SlideShare a Scribd company logo
1 of 10
A CASE STUDY ON UNCONTROLLED
HYPERTENSION
PRESENTED BY
Arunima Shrestha
Harif Ghimire
Mamata Panthi
Romit Subba
Trilochan Pandey
[B.Pharmacy 2nd Year]
SOAPE NOTE
 Subjective – JF is a 64 y/o A.A. M seen today for f/u for his
HTN.
 PMH- HTN*14 yrs, DM II, Stage 2 COPD, BPH & recent
recovery from cold
 SH- Lives alone, occasional drinker, no smoking
 FH- Father & mother had HTN
 MH- Hydrochlorothiazide 25mg po q am
Doxazosin 2mg po q am
Carvedilol 12.5mg po bid
Mucinex D 2 tablets q12 for cough
Naproxen 220mg po q8h for pain
Metformin 500mg po bid
SOAPE NOTE
 Objective- Past[3 months ago] B.P 160/85 mm Hg
B.P 162/90 mm Hg HR- 76 bpm
Wt-95 kg Ht.-6’2 BMI-26.8(overweight)
Na- 138mEq/l Ca- 9.7mEq/l K- 4.7mEq/l
Total Chol.- 171mg/dl LDL- 99mg/dl
HDL- 40mg/dl TG- 158mg/dl
S.cr- 2.2 mg/dl Glucose- 110mg/dl
U.A- 6.7 mg/dl
SOAPE NOTE
 Assessment
- -JF’s BP is not at goal ,because he is diabetic his
goal should be <130/80mmHG.
- -Despite of triple antiHTN therapy ,B.P is not
optimal because of many factors including use of
Mucinex D(contains pseudoephedrine),
Naproxen(NSAID) & non compliance with low
sodium diet
- -ACEIs or ARB as drug of choice in pt. with
Diabetes. CCB is also an option(as he is AA)
- -Continue HCTZ
-Use of non selective beta blocker is not best selection for
COPD pt.
-JF has BPH & is on Doxazosin , an alpha blocker that
seems to control his BPH symptoms as well. However,
dizziness & headaches like side effects of Doxazosin
can be minimize by take the dose at night
-Continue metformin
SOAPE NOTE
 Plan
-Discontinue guaifenesin/pseudoephedrine
preparation(especially if no longer needed for cold
symptoms) or give product containing only
guaifenesin next time.
-Discontinue Naproxen . Go for an
alternative(eg.acetaminophen) for headache and
gout
-Discontinue Carvedilol gradually
-Add Lisinopril 5mg po once daily, increase if not
enough.
It can cause dry cough or angioedema.
Monitor B.P, K, renal function, glucose , Lipid profile
-Continue HCLTZ 25mg po qam
-Continue Doxazosin 2mg po qhs
Change dosing schedule to qhs to reduce possible
Doxazosin-induced dizziness
-Continue metformin 500mg po bid
SOAPE NOTE
 Education
-Emphasize the importance of low-Na diet. Assist JF in recognizing
healthy diet options and consider referring him to a dietitian.
-Encourage physical activity compatible with his COPD. Consider
gradual and steady aerobic exercise 3-4x/week. May refer to
pulmonary rehab program if JF faced difficulty
-If the patient develops persistent dry cough after using lisinopril, it can
be replaced with ARB (e.g. losartan).
-Thiazide diuretics can make pt. sensitive to sunlight. Pt must be sure
to apply a sunscreen before any extended exposure to sunlight.
Thiazide diuretics may also cause to lose potassium. Potassium
should be balance carefully. If pt. experience cramping in feet or
lower extremities, this may be a sign that potassium has dropped. If
this occurs, notify physician.
THANK YOU
QUESTIONS??????

More Related Content

What's hot

case presentation on HYPERTENSION
case presentation on HYPERTENSIONcase presentation on HYPERTENSION
case presentation on HYPERTENSIONJoshuaGeorge46
 
Myocardial infraction by satyavardhan pharm.d
Myocardial infraction by satyavardhan pharm.dMyocardial infraction by satyavardhan pharm.d
Myocardial infraction by satyavardhan pharm.dSatya satyanittu4
 
Case presentation on angina pectoris
Case presentation on angina pectorisCase presentation on angina pectoris
Case presentation on angina pectorisUmme Habeeba A Pathan
 
case on deep vein thrombosis
case on deep vein thrombosis case on deep vein thrombosis
case on deep vein thrombosis maheshwari14
 
