MINISTRY OF HEALTH, LABOUR AND SOCIAL PROTECTION OF

REPUBLIC MOLDOVA
PI NICOLAE TESTEMIŢANU STATE UNIVERSITY OF MEDICINE AND
PHARMACY

PHARMACOLOGY AND
CLINICAL PHARMACOLOGY DEPARTMENT

Head of the department: professor Nicolae BACINSCHI

The group leader: univ. assist. Mihalachi-Anghel Maria

CLINICAL CASE HISTORY

Instructive teaching work

Student: Shady Abo Hamad

Group: M1653
Faculty : Medicine Nr.2

Chisinau 2021
 1. General data:

Name: MM
Age: 55
Birthday: 28.02.1975
Sex: male
Nationality: RM
Address: Mun. Chisinau, Sec: Botanica
Date of hospitalization: 23.12.2020 at 19-00 o'clock
2. Hospitalization diagnosis:
Clinical diagnosis: Heart failure, HTA, epilepsy, asthma, obesity.

3. Patient history: the patient came to the hospital after a work.

4. Treatment history: concomitant treatment

5. Clinical /paraclinical examination according to the established diagnosis Ischemic

heart diasease

6. Clinical / paraclinical examination

Tests and diagnosis of Ischaemic Heart Disease
1. Medical history
2. Electrocardiogram
3. Blood analysis
4. Chest X-ray
5. Echocardiography or echocardiogram
6. Cardiac stress test or ergometry
7. Coronary computed tomography (coronary CT).
The doctor will ask questions about patient medical history, do a physical exam and order
routine blood tests. The patient may suggest one or more diagnostic tests as well, including:
Electrocardiogram (ECG). An electrocardiogram records electrical
signals as they travel through your heart.

7. Treatment – characteristics of the drugs (name of drug, name of

group, mechanism of action, indications, contraindications, side
effects and drug interactions)
Propranolol: name of group: non- selective beta-blockers
MOA:
Propranolol is a nonselective β-adrenergic receptor antagonist. Blocking of these receptors leads
 to vasoconstriction, inhibition of angiogenic factors like vascular endothelial growth factor
(VEGF) and basic growth factor of fibroblasts (bFGF), induction of apoptosis of endothelial
cells, as well as down regulation of the renin-angiotensin-aldosterone system.
Ind: is indicated to treat hypertension, angina pectoris due to coronary atherosclerosis, atrial
fibrillation, myocardial infarction, migraine, essential tremor, hypertrophic subaortic stenosis,
pheochromocytoma, and proliferating infantile hemangioma.
C/ind: is contraindicated in patients with asthma, chronic obstructive pulmonary disease
(COPD), atrioventricular (AV) block, intermittent claudication, and psychosis.
SE: The most frequent adverse effects are lightheadedness, fatigue, dyspnea upon exertion,
bronchospasm, insomnia, impotence, and apathy.
Drug – drug interactions:
 Alpha blockers: Prazosin.
 Anticholinergics: Scopolamine.
 Other high blood pressure medications: Clonidine, acebutolol, nebivolol, digoxin,
metoprolol.
 Other heart medications: Quinidine, digoxin, verapamil.
 Steroid medications: Prednisone.

Furosemide: name of group:  is a loop diuretic

MOA: Furosemide promotes diuresis by blocking tubular reabsorption of sodium and chloride in
the proximal and distal tubules, as well as in the thick ascending loop of Henle. This diuretic
effect is achieved through the competitive inhibition of sodium-potassium-chloride
cotransporters (NKCC2) expressed along these tubules in the nephron, preventing the transport
of sodium ions from the lumenal side into the basolateral side for reabsorption. This inhibition
results in increased excretion of water along with sodium, chloride, magnesium, calcium,
hydrogen, and potassium ions.As with other loop diuretics, furosemide decreases the excretion of
uric acid.Furosemide exerts direct vasodilatory effects, which results in its therapeutic
effectiveness in the treatment of acute pulmonary edema. Vasodilation leads to reduced
responsiveness to vasoconstrictors, such as angiotensin II and noradrenaline, and decreased
production of endogenous natriuretic hormones with vasoconstricting properties. It also leads to
increased production of prostaglandins with vasodilating properties. Furosemide may also open
potassium channels in resistance arteries.The main mechanism of action of furosemide is
independent of its inhibitory effect on carbonic anhydrase and aldosterone.
Ind: to treat hypertension and edema in congestive heart failure, liver cirrhosis, renal disease,
and hypertension.
C/ind:
 diabetes.
 a type of joint disorder due to excess uric acid in the blood called gout.
 low amount of magnesium in the blood.
 low amount of calcium in the blood.
 low amount of sodium in the blood.
 low amount of potassium in the blood.
 low amount of chloride in the blood.
 hearing loss.

SE:
 peeing more than normal, most people need to pee a couple of times within a
few hours of taking furosemide - you may also lose a bit of weight as your body loses
water.
 feeling thirsty with a dry mouth.
 headaches.
 feeling confused or dizzy.
 muscle cramps, or weak muscles.

