teaching plan

Topics: Myocardial infarction, Hypertension, Blood Pages: 5 (1209 words) Published: May 20, 2014
Pharmacology Teaching Plan

The patient is a 70 years old man, admitted in Clinton Cardiology Center for repeated chest pain, fainting, hypotension, thoracic discomfort and cough, which appeared suddenly the same day. The clinical exam showed: cold, pale, sweated skin, dyspnea, tachycardia, a diastolic murmur in the third intercostal space near the sternum edge, a third degree systolic murmur above the lower sternum, and a blood pressure of 80/60 mmHg. The electrocardiogram showed signs of right ventricular overload. The patient was known with arterial hypertension form 2009, had an episode of atrial fibrillation and deep vein thrombosis of the right calf in 2005 and had a hip replacement in 2010. An echocardiographic exam in 2006 noted an ascending aorta aneurism. He had been treated with Betaxolol 20 mg/day for hypertension, Amlodipine 5 mg/day, Indapamide 1.5 mg/day and Trimetazidine 35 mg x 2/day. He was also treated for a severe depression (Olanzapine). The patient states having worked as an accountant at some point in his life has the occasional beer but never smoked; he doesn’t exercise at all and cannot stand for long period of time. The patient is a high fall risk. LEARNING STYLE

English is the patient’s first language and he can read and write; he states having a degree in accounting. He is both an auditory and verbal learner who loves to talk and crack jokes. He speaks clearly and has no trouble communicating at all. He is however feeling discouraged, depressed and is anxious of his current situation but is not eager to learn how to manage his diet and weight as he is not able to exercise due to dyspnea; he is also partially weight bearing on his left leg and is seeing PT as a result from his hip surgery and is still non-compliant with his therapy. The doctor has put him on new medication Reteplase (Retevase) after the doctor diagnosed him with acute myocardium infarction. RETEPLASE (RETEVASE)

Reteplase is a thrombolytic drug that is used to dissolve and break the blood clots that cause a heart attack. It works by activating a substance that helps to break up blood clots. Blood clots can prevent oxygen and nutrients from getting to the heart, which causes tissue death and long-term damage to the heart. It’s indicated for use in the management of acute myocardial infarction (AMI) in adults for the improvement of ventricular function following AMI, the reduction of the incidence of congestive heart failure and the reduction of mortality associated with AMI. Reteplase is given by injection into a vein (IV). Generally, it is given as 10 + 10 unit double bolus injection. Each bolus given over 2 minutes. With the 2nd bolus given, an initial dose follows by a second dose 30 minutes later. Two 10 unit bolus injections are required for a complete treatment. CONTRAINDICATIONS

Active internal bleeding
Recent intracranial or intraspinal surgery or trauma
Severe uncontrolled hypertension
Known bleeding diathesis
hypersensitivity reactions, bleeding
GI upset, hypotension, fever
cardiogenic shock, arrhythmias, AV block, pulmonary edema
Heart failure, cardiac arrest, ischemia, myocardial rupture, mitral regurgitation, pericardial effusion, venous thrombosis, cholesterol embolism SIDE EFFECTS
The most frequent adverse reaction associated with Retavase is bleeding. Other side effects include Pain, redness, or swelling at the injection site
Nausea and vomiting
Severe headache, eye pain or vision changes
Sudden numbness or weakness, especially on one side of the body Sudden headache, confusion, problems with speech, or balance INTERACTIONS
Anticoagulants "blood thinners" (e.g., warfarin or heparins) Antiplatelet drugs (e.g., clopidogrel, dipyridamole, ticlopidine) NSAIDs (e.g., ibuprofen, naproxen)
Drugs that alter platelet function (such as aspirin ) may increase the risk of bleeding if administered prior to or after Retavase (reteplase)...

References: 2009 Edition Delmar 's Nurse 's Drug Handbook By George R. Spratto, Ph.D., Adrienne L. Woods pages 1394-1395
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