Case presentation on MYOCARDIAL INFARCTION
Case presentation on MYOCARDIAL INFARCTIONCase presentation on MYOCARDIAL INFARCTION
Case presentation on MYOCARDIAL INFARCTIONVigneswari Paladugu
 
Case presentation on Alcoholic liver disease
Case presentation on Alcoholic liver diseaseCase presentation on Alcoholic liver disease
Case presentation on Alcoholic liver diseaseHAMMADKC
 
Case presentation on ALD with PORTAL HTN
Case presentation on ALD with PORTAL HTN Case presentation on ALD with PORTAL HTN
Case presentation on ALD with PORTAL HTN BINDU MADHAVI
 
Case presentation - SOAP Format
Case presentation - SOAP FormatCase presentation - SOAP Format
Case presentation - SOAP FormatDeepak Rx
 
A Case Presentation on Angina pectoris
A Case Presentation on Angina pectoris A Case Presentation on Angina pectoris
A Case Presentation on Angina pectoris DR. METI.BHARATH KUMAR
 
Case study on hypertension
Case study on hypertensionCase study on hypertension
Case study on hypertensionmanasa reddy
 
a case study on peptic ulcer
 a case study on peptic ulcer a case study on peptic ulcer
a case study on peptic ulcermartinshaji
 
A CASE PRESENTATION ON IBD (INFLAMMATORY BOWEL DISEASE)
A CASE PRESENTATION ON IBD (INFLAMMATORY BOWEL DISEASE)A CASE PRESENTATION ON IBD (INFLAMMATORY BOWEL DISEASE)
A CASE PRESENTATION ON IBD (INFLAMMATORY BOWEL DISEASE)Dr.Hashim Syed Ali (Dr.Foster)
 
A case study on acute renal failure
A case study on acute renal failureA case study on acute renal failure
A case study on acute renal failureDrMaheshGurajapu
 
Case Presentation On Thrombocytopenia with Acute Renal Failure And Acute Depr...
Case Presentation On Thrombocytopenia with Acute Renal Failure And Acute Depr...Case Presentation On Thrombocytopenia with Acute Renal Failure And Acute Depr...
Case Presentation On Thrombocytopenia with Acute Renal Failure And Acute Depr...Riya Mariam
 
Case Presentation on Parkinsons (Clinical Pharmacy practice) By Dr Ruth, Dr A...
Case Presentation on Parkinsons (Clinical Pharmacy practice) By Dr Ruth, Dr A...Case Presentation on Parkinsons (Clinical Pharmacy practice) By Dr Ruth, Dr A...
Case Presentation on Parkinsons (Clinical Pharmacy practice) By Dr Ruth, Dr A...Dr Arpan Dutta Roy
 
Case Studies Clinical pharmacy
Case Studies Clinical pharmacyCase Studies Clinical pharmacy
Case Studies Clinical pharmacyQurat Ul Ain
 
Case presentation on STROKE
Case presentation on STROKECase presentation on STROKE
Case presentation on STROKEShiva Kumar
 
A CASE PRESENTATION ON GERD ( GASTROESOPHAGEAL REFLUX DISEASE)
A CASE PRESENTATION ON GERD ( GASTROESOPHAGEAL REFLUX DISEASE)A CASE PRESENTATION ON GERD ( GASTROESOPHAGEAL REFLUX DISEASE)
A CASE PRESENTATION ON GERD ( GASTROESOPHAGEAL REFLUX DISEASE)Rajnandini Singha
 
Case Presentation in SOAP format on Ischemic Heart Disease with Acute Coronar...
Case Presentation in SOAP format on Ischemic Heart Disease with Acute Coronar...Case Presentation in SOAP format on Ischemic Heart Disease with Acute Coronar...
Case Presentation in SOAP format on Ischemic Heart Disease with Acute Coronar...Umme Habeeba A Pathan
 

What's hot (20)

case presentation on HYPERTENSION
case presentation on HYPERTENSIONcase presentation on HYPERTENSION
case presentation on HYPERTENSION
 
Myocardial infraction by satyavardhan pharm.d
Myocardial infraction by satyavardhan pharm.dMyocardial infraction by satyavardhan pharm.d
Myocardial infraction by satyavardhan pharm.d
 
Case presentation on angina pectoris
Case presentation on angina pectorisCase presentation on angina pectoris
Case presentation on angina pectoris
 
case on deep vein thrombosis
case on deep vein thrombosis case on deep vein thrombosis
case on deep vein thrombosis
 
Case presentation on MYOCARDIAL INFARCTION
Case presentation on MYOCARDIAL INFARCTIONCase presentation on MYOCARDIAL INFARCTION
Case presentation on MYOCARDIAL INFARCTION
 
