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    HEMEPARESIS

    Uploaded by

    Hari Eshwaran
    - A 65-year-old man presented with weakness on his left side following a suspected stroke. His history included prior angioplasty and smoking. - On examination, he had reduced strength and deviation of his mouth on the left side. Tests showed signs of a previous brain infarction on the right side. - He was started on medications including aspirin, clopidogrel, metoprolol, atorvastatin, and physiotherapy to treat his hemiparesis resulting from the suspected stroke. The pharmacist recommended modifications to the treatment plan to reduce risks and align with guidelines.

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    HEMEPARESIS

    Uploaded by

    Hari Eshwaran
    345 views18 pages
    - A 65-year-old man presented with weakness on his left side following a suspected stroke. His history included prior angioplasty and smoking. - On examination, he had reduced strength and deviation of his mouth on the left side. Tests showed signs of a previous brain infarction on the right side. - He was started on medications including aspirin, clopidogrel, metoprolol, atorvastatin, and physiotherapy to treat his hemiparesis resulting from the suspected stroke. The pharmacist recommended modifications to the treatment plan to reduce risks and align with guidelines.

    Original Description:

    A case presentation on hemiparesis

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    - A 65-year-old man presented with weakness on his left side following a suspected stroke. His history included prior angioplasty and smoking. - On examination, he had reduced strength and deviation of his mouth on the left side. Tests showed signs of a previous brain infarction on the right side. - He was started on medications including aspirin, clopidogrel, metoprolol, atorvastatin, and physiotherapy to treat his hemiparesis resulting from the suspected stroke. The pharmacist recommended modifications to the treatment plan to reduce risks and align with guidelines.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    345 views18 pages

    HEMEPARESIS

    Uploaded by

    Hari Eshwaran
    - A 65-year-old man presented with weakness on his left side following a suspected stroke. His history included prior angioplasty and smoking. - On examination, he had reduced strength and deviation of his mouth on the left side. Tests showed signs of a previous brain infarction on the right side. - He was started on medications including aspirin, clopidogrel, metoprolol, atorvastatin, and physiotherapy to treat his hemiparesis resulting from the suspected stroke. The pharmacist recommended modifications to the treatment plan to reduce risks and align with guidelines.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 18

    CASE PRESENTATION

    ON
    hemiplegia

    - BY
    R.ROSHNI
    16GTIT0016
    PHARM D 4th YEAR
     A 65yrs adult male was admitted to the GM on 30.8.2017 in
    GOVERNMENT HOSPITAL CHITTOOR bearing the IP no.
    20191125117

     Chief complaints :

     C/O weakness of left upper and lower limb since yesterday


    associated with deviation of angle of mouth.
    Past history:
    PTCA (Percutaneuos transluminal angioplasty) was done and the
    necessary drugs was taken 2 years back.
    no H/o of DM/HTN/TB/epilepsy
    no H/o any previous surgery
    no H/o of any blood transfusion/dry allergy
    Family history:
    Patient father has HTN
    Personal history:
    Alcoholic (-)
    smoking(+)
    Vitals and systemic examination

    • Patient : C/C
    • Afebrile
    • BP : 160/100 mm of Hg
    • PR: 88bpm
    • CVS: S1,S2(+)
    • RS: NVBS+
    • CNS: conscious of angle of mouth to right
    power: 3/5 in left upper limb
    4/5 in left lower limb
    LAB INVESTIGATIONS
     P/A: Soft
     Hemoglobin : 13 gm
     WBC count:11,180cells/cumm (4000-10,500)
     RBC :4.48mill/cumm
     MCH: 32.2pg(27-31)
     Lymphocyte: 48.7%(20-45)
     Monocyte : 1.4% (2-8)
     Hbs Ag : -ve
     HIV : Non reactive
    PROVISIONAL DIAGNOSIS
    Cerebro Vascular Artery left hemiparesis
    secondary to right middle cerebral artery
    infarct “ HEMEPARESIS”
    Dosage regime
    Drug name Dose Freq Day1 Day 2 Day 3 Day4 Day 5

