Case Presentation: COPD with Acute Coronary Syndrome Management
A 65-year-old male with COPD presents with chest pain and positive troponin-T. Diagnosis includes COPD with Acute Coronary Syndrome. Treatment goals involve symptom relief, prevention of progression, and minimizing risks. Medications such as salbutamol and formoterol are part of the treatment plan for COPD.
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Presentation Transcript
THERAPEUTICS MINOR CASE PRESENTATION COPD with Acute Coronary Syndrome
SENARIO: Here is a 65years old male hospitalized for 5 days. Chief complaints: Case of chest pain since 3days. History of present illness: Patient was apparently normal then he developed chest pain which was radiating towards neck and jaw. Past Medical history: K/c/o COPD since 4years.
Personal History: Smoking since 25years. Laboratory investigations: test days CPKMB 65 Troponin-T Positive WBC 16,000 Neutrophils 79 Heamoglobin 11 MCH 20.6 MCHC 29 ESR 20
General Physical examination: Percursion: Resonant note heard on left mammary area. Auscultation: Bronchial breath sounds heard Crepts positive Rhonchi-positive Tenderness positive
SOAP note: Subjective: Here is a 65years old male hospitalized with complaints of chest pain since 3days. Objective: CPKMB values are increased: This indicates tissue necrosis. Troponin-T +ve value increased :This indicates tissue necrosis. Neutrophils are increased: This indicates infection. WBC s are increased: This indicates Tissue necrosis
Hb values are decreased: This indicates anemia. The MCH & MCHC values are decreased: this indicates hypochromia. The ESR values are increased:- This indicates tissue necrosis. DIAGNOSIS: COPD with Acute coronary syndrome. ASSESSMENT: Problem list: 1.Chest pain:- It occurs due to ischaemia caused by coronary artery spasm.
2.COPD:- It is a chronic disease of the airways characterized by gradual and progressive loss of lung function.There will be airflow limitation associated with abnormal inflammatory response of lung. 3.Acute coronory syndrome:- It occurs due to ischemia of heasrt muscles caused due to coronary artery occlusion or spasm.
Problem Goals of treatment DRUGS & MOA Dosage 1.COPD 1.Prevent /minimize progression. 2.Relieve symptoms 3.Minimal risks/side- effect from therapy 1.SABA: Salbutamol: They are Beta agonista.they cause bronchodilation. 2.LABA: formeterol 3.Effcorlin 10 gm 100 gm 100-200mg 2.Acute coronary syndrome 1.Early restoration of blood flow to occluded artery. 2.Relief of ischemic chest discomfort. 1.Apirin: Inhibits release of ADP & prevent sticking of platelets. 2.Heparin: Inactivates clotting factors. 3.Nitrates: They reduce pre & after load 75-150mg 0.6Iu/day 10-40mg
Plan: S.n o Generic name Brand name indication dose day1 2 3 4 5 1. T.Sorbitrate 1-1-1 Isosorbide dinitrate ACS 10mg Y Y 2. T.Clopitab 0-1-0 clopidogrel 75mg Y Y Y Y Y 3. T.Azitor 0-0-1 Atorvastain 10mg Y Y Y Y Y 4. T .deriphylline 1-0-1 theophylline+ etiophylline Copd 150mg Y 5. INJ.pan 1-0-0 Pantoprazole ppI 40mg Y Y Y Y Y 6. INJ.Cefara 1-0-1 Ceftriaxone prophylaxis 1.5gm Y Y Y Y Y 7. INJ.graniforce 1-0-1 Granisetran Prophylaxis 1amp Y 8. INJ.lupinox 1-0-1 Enoxaparin ACS 0.6ml Y Y Y Y Y 9. T.Ramace Ramipril ACS 2.5mg Y
S.no Generic name Brand name Indication Dosage Day1 2 3 4 5 10. INJ.lasix 1-0-0 Furosemide Diuretic 2amp Y 11. INJ.dobutami ne ACS 2amp Y Y Y 12. T .Cytogard 1-1-1 Trimetazidine Hcl ACS 20mg Y Y Y Y 13. Duolin neb 1-1-1 salbutamol+ ipratopium COPD Y Y Y Y