Case presentation on Alcoholic liver disease
Case presentation on Alcoholic liver diseaseCase presentation on Alcoholic liver disease
Case presentation on Alcoholic liver disease
 
Case presentation on ALD with PORTAL HTN
Case presentation on ALD with PORTAL HTN Case presentation on ALD with PORTAL HTN
Case presentation on ALD with PORTAL HTN
 
Case presentation - SOAP Format
Case presentation - SOAP FormatCase presentation - SOAP Format
Case presentation - SOAP Format
 
A Case Presentation on Angina pectoris
A Case Presentation on Angina pectoris A Case Presentation on Angina pectoris
A Case Presentation on Angina pectoris
 
Case study on hypertension
Case study on hypertensionCase study on hypertension
Case study on hypertension
 
a case study on peptic ulcer
 a case study on peptic ulcer a case study on peptic ulcer
a case study on peptic ulcer
 
PARKINSON CASE FINAL
PARKINSON CASE FINALPARKINSON CASE FINAL
PARKINSON CASE FINAL
 
A CASE PRESENTATION ON IBD (INFLAMMATORY BOWEL DISEASE)
A CASE PRESENTATION ON IBD (INFLAMMATORY BOWEL DISEASE)A CASE PRESENTATION ON IBD (INFLAMMATORY BOWEL DISEASE)
A CASE PRESENTATION ON IBD (INFLAMMATORY BOWEL DISEASE)
 
A case study on acute renal failure
A case study on acute renal failureA case study on acute renal failure
A case study on acute renal failure
 
Case Presentation On Thrombocytopenia with Acute Renal Failure And Acute Depr...
Case Presentation On Thrombocytopenia with Acute Renal Failure And Acute Depr...Case Presentation On Thrombocytopenia with Acute Renal Failure And Acute Depr...
Case Presentation On Thrombocytopenia with Acute Renal Failure And Acute Depr...
 
Case Presentation on Parkinsons (Clinical Pharmacy practice) By Dr Ruth, Dr A...
Case Presentation on Parkinsons (Clinical Pharmacy practice) By Dr Ruth, Dr A...Case Presentation on Parkinsons (Clinical Pharmacy practice) By Dr Ruth, Dr A...
Case Presentation on Parkinsons (Clinical Pharmacy practice) By Dr Ruth, Dr A...
 
Case Studies Clinical pharmacy
Case Studies Clinical pharmacyCase Studies Clinical pharmacy
Case Studies Clinical pharmacy
 
Case presentation on STROKE
Case presentation on STROKECase presentation on STROKE
Case presentation on STROKE
 
A CASE PRESENTATION ON GERD ( GASTROESOPHAGEAL REFLUX DISEASE)
A CASE PRESENTATION ON GERD ( GASTROESOPHAGEAL REFLUX DISEASE)A CASE PRESENTATION ON GERD ( GASTROESOPHAGEAL REFLUX DISEASE)
A CASE PRESENTATION ON GERD ( GASTROESOPHAGEAL REFLUX DISEASE)
 
Case Presentation in SOAP format on Ischemic Heart Disease with Acute Coronar...
Case Presentation in SOAP format on Ischemic Heart Disease with Acute Coronar...Case Presentation in SOAP format on Ischemic Heart Disease with Acute Coronar...
Case Presentation in SOAP format on Ischemic Heart Disease with Acute Coronar...
 

Similar to A soape note on uncontrolled hypertension

A case study on anemia with congestive heart failure
A case study on anemia with congestive heart failureA case study on anemia with congestive heart failure
A case study on anemia with congestive heart failuremartinshaji
 
Case presentation on alcoholic liver disease
Case presentation on alcoholic liver diseaseCase presentation on alcoholic liver disease
Case presentation on alcoholic liver diseaseRavali Naidu
 
Amphetamines - Recommendations for Appropriate Use
Amphetamines - Recommendations for Appropriate UseAmphetamines - Recommendations for Appropriate Use
Amphetamines - Recommendations for Appropriate UseAlexandria Polles
 
Seminar on LABA & SABA: By RxvichuZ! ;)
Seminar on LABA & SABA: By RxvichuZ! ;)Seminar on LABA & SABA: By RxvichuZ! ;)
Seminar on LABA & SABA: By RxvichuZ! ;)RxVichuZ
 
Case studies in the managment of type 2 diabetes
Case studies in the managment of type 2 diabetes Case studies in the managment of type 2 diabetes
Case studies in the managment of type 2 diabetes NasserAljuhani
 
