A3289C: Mr. Seah, the 68-year-old Male, Was Just Admitted to the Hospital for a Heart Attack: Pharmaceutical Science Assignment, RP, Singapore

Section A: Mr. Seah, the 68-year-old male, was just admitted to the hospital for a heart attack and breathlessness. The following information had been gathered upon his admission.

Past Medical History:

• Hyperlipidemia (diagnosed in 2019)
• High blood pressure (diagnosed in 2018)
• Type 2 diabetes mellitus (diagnosed in 2019)
• Parkinson’s Disease (diagnosed in 2018)
• Epilepsy (recently diagnosed)
• Hypothyroidism (recently diagnosed)

Functional assessment and social history:

• Retired and stays with a wife who is the main caregiver
• Non-smoker does not drink alcohol

Medications that were prescribed for Mr. Seah 3 months ago:

1. Aspirin 100mg OM

2. Diltiazem SR 90mg BD

3. Levothyroxine 25mcg OM

4. Metformin 850mg BD

5. Simvastatin 20mg ON

6. Phenytoin 100mg OM

7. Diazepam 10mg enema PRN

8. Madopar^® (Levodopa 100mg/ Benserazide 25mg) 1 tab TDS

Additional notes: Mr. Seah’s wife has been supplementing his diet with Glucerna^® enteral feeds 3 times a day as his appetite has not been good. She has been serving him the medications stated above regularly and immediately after serving the enteral feed to her husband. Mr. Seah’s wife has a basic level of health literacy.

Vitals and laboratory test results today:

• Bodyweight: 65kg (no significant change in weight since the last review)
• Height: 170cm
• Body temperature: 36.9°C
• BP: 128/80mmHg
• HR: 80bpm
• Serum creatinine: 200µmol/L (Gradual increase from last serum creatinine taken 3 months ago: 180 µmol/L)
• Serum potassium: 4.0mmol/L (Normal range: 3.5mmol/L to 5.0mmol/L)
• Serum phenytoin level: Low
• HbA1c: 7.5%
• LVEF: 30%
• Lipid panel test:
  

  Lipid Panel Test	Measurement (mmol/L)	Reference range (mmol/L)
  Total cholesterol	5.8	Desirable: <5.2
  		Borderline high: 5.2-6.1
  		High: ≥6.2
  LDL	4.2	Optimal: <2.6
  		Desirable: 2.6-3.3
  		Borderline high: 3.4-4.0
  		High: 4.1- 4.8
  		Very high: ≥4.9
  HDL	1.1	Low: <1.0
  		Desirable: 1.0-1.5
  		Optimal: ≥1.6
  Triglycerides	4.1	Optimal: <1.7
  		Desirable: 1.7-2.2
  		High: 2.3-4.4
  		Very high: ≥4.5

• Thyroid function test:

Additional doctor’s notes:

• No known drug allergy
• No episode of seizures for the past 3 months
• The patient is resistant to the idea of injections.
• No changes in gait
• No pulmonary edema or pedal edema observed

Diagnosis for this admission:

1. Myocardial infarction (Blockage was cleared via percutaneous intervention- a stent was inserted today)

2. Chronic heart failure (LVEF: 30%)

3. Gradual worsening of chronic kidney disease

4. Swallowing impairment. The nasogastric tube was inserted during this admission. Diet recommended by dietician: Full enteral nutrition only.

1. Answer the following questions about Mr Seah’s hypertension and heart failure.

a. List ONE guideline which can be used to guide the treatment for Mr. Seah’s hypertension and heart failure respectively. (Note to only use guidelines mentioned in this module.)

i. Guideline for hypertension:

ii. Guideline for heart failure:

b. Determine if Mr. Seah’s hypertension is well controlled. Justify your answer.

c. In no more than 200 words, propose and explain TWO necessary changes to be made to Mr Seah’s medications which were prescribed 3 months ago in view of his latest blood pressure readings and his current heart failure condition.

2. Answer the following questions about Mr. Seah’s hyperlipidemia and myocardial infarction.

a. List ONE guideline which can be used to guide the treatment for Mr. Seah’s hyperlipidemia and myocardial infarction respectively. (Note to only use guidelines mentioned in this module.)

i. Guideline for hyperlipidemia:

ii. Guideline for myocardial infarction:

b. Determine if Mr. Seah’s lipids are well controlled. Justify your answer.

c. In no more than 200 words, propose and explain TWO necessary changes to be made to Mr. Seah’s medications which were prescribed 3 months ago in view of his lipid panel and his current myocardial infarction condition.

3.  Answer the following questions about Mr. Seah’s Type II diabetes mellitus.

a. List ONE guideline which can be used to guide the treatment for Mr. Seah’s Type II diabetes mellitus. (Note to only use guidelines mentioned in this module.)

b.  Determine if Mr. Seah’s Type II diabetes mellitus is well controlled. Justify your answer.

c.  In no more than 100 words, propose and explain ONE necessary change to be made to Mr. Seah’s medications which were prescribed 3 months ago in view of his HbA1c level and his kidney disease.

4. Answer the following questions about Mr. Seah’s hypothyroidism.

a. Determine if Mr. Seah’s thyroid function test is normal. Justify your answer.

b. In no more than 100 words, propose and explain any necessary change to be made to Mr. Seah’s medications which were prescribed 3 months ago in view of his current thyroid function test if required.

5. Answer the following questions about Mr. Seah’s current neurologic disorders (Parkinson’s disease, epilepsy).

a. Determine if Mr. Seah’s Parkinson’s disease and epilepsy are well controlled. Justify your answer.

b. In no more than 150 words, propose and explain any necessary change to be made to Mr. Seah’s medications which were prescribed 3 months ago in view of his current neurologic disorders if required

Section B

You are working as a pharmacy technician and you were told to dispense the full quantity of the following prescription (Figure 1) to a patient by your supervisor. Type out how you will counsel Jane about her medications from the moment you greet her to the moment she leaves to pay for her medications at the cashier.