#Summary_of_Pharmaceutical_Care 1: Summary: A 65 year old patient is hypertensive and diabetic since 10 years and recently, in the month of June 2014 he got paralysis attack. Uncontrolled blood pressure and diabetes are the suspected cause. After discharge, the patient is using diltiazem, telmisartan and hydrochlorthiazide for controlling blood pressure and values are normal i.e 135/73. After getting discharge from the hospital, patient was on sitagliptin 50mg and metformin 1000mg for Diabetes and that time the values was FBS-157 & PPBS-170. Last month, doctor has added glimepiride and metformin, and on 21/10/2014 the values were below normal ie FBS-75 & PPBS-79. There might be two reasons for hypoglycemia; one is drug interaction between fenofibrate and glimepiride, and the other reason might be that the patient doesn’t require additional oral hypoglycemics; glimepiride + metformin as his values are falling under normal. However, dose gaping will be done and based on the next blood sugar levels decision will be taken on the discontinuation of the glimepiride + metformin combination. Diabetic diet is not an issue in this case. Interestingly, 5 drug interactions have been found in this case: 1. Fenofibrate + atorvastatin can cause rhabdomyolysis. But, as the triglycerides values are very high ie 335, we cannot discontinue fenofibrate and should wait for the next report (January) on lipid profile test. However, following symptoms should be reported if occurred: Tenderness, Muscle weakness, Nausea/vomiting, Confusion, dehydration & fever, Dark-coloured urine; reduced or no urine output. 2. Ditiazem + atorvastatin can increase the effect of atorvastatin. Patient should be monitored for signs and symptoms of myopathy or rhabdomyolysis: muscle pain, tenderness, or weakness, or discolored urine. If myopathy or rhabdomyolysis is diagnosed or suspected, monitor creatine kinase (CK) levels and discontinue use if CK levels show a marked increase. Half-life of diltiazem is 3-4 hours. Hence, diltiazem should be preferred in morning. 3. Aspirin + Glimepiride will increase the effect of glimepiride. Hence, aspirin should be given in night. 4. Telmisartan + Aspirin can result in renal deterioration. Hence, aspirin should be given in night and kidney profile should be monitored closely. After getting discharge from the hospital due to paralysis attack, patient is managing his condition well and is able to walk. We recommend him few physiotherapy exercises in order to regain his muscle movements and co-ordinations. Weekly monitoring is planned until his blood sugar values doesn’t comes in normal. Amair Khan
Posted on: Wed, 22 Oct 2014 06:24:26 +0000
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