CASE PRESENTATION

ON
ACCELERATED HYPERTENSION

PRESENTED BY : GUIDED BY :
G.JIGEESHA LAKSHMI Ms.P. RATNA KUMARI
M. Pharm
183M1T0012
ASSISTANT PROFESSOR
KORINGA COLLEGE OF PHARMACY
PHARM-D II/ VI YEAR
KORANGI
KORINGA COLLEGE OF PHARMACY
KORANGI
PATIENT DEMOGRAPHIC DETAILS:

• NAME : xxx • IP NO : 5248

• AGE : 52yrs • SEX : MALE
• DOA :17-08-2019 • DOD : 20-08-2019
• DEPT : CARDIOLOGY • HEIGHT : N/A
• WEIGHT : N/A
• BMR : N/A
CHIEF COMPLAINTS:
• c/o severe weakness
• c/o acute headache
• c/o giddiness since 10 days
PAST MEDICAL HISTORY:
• HYPERTENSION SINCE 5 MONTHS

PAST MEDICATION HISTORY:

• NONE
SOCIAL HISTORY:
• SMOKER: NO
• ALCHOLIC : NO
• ALLERGIES : NO
• DIET : MIXED
• MARITAL STATUS : MARRIED

FAMILY HISTORY : NONE

PHYSICAL EXAMINATION:
1. Pallor : No
2. Iceterus: No
3. Cyanosis: No
4. Clubbing : No

LYMPHADENOPATHY:
1. Edema : No
2. Organomegaly : No
3. Thyromegaly: No
GENERAL PHYSICAL EXAMINATION:
• Blood pressure : 230/130 mm of Hg

• Respiratory cycles: 20 cycles/min

• Temperature: 98° F

• Pulse rate : 82 beats/min

• Spo2 : 96% with oxygen

• GRBS : 100 mg %
SYSTEMIC EXAMINATION:
• CVS : S1+, S2+, no thrills and cardiac murmurs

• CNS : Normal

• RS : DYSPNOEA -- NO
WHEEZES -- NO

• GI : Normal
 PROVISIONAL DIAGNOSIS:

ACCELERATED HYPERTENSION?
 ADVICES:
1.complete blood test
2.renal function test
3.electrolytes test
4.lipid profile
5.thyroid profile
6.ultra sound of abdomen
7.MRI brain
8.2Decho & color doppler scan
9.carotid doppler
LABORATORY DATA :
INVESTIGATIONS NORMAL VALUE LAB VALUE 1 (13/11/2019)
Sr.creatinine 0.6-1.1mg/dl 0.83mg/dl

sr. urea 3-8mmol/l 28mg/dl

SODIUM 135-145meq/l 134meq/l

POTASSIUM 5.7meq/l
3.5-5.5meq/l

CHLORIDES 98-107meq/i 107meq/l

HB 11-16.5g/dl 14.0g/dl

P.C.V 35-50% 48.8%

TOTAL COUNT 3500-10000/cum 7300/cum

LEUCOCYTES 15-30 % 24.1%

MONOCYTES 2-10% 0%
LABORATORY DATA :
INVESTIGATIONS NORMAL VALUE LAB VALUE 1 (13/11/2019)
EOSINOPHILS 1-6% 4.3%

BASOPHILS 1- 3% 0%

PLATELETS 1-4lac cell/cum 2.32lac cell/cum

R.B.C 3.80-5.80m/cu 5.02m/cu

TOTAL CHOLESTROL 130-250mg/dl 193mg/dl

HDL 30-70mg/dl 52mg/dl

TRIGLYCERIDES Upto 170mg/dl 158mg/dl

VLDL 5-40mg/dl 31.6mg/dl

LDL 60-170mg/dl 109.4mg/dl

TSH 0/35-4.0miu/ml 1.30miu/l

FT4 0.8-1.8ng/dl 8.95 mg/dl

FT3 2.3-4.2 pg/dl 1.12pg/dl

 OTHER INVESTGATIONS
• ULTRA SOUND OF ABDOMEN:
-FATTY LIVER
• MRI SCAN OF BRAIN:
-HYPERINTENSE FOCI NOTED IN RIGHT CAPSULO GANGLIONIC
REGION,CORONA RADIATA,BILATERAL CENTRUM SEMI OVALE
AND SMALL VESSEL DISEASE AND CHRONIC INFRACTS ARE NOTED
• 2-D ECHO AND COLOR DOPPLER SCAN:
-NORMAL
• CAROTID DOPPLER:
-MILD ATHEROMATOUS CHANGES IN CAROTID VESSEL
WITHOUT FLOW EXTRICTION IS BEING NOTICED
 FINAL DIAGNOSIS

BASED ON THE CLINICAL MANIFESTATIONS & LABORATORY

INVESTIGATIONS IT WAS FINALLY DAIGNOISED AS

“ACCELERATED HYPERTENSION’’
TREATMENT CHART:
BRAND NAME GENERIC DOSE ROUTE FREQUEN DAY 1 DAY 2 DAY 3 DAY 4
NAME [ROA] CY (17/08) (18/08) (19/08) (20/08)

INJ. THIAMIN - I.V OD - - ✔ ✔

OPTINEURON E

INJ. Pantopraz 40 mg I.V ✔ ✔

PANTAP -ole OD - -

INJ. Ondanset 4 mg I.V

ONDEM -ron TID - - ✔ ✔

INJ.LERSURIDE LEVOSUL 25 gm I.V SOS - - ✔ ✔

PIRIDE

INJ.NTG infusion nitoglycer 5 ml IV OD ✔ ✔ - -

in

TAB.ECOSPRIN ASPIRIN 150 mg ORAL OD - - ✔ ✔

TREATMENT CHART:
BRAND NAME GENERIC DOSE ROUTE FREQUE DAY 1 DAY 2 DAY 3 DAY 4
NAME [ROA] NCY (17/08) (18/08) (19/08) (20/08)

