CASE PRESENTATION ON

ISCHEMIC STROKE

G.HARI PRAKASH
PHARM.D INTERN
DEMOGRAPHICS
• NAME: MR.V
• AGE: 63 years
• SEX: Male
SUBJECTIVE:
CHIEF COMPLAINTS: Pt is drowsy,
C/o severe headache
On Manditory Hemodialysis Dialysis,
c/o of vomiting since 1 week,
Constipation since 1 week
PAST MEDICAL HISTORY:
• K/C/O HTN since 20 years(on medication)
• D.M since 20 years on medication
• Stroke 5 years back
• K/C/O since 2011 on MHD (Thrice weekly)
VITALS - OBJECTIVE
GENERAL EXAMINATION SYSTEMIC EXAMINATION

Temperature : 98.6 CNS : Abnormal(psychoses)

Pulse rate : 84 beats /min CVS :S1 S2+

Respiratory rate : 22/ min RS : BAE+

Blood pressure :140/90 mm Hg P/A :Soft

LABORATORY PARAMETERS
S.NO PARAMETER VALUE NORMAL RANGE
COMPLETE BLOOD COUNT
1 Haemoglobin 13 12-15 g/dl
2 Packed cell volume 41 31-46%
3 WBC 2600 4000-11000 cells/cu mm
4 Platelet count 3 1.5- 4 lakhs/cu mm
5 MCV 90 76-96 fl
6 MCH 30 27-32 pg
7 MCHC 34.5 31-35 %
8 ESR 12 3-15 mm
RENAL PROFILE
9 Urea 64 7-18mg/dl
10 Creatinine 2.2 0.6-1.4mg/dl
11 Sodium 135 134-144mmol/L
12 Potassium 4.8 3.5-5.0mmol/L
13 Chloride 105 98-106mmol/L
14 Bicarbonate 25 21-28mmol/L
 BLOOD SUGAR
FBS 115 <110 mg/dl  
RBS 150 80-140mg/dl  

LIVER FUNCTION TEST

14 Bilirubin(T) 1.1 0.3-1.2mg/dl

15 Bilirubin(D) 0.1 0.1-0.3mg/dl
16 Total protein 7.6 6.4-8.2mg/dl
17 Albumin 4.7 3.5-5.2g/dl
18 SGOT 37 15-37U/L
19 SGPT 38 30-65U/L
20. ALP 60 50 – 136U/L
21. Albumin 4 3.4-5 g/ dl
22. Globulin 4.1 3-4.5 g/ dl
CARDIAC MARKERS
CPK-MB 15 0-20 U/L
CK-MB 17 0-20 U/L
ASSESSMENT:
Based on the previous medical history, chief complaints, abnormalities the patient was diagnosed to
have Ischemic stroke( HTN, DM, kidney failure)
 DRUG GENERIC RO DOSE 6/7 7/7 8/7 9/7 10/7 11/7
NAME A
Tab CINOD CILNIDIPIN RTF 20mg √ √ √ √ √ √

E
Tab MOXONIDI RTF 0.3mg √ √ √ √ √ √

MOXOVAS NE
Tab CLOPIDOG RTF 40mg √ √ √ √ √ √

ATORFIT REL
CV
Inj.PANTO PANTOPRA IV 40mg √ √ √ √ √ √

CID ZOLE
Inj.EMESE ONDANSE IV 4mg √ √ √ √ √ √

T TRON
Tab PHENYTOI RTF 100m √ √ √ √ √ √

EPTOIN N SODIUM g
Tab PYZINA PYRAZIN RTF 1000
√ √ √ √ √ √
AMIDE mg
Tab ISOSORBI RTF 2 tab √ √ √ √ √ √ √
ISOLAZIN DE
E DINITRATE

Tab URSODIOL RTF 800m √ √ √ √ √ √ √

URSOCOL g

Tab HYDROXY RTF 25mg

√ √ √ √
ATARAX ZINE

Tab LEVOCETI RTF 5mg

√ √ √
LEVOCET RIZINE

Tab ISOSOR RTF 5mg

SORBITRAT BIDE
E DINITRA √ √ √ √ √ √ √
TE
ISCHEMIC STROKE
Ischemic stroke can be divided into two main types: thrombotic and embolic. Deprived of oxygen and other nutrients,
the brain suffers damage as a result of the stroke. A thrombotic stroke occurs when diseased or damaged cerebral
arteries become blocked by the formation of a blood clot within the brain.
 
