatinine – 1.31 mg/dl (normal: 0.6- 1.4

mg/dl)

 ECG – ST segment abnormality consider left

ventricular hypertrophy

 CT scan – Left basal ganglia infarct.

7
Diagnosis

Hypertension with stroke

 Medication details

S. Medication Dose Std. Frequency Route Date

no dose
(mg)
22 23 24

1 Tab.Nicardia 20 mg 30-60 o.d. oral y y y

retard
(Nifedipine)

2 Tab.Losar H 50mg 50 o.d. oral y y y

(Losartan + +12.5mg
Hydrochlorthiaz
ide)
3 Inj .Lasix 40 mg 40-80 o.d. i.v. y _ _
(Furosemide)

4 Tab. Atorac 10 mg 10 o.d. oral y y _

(Atorvastatin)
9
5 Tab.Antiplar 75mg 75 o.d. oral y y y
(Clopidrogrel)
S. Medication Dose td. Frequency Route Date
no dose
(mg)
22 23 24

6 Inj.Mannitol 100 ml 100- t.i.d. i.v. Y y y

200ml

7 Tab.Somazina 500 mg 500 b.d. Oral y y y

(Citicholine)

8 Tab.Neurobion 500 mg 500 o.d. Oral y y y

Forte ( Multi
Vitamins)

9 Inj.Fragmin 5000 5000- b.d. s.c. y y y

(LMWH) unit 10000
units

10 Tab.Rantac 150 mg 150- o.d. Oral y y _

(Ranitidine) 600
10
 Post medication
Tab. Nicardia retard (Nifedipine 20 mg ) o.d. for 15 days

Tab. Losar H (Losartan50 mg + HCTZ 12.5 mg) o.d. for15 days

Tab. Atorac (Atorvastatin 10 mg) o.d. for 15 days

Tab. Antiplar (Clopidrogrel 75 mg) o.d. for 10 days

Tab. Somazina (Citicholine500 mg) b.d. for 10 days

Tab. Neurobion Forte ( Multi Vitamins) o.d. for 10 days

11
 Pharmaceutical issues

 Calcium channel blockers and diuretics are used

clinically in combination for their additive
antihypertensive effects but care is required to avoid
hypotension.

 Combination of losartan and furosemide produces a

significant and useful additional reduction in blood
pressure.

12
 Losartan and mannitol in combination may result in
marked decrease in GFR and cause acute renal failure in
diabetic patient.

 Ranitidine when combined with furosemide, increases it’s

bioavailability.

13
 A pharmacodynamic interaction is possible between
clopidogrel and heparin, leading to increased risk of
bleeding and thus concurrent use should be undertaken
with caution.

 Atorvastatin may competitively inhibit the activation

of clopidogrel both are metabolized by isoenzyme
CYP3A4.

14
 Patient counseling
 Avoid too much coffee, cola, tea. Since caffeine has
shown too raise the blood pressure.

 Take sugar & salt restricted diet.

 Check your weight at least twice a week.

 Blood pressure may be taken at home, records that are

kept should be received periodically by the doctor.

15
 Medication must be taken every day, most likely for
the rest of your life.

 If you forgot a dose, do not take it later, never take

two doses at a time.

 If dizziness is experienced, you should lie down or sit

with your head down for a few minutes. The dizziness
will usually go away.

 If you experiences any side effect from medication

prescribed by physician, he must inform the physician.

16
 y o u
a nk
Th
17