COPD case presentation
COPD case presentation COPD case presentation
COPD case presentation sara_abudahab
 
Recent advances in diabetic gastroparesis
Recent advances in diabetic gastroparesisRecent advances in diabetic gastroparesis
Recent advances in diabetic gastroparesisViraj Shinde
 
Anti htn medication.pptx maqsood
Anti htn medication.pptx maqsoodAnti htn medication.pptx maqsood
Anti htn medication.pptx maqsoodMohd Maqsood
 
Renal failure case presentation
Renal failure case presentationRenal failure case presentation
Renal failure case presentationRajnandini Singha
 
Session 2 Hypertension | Dr. Ahmed othman
Session 2 Hypertension | Dr. Ahmed othmanSession 2 Hypertension | Dr. Ahmed othman
Session 2 Hypertension | Dr. Ahmed othmanEmad Qasem
 
Newer drug targets for obesity
Newer drug targets for obesityNewer drug targets for obesity
Newer drug targets for obesitySiddharth Naruka
 
Pharmaco2 asthma
Pharmaco2  asthmaPharmaco2  asthma
Pharmaco2 asthmaLim Wee Yi
 
Inferior myocardial infarction
Inferior myocardial infarctionInferior myocardial infarction
Inferior myocardial infarctionNikhil Peter
 
Case Presentation on Appendicitis.
Case Presentation on Appendicitis.Case Presentation on Appendicitis.
Case Presentation on Appendicitis.Dr.Saroj Poudel
 
Case Presentation On Renal Calculi with Type II Diabetes Mellitus By Riya Mariam
Case Presentation On Renal Calculi with Type II Diabetes Mellitus By Riya MariamCase Presentation On Renal Calculi with Type II Diabetes Mellitus By Riya Mariam
Case Presentation On Renal Calculi with Type II Diabetes Mellitus By Riya MariamRiya Mariam
 
DIABETES CARDIOMYOPATHY
DIABETES CARDIOMYOPATHYDIABETES CARDIOMYOPATHY
DIABETES CARDIOMYOPATHYKAVIYA AP
 

Similar to A soape note on uncontrolled hypertension (20)

A case study on anemia with congestive heart failure
A case study on anemia with congestive heart failureA case study on anemia with congestive heart failure
A case study on anemia with congestive heart failure
 
Case presentation on alcoholic liver disease
Case presentation on alcoholic liver diseaseCase presentation on alcoholic liver disease
Case presentation on alcoholic liver disease
 
Sepsis
SepsisSepsis
Sepsis
 
Incretins based therapy :How Early
Incretins based therapy :How EarlyIncretins based therapy :How Early
Incretins based therapy :How Early
 
Chronic Renal Failure
Chronic Renal Failure Chronic Renal Failure
Chronic Renal Failure
 
Amphetamines - Recommendations for Appropriate Use
Amphetamines - Recommendations for Appropriate UseAmphetamines - Recommendations for Appropriate Use
Amphetamines - Recommendations for Appropriate Use
 
Session 10 rieb medication management
Session 10  rieb medication managementSession 10  rieb medication management
Session 10 rieb medication management
 
Seminar on LABA & SABA: By RxvichuZ! ;)
Seminar on LABA & SABA: By RxvichuZ! ;)Seminar on LABA & SABA: By RxvichuZ! ;)
Seminar on LABA & SABA: By RxvichuZ! ;)
 
Case studies in the managment of type 2 diabetes
Case studies in the managment of type 2 diabetes Case studies in the managment of type 2 diabetes
Case studies in the managment of type 2 diabetes
 
COPD case presentation
COPD case presentation COPD case presentation
COPD case presentation
 
Recent advances in diabetic gastroparesis
Recent advances in diabetic gastroparesisRecent advances in diabetic gastroparesis
Recent advances in diabetic gastroparesis
 
Anti htn medication.pptx maqsood
Anti htn medication.pptx maqsoodAnti htn medication.pptx maqsood
Anti htn medication.pptx maqsood
 
Renal failure case presentation
Renal failure case presentationRenal failure case presentation
Renal failure case presentation
 
Session 2 Hypertension | Dr. Ahmed othman
Session 2 Hypertension | Dr. Ahmed othmanSession 2 Hypertension | Dr. Ahmed othman
Session 2 Hypertension | Dr. Ahmed othman
 
Newer drug targets for obesity
Newer drug targets for obesityNewer drug targets for obesity
Newer drug targets for obesity
 
Pharmaco2 asthma
Pharmaco2  asthmaPharmaco2  asthma
Pharmaco2 asthma
 
Inferior myocardial infarction
Inferior myocardial infarctionInferior myocardial infarction
Inferior myocardial infarction
 
Case Presentation on Appendicitis.
Case Presentation on Appendicitis.Case Presentation on Appendicitis.
Case Presentation on Appendicitis.
 
