SOAP ANALYSIS FOR HYPERTENSION AND VERTIGO HYPERTENSION ACCORDING TO JNC8 PATIENTS 60YEARS OF AGE OR OLDER START PHARMACOTHERAPY AT 140/90mmHg. SINCE THERE IS NO COMPELING INDICATIONS AND ITS STAGE 1 HTN START MONOTHERAPY DRUG USING. ACE INHIBITOR ARB CCB THIAZIDE-TYPE DIURETIC OR 2 DRUG COMBINATION VERTIGO IS USUALLY MANAGED WITH VESTIBULAR SUPPRESSANTS, ANTIVIRAL MEDICATION AND ANTIEMETIC MEDICATIONS. VESTIBULAR SUPPRESANTS SHOULD BE USED ONLY FOR A FEW DAYS AT MOST BECAUSE IT MAY DELAY THE BRAIN NATURAL COMPENSATORY MECHANISUM FOR PERPHERAL VERTIGO

1. CASE PRESENTATION ON
HYPERTENSION AND
VERTIGO
BY JASON FERNANDES JOEKIM
PHARM-D
FATHER MULLERS MEDICAL COLLEGE AND HOSPITAL

2. A 65 YEAR OLD WOMAN WAS ADMITTED IN R1 WARD OF F.M.M.C
ON 11-11-19 AND DISCHARGED ON 13-11-19. SHE WAS ADMITTED
WITH THE CHIEF COMPLAINT OF GIDDINESS AND GENERAL
WEEKNESS .

3. PATIENT DATA
 NAME :
 AGE :
 SEX :
 DOA :
 DOD :
 IP NO. :
MrsX
65yrs
Female
11-11-19;14:11
13-11-19;9:14
14/190088309/766970
DIAGNOSIS:THEPATIENT WAS DIAGNOSED WITHHYPERTENSION AND VERTIGO

4. S=SUBJECTIVE O=OBJECTIVE
A=ASSESMENT P=PLAN
SOAP

5. SOAP ANALYSIS FOR HYPERTENSION
AND VERTIGO

6. SUBJECTIVE

7. SUBJECTIVE DATA
• PERSONAL HISTORY :THE PATIENT HASBEEN SUFFERING FROM GENERAL WEAKNESS BUT .
HAS NORMAL SLEEP ,URINEAND BOWEL MOVEMENT.
• PAST MEDICAL HISTORY:PAST HISTORY OF HTN BUTPATIENT WAS NOT ON ANY MEDICATION.
• FAMILYHITORY : NO RELEVANTFAMILYHISTORY HASBEEN PROVIDED BYTHE PATIENT.
• SOCIAL HISTORY : NO RELEVANTSOCIAL HISTORYHAS BEEN PROVIDEDBY THE PATIENT.
• KNOWN ALLERGIES :NO ALLERGIES.

8. OBJECTIVE

9. OBJECTIVE
 ON PHYSICALEXAMINATIONTHEPATIENT HASPALLOR,NO CYNOSIS,NO CLUBBING,NO LYMPHODEMOPATHY,NO EDEMAAND NO
ICTRUES
 VITALS: BLOOD PRESSURE 140/90mHg
PULSE RATE 90 beats/min
RESPIRATORYRATE 20 cycl/min
TEMPERATURE 98.6° F
CVS S1&S2 NORMAL
CRANIALNERVE NORMAL

10. HAEMATOLOGY NORMAL FINDINGS
LEUKOCYTE COUNT 4000-
11000/cumm
9200/cumm
NEUTROPHILS 40-60% 64%
LYMPHOCYTES 20-40% 25%
ESINOPHILS 1-4% 02%
MONOCYTES 2-9% 09%
BASOPHILS 0-1% 00%
Hb 12-15.5g/dl 11.3 g/dl
ERYTHROCYTE
SEDIMENTATION
RATE
0-20mm/hr 48 mm/1st hr
LIVERFUNCTION
TEST
NORMAL FINDINGS
SERUMFT4 0.8-2.0ng/dl 2.90ng/dl
SERUMTSH 0.35-
5.5uiU/ml
0.97uiU/ml
SERUMUREA 5-20mg/dl 17mg/dl
SERUMCREATIN 0.8-
1.3mg/dl
0.95mg/dl
LAB INVESTIGATION

