DAY 4, WEEK 2 (DRP)
- Rationale of using Pantoprazole in patient receiving DAPT
- Inappropriate regimen of bisoprolol
- 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.