..

561010077

(CHRONIC CASE REPORT )

Patient profile

65 86 kg 171 cm (BMI 29.41 kg/m2)

31/5/60

CC:
5

HPI:

31/5/60 BP1 170/85 mmHg (PR 87/min) BP2 171/81 mmHg (PR 87/min)
BP3 158/72 mmHg (PR 84/min) Losartan 50 mg 1x1 Amlodipine 5mg 1x1 pc

7/6/60
Amlodipine 10 mg 1x1 pc

MH:

31/5/60 Losartan 50 mg 1x1 Amlodipine 5mg 1x1 pc

7/6/60 Amlodipine 10 mg 1x1 pc

SH:

FH:

PMI: 5

ALL: //

SOAP NOTE
Problem list: Uncontrolled Hypertension with DRP: Non-compliance
SUBJECTIVE DATA(S)
65 86 kg 171 cm (BMI 29.41 kg/m2)
31/5/60

OBJECTIVE DATA (O)

31/5/ 60 BP1 170/85 mmHg (PR 87/min)

BP2 171/81 mmHg (PR 87/min)

BP3 158/72 mmHg (PR 84/min)

31/5/60 Losartan 50 mg 1x1 Amlodipine 5mg 1x1

7/6/60 Amlodipine 10 mg 1x1

ASSESSMENT (A)

ETIOLOGY
(hypertension) (systolic blood pressure, SBP) > 140
. / (diastolic blood pressure,DBP) >90 .

2 Primary hypertension

Secondary hypertension

amphetamine, corticosteroids, ergot alkaloids, estrogencontaining, oral contraceptive

RISK FACTOR

INDICATION OF THERAPY
 2 (SBP 160-179 DBP 100-109 mmHg)

Category SBP(mmHg) DBP(mmHg)

Optimal <120 <80
Normal 120-129 80-84
High normal 130-139 85-89
Grade 1 Hypertension(mild) 140-159 90-99
GRADE 2 HYPERTENSION 160-179 100-109
(MODERATE)

Grade 3 Hypertension(severe) 180 110

Isolated systolic hypertension (ISH) 140 <90
1 18 (
2558)

10

2 10 (
2558)
 10
(moderate to high risk)

3 (
2558)

ASSESSMENT OF THERAPY
.. 2555 .. 2558
CVD 10

CVD
>140/90 . 1

>140/90 . 1

ARB ACEI
competitive inhibitor Ag II receptor angioedema
active metabolite
Losartan Valsartan Candesartan Irbesatan Olmesartan Telmisartan
Losartan ( .) 50 mg 1x1 pc

CCB
 1

CCB Dihydropyridine Amlodipine Nicardinine Nifedipine

Nimodipine Non- Dihydropyridine Verapamil Diltiazem Dihydropyridine

IESAC CCB

peripheral edema, hypotension, flushing Amlodipine Nicardinine Nifedipine
Nimodipine

Amlodipine Nicardipine Nifedipine Nimodipine

I
E Tmax(oral) 6-12 hr,bioavailability 64- Bioavailability: Bioavailability: 45-70% Bioavailability:
90%,protein binding 93%,T1/2 30-60 hr, 35% protein binding: 90% 13%
CHD and protein T1/2 1-2 hr
nonfatal MI onset<1min(IV)
binding>98% Extensively
stroke CVD 5-20 min(subligual 0r
onset 20 min 0ral) metabolized
T1/2 2-4 hr T1/2 4 hr
S S/E: peripheral edema, headache, nausea, S/E:edema, S/E:edema, dizziness, S/E: headache,
flushing dizziness, headache, flushing, diarrhea
headache, flushing hypotension,
constipation
A 5 mg OD max:10 mg/d 20-40 mg q 8 hr 3-10 mg/kg 60 mg q 4 hr po
IV:20-40 mg q 8 hr po
C . . . .
Amlodipine
5 mg 1x1 10 mg 1x1 pc

PLAN

THERAPEUTIC PLAN

Continue: Losartan 50 mg 1x1 pc Amlodipine 10 mg 1x1 pc

GOAL

<140/90 mmHg

THERAPEUTIC MONITORING

BP<140/90 mmHg hypotension

TOXIC MONITORING

Losartan: Hypotension, Dizziness

Amlodipine: Peripheral edema, Hypotension, Headache, Nausea

PATIENT EDUCATION

30 5

FUTURE PLAN

Losartan (100 mg/d)


1 . :

2 Saseen JJ, Maclaughlin EJ. Hypertension. In : Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM,
editors, Pharmacotherapy a pathophysiologic approach. 9th ed. New York McGrew-Hill Dducdation; 2014. P.49-56.

3 James PA, Oparil S, Carter BL, Cushman WC, Himmelfarb CD, Handler J, et al. Evidence-based guideline for the
management of high blood pressure in adults: report from the panel member appointed to the eighth joint national
committee (JNC 8). JAMA; 2013.

4 Gluseppe Mancia, Robert Fagard, Krzysztof Narkiewicz, Josep Redon, Alberto Zanchetti,Michael Bohm, et al. 2013
ESH/ESC Guidelines for the management of aerial hypertension. European Heart Journal (2013) 34, 2159-2219.

5 .2555
2558.