11. DATE BP(mmHg)
11/11 140/90 140/80
2:30PM 8:00PM
12/11 120/80 120/70
6:0AM 8:O0PM
13/11 120/70
6:00AM
BP INVESTIGATION CHART

12. ASSESMENT

13. ASSESMENT
FROM THE SUBJECTIVE AND OBJECTIVE EVIDENCE THE PATIENT WAS
DIAGNOSED WITH HYPERTENSION AND VERTIGO.

14. STANDARD TREATMENT
HYPERTENSION
ACCORDINGTO JNC8
PATIENTS60YEARS OF AGEOR OLDERSTARTPHARMACOTHERAPY
AT 140/90mmHg.
SINCE THEREIS NO COMPELING INDICATIONSAND ITS STAGE
1 HTN STARTMONOTHERAPYDRUGUSING.
 ACE INHIBITOR
 ARB
 CCB
 THIAZIDE-TYPEDIURETICOR 2 DRUGCOMBINATION

15. VERTIGO
 VERTIGOIS USUALLYMANAGEDWITHVESTIBULARSUPPRESSANTS, ANTIVIRAL
MEDICATIONAND ANTIEMETICMEDICATIONS.
 VESTIBULARSUPPRESANTS SHOULD BE USED ONLY FOR A FEW DAYSAT MOST
BECAUSEIT MAY DELAYTHE BRAINNATURALCOMPENSATORY MECHANISUM FOR
PERPHERALVERTIGO.

16. SI
NO
BRAND GENERIC NAME ROUTE OF
ADMISTRA
TION
DOSE DIRECTION
NO.OF
DAYS
1. TAB.AMLODIPINE AMLODIOPINE ORAL 5mg 1-0-0 D2
2. TAB.CLOZE CLONAZEPAM ORAL 0.5mg 0-0-1 D2
3. TAB.RENTAC RANTIDINE ORAL 150mg 1-0-1 D2
4. TAB.STUGIL DOMPERIDONE
CINNARIZINE
ORAL 15mg
20mg
1-1-1 D2
ASSESMENT OF CURRENT DRUG THERAPY

17. TAB.AMLOKIND
AMLODIPINE
 CATEGORY:CALCIUM CHANNEL BLOCKER (CCB)
 INDICATION:HYPERTENSION(ANTI-HYPERTENSIVE)
 MOA :RELAXATIONOF THECARDICMOOTH MUSCLESBY BLOCKING VOLTAGESENSITIVECALCIUM
CHANNELS,THEREBYREDUCINGTHE EXTARCELLULARENTRYOF CALCIUM INTO THE CELLS.
 STDDOSE:2.5-10mg
 ADR: PERIPHERALEDEMA, POSTURALHYPOTENSION, HEADACHE,PALPITATION.

18. TAB. CLOZE
CLONAZEPAM
 INDICATION:TREATMENTOF ANXIETY AND EPILEPSY,SEZIURES.
 CATEGORY:BENZODIAZEPINES.
 MOA : ITINCREASESTHE ACTION OF CHEMICALMESSENGER(GABA) WHICHSUPPRESTHE
ABNORMAL ANDEXCESSIVEACTIVITYOF THE NERVE CELL OF THE BRAIN.
 SIDEEFFECTS: DIZZINESS,FATIGUE,DEPRESSON,DROWNINESS.
 GIVEN DOSE:0.5mg

19. TAB.STUGIL
 DOMPERIDNE(15mg)&CINNARIZINE(20mg)
 INDICATION:TREATMENTOF VERTIGO.
 CATEGORY:CINNARIZINEIS AN ANTIHISTAMINE.
 MOA:DOMPERIDINEISAANTIEMETICAND PROKINETIC ITWORKS BY BLOCKING THE ACTIONOF
DOPAMINE IN THE BRAIN WHICHCAUSESNAUESEAAND VOMITING.
CINNARZINEIS CALCIUMCHANNEL ANTAGONISTWHICHWORKS BY CONSTRICTIONOF BLOOD
VESSELSOF THE INNERAREAR.THISIMPROVESTHE MICROCIRCULATIONOF THE EAR.
 SIDEEFFECTS:DRYNESS OF THEMOUTH,DYSPEPSIA,SLEEPINESS,WEIGHTGAIN.

