DAY 4, WEEK 2 (DRP)

  1. Rationale of using Pantoprazole in patient receiving DAPT
  1. Inappropriate regimen of bisoprolol
  1. Inappropriate Drug Choice of Clopidogrel

Patient receiving dual antiplatelet therapy may have a high risk to obtain gastrointestinal bleeding

Administration of Tablet Pantoprazole 40 mg OD

Justification

Currently, there is an issue arise on the uses of Proton pump inhibitor will reduce the antiplatelet effect of clopidogrel.

This agent is said to be competitively inhibit CYP2C19 (enzyme that metabolized clopidogrel to its active form), thus reduce the antiplatelet effect.

However, the present study showed that pantoprazole does not reduce the antiplatelet effectiveness of clopidogrel as it is a weak inhibitor of CYP2C19.

The short-term application of pantoprazole reduced the risk of gastrointestinal bleeding but did not increase the incidence of MACE events in patients with acute STEMI, thus being worth extending clinically, especially for high-risk patients

Outcome

Tx plan: Proceed the administration of Pantoprazole in the patient.

Monitoring: Monitor any sign of major adverse cardiac events (MACE)

Education: Educate the patient on the side effect of the drugs.

Left sided chest pain at rest

Elevated troponin-I (3245.9)

Elevated BP (131/81 mmHg)

Discharge with bisoprolol 5 mg TDS

Justification

Outcome

Bisoprolol has long-half life (9-12 hours) thus, can be administered once daily to reduce the need for multiple doses

Important to establish and maintain the lower and optimal dose.

Tx plan: Administer bisoprolol 5 mg OD

Monitoring: Heart rate, Blood pressure & Blood glucose

Past medical Hx: Diabetes mellitus

Past medication Hx:

Tab Metformin 1g BD

Tab Gliclazide MR 80mg OD

DXT = 11.3mmol/L (Normal: 4-7mmol/L)

Prescribed with Tab Clopidogrel 75mg OD


DAPT for the management of NSTEMI

Justification

Prasugrel is more effective in diabetics

It is from the same class as Clopidogrel.

Adenosine diphosphate (ADP) antagonists, a class of therapeutic agents that bind selectively to the P2Y12 receptor to inhibit platelet function.

The degree of platelet inhibition remained markedly different from clopidogrel and favoring prasugrel

Outcome

Tx plan: Recommend the Tab Clopidogrel 75mg OD to be changed to Tab Prasugrel 10mg OD

Monitor any signs of bleeding.

Complete blood counts with differential, bleeding time, and liver function tests.

Educate the patient on the potential side effect of the drugs.