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Patient age 80
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Sex M/F
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Allergies and brief description of allergic reaction:
Allergy from penicillin
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Weight (if applicable; approximate if not available)
77 kg
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Height (if applicable; approximate if not available)
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Drug History (on admission to hospital, or from PMR in community)
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List all drugs and doses including medications taken as required
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State the indication for each drug treatment
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Warfarin 2mg/2.5mg alternative
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Bisoprolol 10mg once daily
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Isosorbide mononitrate 30mg once daily
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Candesartan 32 mg once daily
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Spironolactone 25mg once daily
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Lercanidipine 10mg once daily
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GTN spray one or two
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Digoxin oral 125mcg once daily
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Asprinoral 75mg once daily
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Tricagrelor 90mg once daily
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Arovastatin 2.5 mg once daily
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Date
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Presenting Complaint
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Chest pain, radiates to the left shoulder, clammy, dizziness
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History of Presenting Complaint
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Patient developed acute kidney injury, hyperkalaemia, low heart rate
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Past Medical History
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Angina, Atrial fibrillation and Ischemic heart disease
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Diagnosis
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Current Medication (if different to drug history i.e. changes on admission or from PMR in community. You may not need to repeat the information given in the drug history table)
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List all drugs and doses including medications taken as required
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Indication for use
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Comments
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Warfarin 2 mg/2.5 mg alternative
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oral
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Bisoprolol oral 10 mg once daily
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oral
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Isosorbide mononitrate oral 30mg od
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oral
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Doxazocin 4 mg od
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oral
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Candesartan 32 mg od
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oral
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Spironolactone 25mg od
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oral
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Monitoring Parameters and Results if Relevent
If laboratory/clinical data are not available, list those results you think should be monitored, and comment why
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Parameter
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Date
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Normal Range
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Comments
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30/1/2017
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WBC
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normal
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4-11 109/L
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normal
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Hb
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normal
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120-160 g/l
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normal
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CRP
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normal
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0-5 mg/l
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normal
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NA
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130
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135-145 mmol/L
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low
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K3
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5.4
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5-5.1 mmol/L
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normal
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Cr
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115
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50-110 umol/L
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high
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Urea
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9.6
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2.5-7.1 mmol/L
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igh
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Drug-related Problems List
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List the patient’s drug related problems which are of highest priority
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Bisoprolol, Ramipril and Isosorbide Mononitrate cause hypotension.
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Are there any drug administration problems? Yes/ No
Please detail if yes:
It changes the rhythm and speed of the heartbeat
SOAP Analysis
For two of the drug related problems you have listed, evaluate these problems using the Subjective, Objective, Assessment, Plan (SOAP) process. If possible choose one clinical problem and one problem relating to administration or use of treatment. (See earlier notes for further guidance on how to make SOAP notes.)
Add the details to the following table
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Drug related problem 1 (clinical).
Add details
Bisoprolol
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Drug related problem 2 (administration/use of treatment). Add details)
Digoxin
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Subjective
It causes dizziness and the patient is unable to stand
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Subjective
Dizziness, changes in mood, depression and lost interest in usual activities
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Objective
It lowers the blood pressure and the patient suffers from anaemia
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Objective
Changes in rhythm of heartbeat, low platelet count
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Assessment
The patient who is on the intake of Bisoprolol are prone to have hypertension
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Assessment
Digoxin cause sleepiness, confusion, and problems with balance.
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Plan
Discuss with the doctor that how to maintain normal blood pressure and to stop the intake of BB
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Plan
Discuss with doctor and they will decide by drawing blood to determine how much digoxin the patient should be taking each day.
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References
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• Walker, R. and Edwards, C. (2007). Clinical Pharmacy and Therapeutics. Edinburgh: Churchill Livingstone.
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