20. TAB.RANTAC
 RANTIDINE
 INDICATION:TREATMENTOF GASTROESOPHAGULREFLEXDISEASEAND PEPTIC ULCER.
 CATEGORY:HISTAMINEH2 BLOCKERS
 MOA:ITIS A REVERSIBLEINHIBITOROF THE ACTION OF HISTAMINEAT THEHISTAMINEH2
RECEPTORSFOUND IN GASTRICPARIETALCELLS,WHICH RESULTSIN DECREASEIN GASTRIC
ACIDPRODUCTION. AND REDUCE HYDROGENION CONCENTRATION.
 SIDEEFFECTS: CONSTIPATON,HEADACHE,TIREDNESS.

21. PLAN

22. GOALS OF THE THERAPY
 GENERAL GOAL
• TARGET BP OF <140/80mmHg AND LOWER TARGETSIN CERTAIN PATIENTS.
• TO MINIMIZE THE DIZZINESS, IMPROVE BALANCE AND PREVENT FALLS .
• TO BRING THYROID LEVELS TO NORMAL
 PATIENT SPECIFIC GOALS
 TO MINIMIZE THE DIZZINESS, IMPROVE BALANCE AND PREVENT FALLS BY RESTORING NORMAL
FUNTION OF THE VESTIBULAR SYSTEM.
 TO BRING THEBP TO NORMAL,<140/80mmHg.
 TO BRING THETHYROID LEVELS BELOW 2ng/dl
 MONITORING PARAMETERS
• SERUM FT4
• HAEMOGLOBIN LEVEL

23. POINTS TO THE PHYSICIAN
THESERUM FT4 LEVELIS 2.9ng/dlTHE PATENT MAY BE SUSPECTED TO HAVEHYPER
THYROIDISM.STARTTREATINGTHE PATIENT WITHMETHIMAZOLE(METHIMEZ).
 POINTS TO THE PATIENT
ABOUTTHE DISEASE :YOU ARESUFFERING FROM HIGHBLOOD PRESSURE, MAY BE DUETO STRESS
VERTIGOIS A CONDITIONWHEREYOU ARE FEELING ASENSE OF DIZZINESS CAN BE MANAGEDBY TAKING
YOU MEDICATION ON TIME.
DISCHARGE MEDICATION
SI NO BRAND GENERIC NAME ROUTE OF
ADMISTRATIO
N
DOSE DIRECTION
1. TAB.AMLODIPINE AMLODIOPINE ORAL 5mg 1-0-0
2. CAP.SOFTERON DOCUSATESODIUM
IRON&FOLIC ACID
ORAL 50mg+54mg+
7.5mg
1-0-0
3. TAB.RENTAC RANTIDINE ORAL 150mg 1-0-1
4. TAB.STUGIL DOMPERIDONE
CINNARIZINE
ORAL 15mg
20mg
1-1-1

24.  DISCHARGE MEDICATION(ADVICE)
1. TAB.AMLIOKINDH– HALFTABLETIN THE MORNING ONCE A DAYFOR HTN.
2. TAB.STUGIL-3TIMES ADAY BEFORE FOOD FOR DIZZINESS[VERTIGO]
3. TAB.RANTAC150MG-2TIMESA DAYABOUT30MIN BEFORE FOOD FOR GASTIC PROBLEMS
4. CAP SOFTERON –ONCE ADAY, FOR LOW HEAMOGLOBIN
 LIFE STYLE MODIFICATION
• WEIGHT REDUTIONIFOVERWEIGHT.
• ADOPTION OF DIETARYAPROACH TO STOP HYPERTENSION OF EATING PLANS.
• DIETARYSODIUM RESTRICTIONIDEALLYTO 1.5 g/dayOR 3.8 g/dayOF NaCl.
• REGULARAEROBICPHYSICAL ACTIVITY
• MODERATE ALCOHOL CONSUPTION.[IF CONSUMING]
• MEDITATEFOR 15 MIN TO RELEIVESTRESS.