    T.Aspirin 75mg 0-1-0 + + + + +

    T. 75 mg 0-1-0 + + + + +
    Clopidrogel
    T. 25 mg 1-0-0 + +
    Metoprolol
    T. Atorvae 20 mg 0-0-1 + + + + +

    Inj. Pantop 40 mg IV 1-0-0 + + + + +

    Inj. 20% IV 1-1-1 + + +


    Mannitol
    T. Lasix 40mg 1-0-0 + +

    Inj. B12 1000mcg IM 0-1-0 + +

    Inj. 5mg IV SOS +


    Diazepam
    PHYSIOTHERAPY
     ACTIVE MOVEMENTS AND STRENGTHENING
     FINGER GRIPPING AND STRENGTHENING AND GRASPING WAS TAUGHT
    PATIENT COUNSELLING
    1. Stay active to keep your muscle engaged.
    2. Take low fat and salt and have diet rich in fruits, berries, nuts, vegetables
    3. Stay hydrated.
    4. Wear flat shoes for better balance’
    5.Consider adding almond oil as it reduces cholesterol and improve blood flow
    the brain.
    6. Adding tulsi, garlic, ginger, turmeric will increase healing and strengthening
    the muscles, circulatory system and immune system.
    7. Take adequate rest for 7 to 8 hours sleep
    8. Practice relaxation techniques
    9. Choose eating white meat and avoid red meat.
    10.Consuming carrot, beetroot, asparagus with your daily will supplement
    your better health
    DRUG INTERACTIONS
    1. CLOPIDOGREL<>PANTOP: effectiveness of clopidogrel in preventing
    heart attack or stroke is reduced.
    2. ASPIRIN<>CLOPIDOGREL: adverse affects like unusual bleeding,
    abdominal pain, weakness, appearance of black tarry stool’
    3. ATORVOSTATIN<>CLOPIDOGREL: reduce the effect of clopidogrel.
    Signs of blood clots such as chest pain, shortness of bteath, sudden
    loss of vision or pain, redness or swelling in extremity.
    4. ATORVOSTATIN<> PANTOP: increased blood levels and effects of
    atorvastatin. Risk of liver damage, rhabdomyolysis, kidney damage.
    5.ATORVASTATIN<> GRAPEFRUIT JUICE: side effects like liver damage
    and rhabdomyolysis can be seen.
    6.LASIX<>METOPROLOL: lower blood pressure and decreae in heart
    rate is seen.
    Pharmacist Intervention
     Given dual antiplatelet therapy could modified. According to NICE guidelines
    recommend ASPIRIN OR CLOPIDOGREL. Recent research have proved that dual
    therapy better curability but also have higher bleeding risk( recent research
    in UK)
     Two Antihypertensive drugs have been included in the drug regimen which
    was unneccesary. According to the NCBI, beta blocker +thiazides are enough
    for the management of the hypertension in case of stroke and seizure.
     Baclofen could be added in the drug regimen for relaxation of of muscles.
     Along with the physiotherapy, MUSCLE CONSTRAINT INDUCED MOVEMENT
    THERAPY could also be given for better therapeutic outcome.
    PRESCRIPTION ANALYSIS
     According to current UK GUIDELINES and NICE GUIDELINES , dual anticoagulant
    therapy is NOT recommended.
     The above prescription is found to be Irrational according to the NICE
    GUIDELINES as it as unnecessary drugs in the drug regimen as it would
    increase the ADRs and unwanted side effects.
     FOLLOW UP: ANTIHYPERTENSIVE DRUGS SHOULD BE STOPPED AS THE
    BLOOD PRESSURE IS FOUND TO BE 160/90 mm of Hg WHICH DOES NOT
    DUAL ANTIHYPERTENSIV THERAPY.
    Thank you……

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