Drug – drug interactions:

 amikacin.
 amisulpride.
 cisapride.
 ethacrynic acid.
 gentamicin.
 kanamycin.
 neomycin po.
 netilmicin.

Aspirin: name of group:  salicylates non-steroidal anti-inflammatory drug (NSAID)

MOA:
Acetylsalicylic acid (ASA) blocks prostaglandin synthesis. It is non-selective for COX-1 and
COX-2 enzymes . Inhibition of COX-1 results in the inhibition of platelet aggregation for about
7-10 days (average platelet lifespan). The acetyl group of acetylsalicylic acid binds with a serine
residue of the cyclooxygenase-1 (COX-1) enzyme, leading to irreversible inhibition. This
prevents the production of pain-causing prostaglandins. This process also stops the conversion of
arachidonic acid to thromboxane A2 (TXA2), which is a potent inducer of platelet aggregation .
Platelet aggregation can result in clots and harmful venous and arterial thromboembolism,
leading to conditions such as pulmonary embolism and stroke.
Ind: Pain, fever, and inflammation

Acetylsalicylic acid (ASA), in the regular tablet form (immediate-release), is indicated to relieve
pain, fever, and inflammation associated with many conditions, including the flu, the common
cold, neck and back pain, dysmenorrhea, headache, tooth pain, sprains, fractures, myositis,
neuralgia, synovitis, arthritis, bursitis, burns, and various injuries. It is also used for symptomatic
pain relief after surgical and dental procedures .

The extra strength formulation of acetylsalicylic acid is also indicated for the management

migraine pain with photophobia (sensitivity to light) and phonophobia (sensitivity to sound)
 C/ind: s contraindicated in patients with known allergy to NSAIDs and in patients with asthma,
rhinitis, and nasal polyps.
SE: s contraindicated in patients with known allergy to NSAIDs and in patients with asthma,
rhinitis, and nasal polyps.
Drug – drug interactions: Aspirin can interact with many drugs. Some of these include: Anti-
inflammatory painkillers: Examples include such as diclofenac, ibuprofen, and naproxen.
Combined with aspirin, these types of drugs can increase the risk of stomach bleeding.

Verapamil: name of group: calcium-channel blockers

MOA: Verapamil inhibits L-type calcium channels by binding to a specific area of their alpha-1
subunit,Cav1.2, which is highly expressed on L-type calcium channels in vascular smooth
muscle and myocardial tissue where these channels are responsible for the control of peripheral
vascular resistance and heart contractility.Calcium influx through these channels allows for the
propagation of action potentials necessary for the contraction of muscle tissue and the heart's
electrical pacemaker activity. Verapamil binds to these channels in a voltage- and frequency-
dependent manner, meaning affinity is increased 1) as vascular smooth muscle membrane
potential is reduced, and 2) with excessive depolarizing stimulus.
Ind:
Verapamil is indicated in the treatment of vasopastic (i.e. Prinzmetal's) angina, unstable angina,
and chronic stable angina. It is also indicated to treat hypertension, for the prophylaxis of
repetitive paroxysmal supraventricular tachycardia, and in combination with digoxin to control
ventricular rate in patients with atrial fibrillation or atrial flutter.
C/ind:
 Severe hypotension or cardiogenic shock.
 Second- or third-degree AV block (except in patients with a functioning artificial
ventricular pacemaker).
 Sick sinus syndrome (except in patients with a functioning artificial ventricular
pacemaker).

SE: Dizziness, slow heartbeat, constipation, stomach upset, nausea, headache, or tiredness may
occur.
Drug – drug interactions: Some products that may interact with this drug include: aliskiren,
clonidine, disopyramide, dofetilide, dolasetron, fingolimod, lithium. Other medications can
affect the removal of verapamil from your body, which may affect how verapamil works.

8. CONCLUSION: the treatment is appropriate and have shown that the patient improved
and her status start to be good, and we agree with the treatment.

 Aspirin. . This can reduce the tendency of your blood to clot, which may help
prevent obstruction of your coronary arteries.
 If payient 've had a heart attack, aspirin can help prevent future attacks. But aspirin
can be dangerous if patient have a bleeding disorder or you're already taking
another blood thinner, so ask your doctor before taking it.

 Beta blockers. These drugs slow patient heart rate and decrease his blood
pressure, which decreases his heart's demand for oxygen. If he've had a heart
attack, beta blockers reduce the risk of future attacks.

 Calcium channel blockers. These drugs may be used with beta blockers if beta
blockers alone aren't effective or instead of beta blockers patient're not able to take
them. These drugs can help improve symptoms of chest pain.

9. Personal Drug Selection (select the most efficient and harmless drugs)
Note – Selecting your P-drugs accordingly to WHO Guide to Good Prescribing, A practical
manual, World Health Organization Action Programme on Essential Drugs

Conclusion: The P-drug for my patient is Propanolol, because:

 treat high blood pressure.
 treat illnesses that cause an irregular heartbeat, like atrial fibrillation.
 prevent future heart disease, heart attacks and strokes.
 prevent chest pain caused by angina.