King Abdulaziz University, College of pharmacy, Clinical Pharmacy

King Abdulaziz University, College of pharmacy, Clinical Pharmacy Dept.
Therapeutics II
November 2007
Case Study for Ischemic heart diseases
J.P.,a 62-year-old retired dairy farmer, is hospitalized for evaluation of chest pain.
About 3 weeks before admission, he noted substernal chest pain brought on by lifting
heavy objects or walking uphill. He describes a crushing pain that never occurs at rest
and is not associated with meals, emotional stress, or a particular time of day. When
J.P. stops working, the pain subsides in about 5 minutes.
Family History:
His mother & brother died of a heart attack; his father, who alive at age 86,has
survived one heart attack and one stroke. His family history is negative for DM.
Social History:
He drinks two or three beers per day and does not smoke or chew tobacco.
Past Medical History:
J.P.´s other medical problems include a 10-year history of hypertension, diabetes for 4
years, and traumatic amputation of the right hand. Until 3 weeks ago, J.P. could
perform all his farm chores without difficulty, including heavy labor. He follows a noadded-salt diet, but consistently eats at fast-food establishments with his favorite meal
consisting of two cheeseburgers and French fries.
Medication History:
Atenolol 50mg QD
Glipizide 5mg BID
Losartan 50mg QD
-He rarely use OTC medications
-He has a history of an allergic reaction to sulfa drugs
Physical Examination:
VS: BP 164/98 mm Hg HR=73 beats/min RR=12 breath/min Ht=160 cm
Gen: On admission to the cardiac ward,J.P.appears his stated age and is in no
apparent distress
CVS: Regular rate & rhythm with a normal S1 &S2;Third or fourth heart sounds and
murmurs are not noted.
Chest: Clear to auscultation and percussion
ABD: Unremarkable
Ext: No peripheral edema
Neuro: Oriented to time, place, and person; cranial nerves intact; normal deep tendon
Prepared by: Dr/Ohoud Al-juhani
Clinical pharmacy department
Laboratory Values:
Na 140
Hct 43.5%
RBS 152
K 4.7
Mg 1.9
BUN 27
SrCr 1.4
WBC 5,000/mm
ECG: Reveals normal sinus rhythm at a rate of 75 without evidence of previous MI.
Chest x-ray: Normal
# Chose the single correct answer
1) All of the following are characteristics related to angina pectoris, except:
a- Sensation of pressure on chest alone or with pain
b- The pain located over the sternum or very near to it
c- Weight loss
d- SOB with feeling constriction about the larynx of upper trachea
2) Select the independent risk factors for CAD present in J.P.
a- Male gender, strong family history of CAD
b- Hypertension
c- Smoking
d- Obesity
3) What are the goals of medical therapy in J.P.
a- Relief of symptoms
b- Reduction of myocardial ischemia
c- To prevent complications such as AMI
d- All of the above
# Answer the following questions by true or false and correct the false one
1- Most episodes of exertional angina last several minutes in-duration and are relived
with rest ( T )
2- J.P.’s symptoms can be classified as typical chest pain. However, symptoms don't
occur at rest, so they can be classified as Unstable angina ( F ) STABLE
3- ECG during an anginal episode would confirm CHD &angina if T-wave inversion,
ST-segment depression are noted ( T )
4- Nitrates are effective in treating all forms of angina because they decrease arterial
return to the heart &therefore decrease cardiac workload ( F )VENOUS
5- During anginal episodes the patient can take a maximum of five tablets over 15
min of NTG tablet ( F ) THREE
# Comment on drug list, suggest any modification (add or delete drugs)? Why
should J.P., continue his Atenolol therapy?
Prepared by: Dr/Ohoud Al-juhani
Clinical pharmacy department
Prepared by: Dr/Ohoud Al-juhani
Clinical pharmacy department