TAB.ROSOVAS ROSUVA 20 mg ORAL H/S - - ✔ ✔

STATIN

TAB.VERTISTAR BETA- 16mg oral BD - - ✔ ✔

HISTINE

TAB.TSART TELMIS 40mg oral OD - - ✔ ✔

ARTAN

TAB.AMLOAT AMLODI 50mg oral OD - - ✔ ✔

PINE
DAY WISE ASSESSMENT:

DAYS BP PULSE TEMP RESP.RAT O/E

E

DAY 1 230/130 82/min 98° F 20/min elevated blood pressure

(17/08) mm Hg

DAY 2 170/110 72/min 99 °F 22/min No fresh complaints

(18/08) mm Hg

DAY 3 180/90 81/min 99 °F 21/min No fresh complaints

(19/08) mm Hg

DAY4 160/100 72/MIN 99°F 20/MIN No fresh complaints

(20/08) mmHg
DISCHARGE MEDICATION:
BRAND NAME GENERIC NAME DOSE FREQUENCY ROUTE

TAB. PANZAC Pantoprazole 40 mg OD P/O

TAB.EME Palanosteron OD P/O

CAP.ROSUKEM ROSUVASTATIN 150mg H/S ORAL

TAB.VERTISTAR BETA HISTONES 16mg BD ORAL

TAB. TSART TELMISARTAN 80mg OD ORAL

TAB.AMLO AT AMLODIPINE 50mg 0D ORAL

 SOAP ANALYSIS

SUBJECTIVE:
• A male patient of 52 years was admitted in the
hospital with the cheif complaints of severe
weakness,acute headache and giddiness since 10
days.
OBJECTIVE:
OBJECTIVE:
• elevated serum urea levels ( 28mg/dl)
• Increased FT4 Level (8.95 ng/dl)
• Decreased FT3 levels (1.12 pg/dl)
• ultrasound of abdomen reveals fatty liver
• MRI brain recognises hyperintense foci in right
capsulo ganglionic region,corona
radiata,bilateral centrum semiovale
• small vessel disease & chronic infarcts
• carotid Doppler scan reveals mild
atheromatous changes in carotid vessels
without flow obstruction
ASSESSMENT:
• Based on subjective ( severe weakness,
giddiness and acute headache)and objective
(chronicinfarcts,atheromatouschanges)evide
nces it was finally assessed as
‘‘ACCELERATED HYPERTENSION’’
PLAN:
ASSESSMENT:

GOALS OF THERAPY :
• To overcome the consequences and comorbities
associated with hypertension
• To improve the clinical conditions of the patients by
administrating statins,vasodilators, calcium channel
blockers and nitroglycerine.
CLINICAL ADVICES:
• Follow up after 5 days if symptoms of
increased blood pressure and breathlessness
is being observed
SIDE EFFECTS :
1.ROSUVASTATIN:
headache,musclepain,abdominal.pain,weakness,nausea,dizziness,hypersensitivity reactions
(including rash, pruritus, hives, and swelling), and.pancreatitis.
2.PANTOPRAZOLE:
muscle spasms,seizures,signs of lupus,low magnesium blood level,irregular heart beat,hyper
sensitivity.
3.PALANOSETRON:
headache,throat irritation,stomach upset,raises blood pressure,trouble sleeping,severe dizziness.
4.ONDASTERAN:
headache,fever,lightheadedness,dizziness,weakness,tiredness,drowsiness,
5.LEVOSULPIRIDE: Side effects include amenorrhea, gynecomastia, galactorrhea, changes in
libido, and neuroleptic malignant syndrome.
6.ASPIRIN: ringing in your ears, confusion, hallucinations, rapid breathing, seizure
(convulsions);severe nausea, vomiting, or stomach pain;bloody or tarry stools, coughing up blood
7.VERTISTAR: dizziness.excessive daytime sleepiness (somnolence)headaches.nausea.abdominal
pain.diarrhea.
8.TELMISARTAN: sinus pain and congestion.back pain.diarrhea.sore throat.flu-like symptoms,
such as fever and body aches.upset stomach.muscle pain.headache.
9.AMLODIPINE: swelling of your legs or ankles.tiredness or extreme sleepiness.stomach
pain.nausea.dizziness.hot or warm feeling in your face (flushing)irregular heart rate
(arrhythmia)very fast heart rate (palpitations)
DRUG INTERACTIONS:
• NO SIGNIFICANT DRUG INTERACTIONS WERE
FOUND
PATIENT COUNCELLING:
DISEASE BASED:
• Hyper tension: A Condition in which tge the force of the blood
against the artery wall is too high - It is defined as blood pressure
above 140/90,and is considered severe if the presssure is above
180/120.
• Causes: blood plasma volume alterations, hormone activity,
environmental factors,stress, CKD, diabetes, hyperthyroidism.
• Symptoms: severe headache, fatigue,vision problems,chest pain,
irregular heartbeat, difficulty in breathing, blood in urea
DRUG BASED:
• Patient should be advised to take all the prescribed
medicines in right dose, right time, right frequency
for the complete regimen as prescribed.
• The patient should be advised to consult the doctor
if any unusual effects are seen[ symptoms of fever,
restlessness, sweating ,weakness, breathelessness].
• patient should be advised about the usage and
proper storage of the Drugs.
LIFE STYLE MODIFICATIONS:
• maintain healthy diet , reduce stress by
practising muscle relaxation & monitor blood
pressure regularly.
• Avoid saturated foods and high cholesterol
intake.
• Manage stress levels and decrease salt intake.
TREATMENT ALGORITHM