Prathista institute of

pharmaceutical sciences

Prasad
CASE STUDY. 19CK1T0009
Pharm D Intern
SUBJECTIVE EVIDENCE.
• A male patient of age 62 years is admitted in the department of neurology.
• Chief complaints:
• C/o forgetting incidence, left hand weakness, deviation of angle of mouth
since 1 day.
• C/o slurred speech since 2 days.
• C/o incontinence of urine, fall from the bed.

• H/O present illness:

• Social history:
• Diet _ Mixed.
• Sleep_Irregular.
• Exercise _Nill.

• Personal history:Nill.
OBJECTIVE EVIDENCE.
• Physical examination: A 62 years old male patient was admitted in
general ward was semi_conscious and disoriented to time, place and
surrounding.
• Systemic examination:
CVS _ s1 s2 (+)
RS _Bilateral air entry (+)
Per abdomen _Soft
CNS_Disoriented, semiconscious, Drowsy.
• Vital signs:
B.p_160/100 mmhg
R. R_20 Cpm.
P. R_128 Bpm.
Temperature_Afebrile.
• PICCLE_ Negative.
• Provisional diagnosis-cerebrovascular accident (stroke).
LABORATORY INVESTIGATIONS.
PARAMETERS VALUE NORMAL VALUE
• Hb (g/dl) 13.2 13-18 g/dl.
TLC 8500 4000-11000 cells /cumm.
PLATELETS 3.6 1.5-4.5 lakhs /cumm.
TOTAL CHOLESTEROL 225 Less than 200 mg/dl.
LDL 147 Less than 100 mg/dl.
PT 10.5 11-15.8 sec.
INR 0.6 0.8-1.2.
GRBS 145 79-160 mg/dl.
• RADIOGRAPHIC DATA.
X-RAY-lung field is clear,cardiac size is normal.
MRI SCAN-Mild to moderate acute infarct in right superior cerebral
peduncle,infarct in bilateral middle and inferior cerebral peduncle.
ANGIOGRAM-Bilateral internal carotid artery show intimal thickening.
ASSESSMENT.
• Confirmatory diagnosis:
• Based on the –
• Subjective evidence:Forgetting incidence ,left hand weakness.
• Objective evidence: Slurred speech,incontinence of urine.
• Laboratory evidence:Increased cholesterol,increased LDL,increased
prothrombin time,increased INR, abnormality in MRI and abnormality
in angiogram.
The patient condition was confirmed as cerebrovascular
accident(stroke).
ABOUT THE DISEASE.
• Stroke is defined as sudden onset of focal neurological deficit.
• Ischemic stroke occurs when blood supply to the part of the brain is
interrupted (or)reduced , preventing brain tissue from getting oxygen
and nutrients.
• The main cause of ischemic stroke is atherosclerosis (or) fatty
deposits (Plaque) that line the bloodvessel.
GOALS OF TREATMENT.
• To minimize the signs and symptoms of stroke.
• Reduce ongoing neurologic injuryand decreased mortality and long-
term disability.
• Prevent complications secondary to immobility and neurologic
dysfunction.
• Prevent stroke recurrence.
• To maintain normal vitals.
• To improve quality of life and avoid fresh complaints.
• To provide non-expensive and effective treatment.
PLAN.
PROGRESS CHART.
Day-1:
Patient was admitted with given complaints and kept under observation in ICU for 48 hrs
and patient have c/o hematuria.
DAY-2:
All vitals are checked and no fresh complaints.
Day -3:
Patient became completely conscious ,vitals checked and reported complaints of
constipation.
Day-4:
Slurred speech,mild dysarthria,N/O of blood in urine,headache,vomiting.
Day-5:
Requested for discharge.
BRAND NAME GENERIC NAME DOSE FREQUENCY DAY
INJ.HEPARIN Heparin 5000U 1-1-1 Day 1-3
INJ.STROCIT Citicoline 250mg/ml 1-0-1 Day 1-3
TAB.COLIHENZ Citicoline 500mg 1-0-1 Day 4-5
INJ.LEVIPIL Levitriacetum 500mg 1-0-1 Day 1-4
TAB.ATORVA Atorvastatin 20mg 0-0-1 Day 1-5
TAB.BETALOC Metaprolol 25mg 1/2-0-1/2 Day 1-3
TAB.PANTOP Pantoprazole 40mg IV 1-0-1 Day 3-5
TAB.ECOSPRIN Aspirin 150mg 0-1-0 Day 3-4
SYP.POTKLOR Potassium chloride 15ml 1-1-1 Day 2-5
SYP.CREMAFIN Magnesium 30ml 1-0-1 Day 3-5
hydroxide,liquid
paraffin.
ABOUT DRUGS.
INJ Heparin-To treat blood clots.
ADR-Swelling of the face,breathing difficulty.
INJ.Citicoline-Used to treat stroke,head injury,alzheimers disease,dementia.
ADR-GI disturbances,hypotension,tachycardia.
INJ.Levitriacetam-Used to treat seizures.
ADR-Nasal congestion ,decreased appetite,irritability.
TAB.Atorvastatin-Used to lower cholesterol and triglyceride levels in blood.
ADR-Liver damage,kidney damage,muscle damage.
TAB.Metoprolol-To treat high blood pressure.
ADR-Shortness of breath,wheezing,tightening of chest.
TAB.Pantoprazole –Used to treat heartburn,acid reflux,GERD.
ADR-Blurred vision,dry mouth,increased urination.
TAB.Aspirin-Used to treat blood clots,muscle aches,fever.
ADR-Nausea,vomiting,stomach pain.
Syp.potassium chloride –Prevents and treats low levels of potassium in
our body.
ADR-Nausea,vomiting,diarrhoea,stomach pain.
• Goals achieved:
Disease progression is stopped and symotoms are improved.
All vitals came to normal.
Quality of life improved.
• Discharge medication:
TAB. Clopidogrel-75 mg, 0-0-1, 3days.
TAB.Atorvastatin-20 mg,0-0-1,6 days.
TAB.Pantaprozole-40 mg ,1-0-1,6 days.
PATIENT COUNSELLING.
• Disease related- Cerebrovascular accident also called as stroke which
is a condition in which the damage to the brain from interruption of
the blood supply.
• Drugs related-
Citicoline is used for stroke ,its a nerve protecting medicine,nourish
and protect nerve cell.
Heparin and aspirin is used to prevent blood clots.
Atorvastatin is used to control the blood cholesterol.
LIFE STYLE MODIFICATIONS.
• Advised to take low fat ,low salted food.
• Reduce fatty meat,egg yolk,liver.
• Increase intake of nuts ,seeds and dry beans.
• Increase and promote intake of vegetables and fruits like banana,
carrot ,beetroot and apple etc...
Follow up:
Reviewed after 10 days.
Consult the doctor if any problem persist.
THANK TOU