Case Presentation On Renal Calculi with Type II Diabetes Mellitus By Riya Mariam
Case Presentation On Renal Calculi with Type II Diabetes Mellitus By Riya MariamCase Presentation On Renal Calculi with Type II Diabetes Mellitus By Riya Mariam
Case Presentation On Renal Calculi with Type II Diabetes Mellitus By Riya Mariam
 
DIABETES CARDIOMYOPATHY
DIABETES CARDIOMYOPATHYDIABETES CARDIOMYOPATHY
DIABETES CARDIOMYOPATHY
 

Recently uploaded

Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptxNIKITA BHUTE
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfDolisha Warbi
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 

Recently uploaded (20)

Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 

A soape note on uncontrolled hypertension

  • 1. A CASE STUDY ON UNCONTROLLED HYPERTENSION PRESENTED BY Arunima Shrestha Harif Ghimire Mamata Panthi Romit Subba Trilochan Pandey [B.Pharmacy 2nd Year]
  • 2. SOAPE NOTE  Subjective – JF is a 64 y/o A.A. M seen today for f/u for his HTN.  PMH- HTN*14 yrs, DM II, Stage 2 COPD, BPH & recent recovery from cold  SH- Lives alone, occasional drinker, no smoking  FH- Father & mother had HTN  MH- Hydrochlorothiazide 25mg po q am Doxazosin 2mg po q am Carvedilol 12.5mg po bid Mucinex D 2 tablets q12 for cough Naproxen 220mg po q8h for pain Metformin 500mg po bid
  • 3. SOAPE NOTE  Objective- Past[3 months ago] B.P 160/85 mm Hg B.P 162/90 mm Hg HR- 76 bpm Wt-95 kg Ht.-6’2 BMI-26.8(overweight) Na- 138mEq/l Ca- 9.7mEq/l K- 4.7mEq/l Total Chol.- 171mg/dl LDL- 99mg/dl HDL- 40mg/dl TG- 158mg/dl S.cr- 2.2 mg/dl Glucose- 110mg/dl U.A- 6.7 mg/dl
  • 4. SOAPE NOTE  Assessment - -JF’s BP is not at goal ,because he is diabetic his goal should be <130/80mmHG. - -Despite of triple antiHTN therapy ,B.P is not optimal because of many factors including use of Mucinex D(contains pseudoephedrine), Naproxen(NSAID) & non compliance with low sodium diet - -ACEIs or ARB as drug of choice in pt. with Diabetes. CCB is also an option(as he is AA) - -Continue HCTZ
  • 5. -Use of non selective beta blocker is not best selection for COPD pt. -JF has BPH & is on Doxazosin , an alpha blocker that seems to control his BPH symptoms as well. However, dizziness & headaches like side effects of Doxazosin can be minimize by take the dose at night -Continue metformin
  • 6. SOAPE NOTE  Plan -Discontinue guaifenesin/pseudoephedrine preparation(especially if no longer needed for cold symptoms) or give product containing only guaifenesin next time. -Discontinue Naproxen . Go for an alternative(eg.acetaminophen) for headache and gout -Discontinue Carvedilol gradually -Add Lisinopril 5mg po once daily, increase if not enough. It can cause dry cough or angioedema. Monitor B.P, K, renal function, glucose , Lipid profile
  • 7. -Continue HCLTZ 25mg po qam -Continue Doxazosin 2mg po qhs Change dosing schedule to qhs to reduce possible Doxazosin-induced dizziness -Continue metformin 500mg po bid
  • 8. SOAPE NOTE  Education -Emphasize the importance of low-Na diet. Assist JF in recognizing healthy diet options and consider referring him to a dietitian. -Encourage physical activity compatible with his COPD. Consider gradual and steady aerobic exercise 3-4x/week. May refer to pulmonary rehab program if JF faced difficulty -If the patient develops persistent dry cough after using lisinopril, it can be replaced with ARB (e.g. losartan). -Thiazide diuretics can make pt. sensitive to sunlight. Pt must be sure to apply a sunscreen before any extended exposure to sunlight. Thiazide diuretics may also cause to lose potassium. Potassium should be balance carefully. If pt. experience cramping in feet or lower extremities, this may be a sign that potassium has dropped. If this occurs, notify physician.