Causes of Stroke
The primary pathophysiology of stoke is an underlying heart or blood vessel disease. The secondary manifestations in
the brain are the result of one or more of these underlying diseases or risk factors. The primary pathologies include
hypertension, atherosclerosis leading to coronary artery disease, dyslipidemia, heart disease, and hyperlipidemia. The
two types of stroke that result from these disease states are ischemic and hemorrhagic strokes.
PATHOPHYSIOLGY:
Ischemic stroke occurs because of a loss of blood supply to part of the brain, initiating the ischemic cascade. Brain tissue
ceases to function if deprived of oxygen for more than 60 to 90 seconds, and after approximately three hours will suffer
irreversible injury possibly leading to the death of the tissue, Atherosclerosis may disrupt the blood supply by narrowing
the lumen of blood vessels leading to a reduction of blood flow, by causing the formation of blood clots within the vessel,
or by releasing showers of small emboli through the disintegration of atherosclerotic plaques. Embolic infarction occurs
when emboli formed elsewhere in the circulatory system, typically in the heart as a consequence of atrial fibrillation, or in
the carotid arteries, break off, enter the cerebral circulation, then lodge in and block brain blood vessels. Since blood
vessels in the brain are now blocked, the brain becomes low in energy, and thus it resorts into using anaerobic
metabolism within the region of brain tissue affected by ischemia. Anaerobic metabolism produces less adenosine
triphosphate (ATP) but releases a by-product called lactic acid.
 
PHARMACOTHERAPY:

CINOD:
• Classification: cognitive enhancer
• Mechanism of action: It claimed to improve ATP/ADP ratio in telencephalon. And increase sympathetic
flow.
• Adverse effects: Nausea, Nervousness, Rash, Abdominal pain, Anxiety, Confusion, Depression, Diarrhoea,
Hallucination, Headache, Increased muscular activity, Insomnia 
• Dose :0.8-1 g.
• Brand names: NEUROCETAM, NEUROSYS, NOOTROPIL.
SODIUM BICARBONATE
• Classification: Electrolytes
• Mechanism of action: It increases the pH of blood in the case of ketoacedocis.
• Adverse effects: Hypernatremia.
• Dose: 150mg
• Brand names: SODAMINT.

URSODIOL:
• Mechanism of action: The drug reduces cholesterol absorption and is used to dissolve (cholesterol) gallstones.
Ursodeoxycholic acid has been shown to exert anti-inflammatory and protective effects in human epithelial cells of
the gastrointestinal tract. It has been linked to regulation of immunoregulatory responses via regulation
of cytokines, antimicrobial peptides defensins, and take an active part in increased restitution of wound in the colon.
•  Adverse effects: Nausea, Nervousness, Rash, Abdominal pain, Anxiety, Confusion, Depression, Diarrhoea,
Hallucination, Headache
• Dose :500-1000 mg.
• Brand names: URSOCOL
ATORVOSTATIN
• Classification: HMG-coA reductase inhibitor.
• Mechanism of action: It inhibit the enzyme HMG-coA reductase enzyme.
• Adverse effects: Myopathy, Rhabdomyolysis, Sleep distrubances.
• Dose: 10-40mg
• Brand names: AZTOR, ATORVA, ATIRLIP.

PANTOPROZOLE
• Classification: Proton pump inhibitor.
• Mechanism of action: It inhibist the H+K+ ATPase pump.
• Adverse effects: Serious skin conditions, Serious allergic reactions.
• Dose:20g, 40mg
• Brand names: PANTOP, PANTODAC, PANTIUM, PANTOCID.
NIFEDIPINE
• Classification : Dihydropyridines (DHP).
• Mechanism of action :They act by blocking the calcium channel and there by fall in BP.
• Adverse effects : Palpitations, flushing, ankle edema, head ache, nausea, hypotension.
• Dose : 5-10mgBD/TDS oral
• Brand names : DEPIN,NIFECAT,CALCIGARD, NICARD.

CALCIUM+VIT D
• Classification: Vitamin supplements
• Mechanism of action: It demonstrate the neuronal and skelital muscle function.
• Adverse effects: Hypercalcimia, weakness.
• Dose:40IU
• Brand names: CALDIKIND.
PHARMACIST INTERVENTION:

• 1.No clinically significant medication errors were found.

• 2.No clinically significant adverse drug reactions were observed.
• 3.Mild drug interactions were observed
Phenytoin + Ondensatron = Phenytoin increases the clearance of
ondensatron
Discharge Mediction:
Tab. Cinod – 20mg - BD
Tab. Atorfit CV – 40mg-OD
Tab. Pantocid – 40mg - OD
Tab. Eptoin – 100mg -OD
Tab. Levocet – 5mg – OD
Tab. Nifedipine – 20mg - OD
Review after 15 days
LIFE STYLE MODIFICATIONS
DO’S:
• Practice yoga with breathing exercises.
• Reduce intake of salt.
• Mild exercise daily.
• Steam inhalation should be regular.
• Follow the medication without skipping.
• Drugs should be taken carefully.
• Sleep properly.
• Take adequate fruits and vegetables.
• Take drugs as advised by your physician.
• Have aerobic physical activity such as brisk walking at least 30min/day.
• Consume soluble fibers.
DONT’S:

• Don’t take food which contain high amount of salt.

• Avoid stress.
• Reduce intake of carbohydrate.
• Reduce salt intake.
• Avoid fatty foods.
• Reduce sugar intake.
• Quit alcohol and smoking
THANK YOU