Patient Encounter 2 Part

Patient RR undergoes coronary angiography and PCI with a drug-eluting stent placed for a 90% stenosis in his right coronary artery on hospital day 1.

Identify the long-term treatment goals forRR

What additional pharmacotherapy should be initiated prior to hospital discharge?

Create a care plan for RR for hospital discharge that includes pharmacotherapy, desired treatment outcomes, and monitoring for efficacy and adverse effects.

Table 8-4 Therapeutic Drug Monitoring for Adverse Effects of Pharmacotherapy for ACSs

Drug

Advene fffeets

Monitoring

ASA iltfjiduyitl

Enjjupjnn

Fondaparinu*

Bivalhudin

Fibrinolytics

GlytciJiiQU'in 1Mb teceptor Inhibitors Intravenous nuraies

DiHianerri ind verapamil AmVxJipHf*

ACE inhibitors and AflBs Aldosterone antagonists

H/orphine

DyKWjil, blecdinji Qitlri-i1! Bleodinci 1 TP 1/Jiri dlwtwdi i<^li

Weeding hepifin-lndueed thrornhotytopsrua

I'ttMiiri iridut'.tl thmrtbocylopenta

Bleeding

BlMdlng

Bleeding^ oipockilij.- intiacranial hemontitge

Blityii"t> jcuH' ivniwjnd thiori'ticicyioparra

K>pc;cniiQ^ IKjshing, headache, tachycardia tyrx^cnyo«, budytardu, hiejri bkxli. iMQixhospiim, h»n iiiKjie.fatigtJfi. depression, sexual dysfunction (Hflhimari^ rnJskinri liypo^lytt'inij fyfflStOmi

!1ypo-1ensiori biadycardia. heart Wort. In'jir failure, gingival hyperplasia

Hygxm?nsiur\ dependent ¡plural edemat gingival hyperplasia

Hypolensiofi cough farith ACE inhit^'iH"^ hypCftjWlnU, pir.'UTol azoteiri^.angioedania :ACE inhibiftwi mote so than ARBs)

t^lpctemloi\ hypertonia, ininiaSid 5Ci

Hypolensiofv respiratory depression

(III III ,il ■Jijm ill tilj-i-iJn-Mj." Cil ujiui: kiu'linoC&C *nd pliwHet COUVi;

CflCanrt pLiielei coum every f> rnonfhi Oinkj'l sign! erf btetJih^ tuvJini.' CK jnd pteuM COUTH; CBC jnd plalolel count every 6 months fouling hospital discharge iiiniiii (jgiYLof hii^infji t»seCne ttc pbteiei count, ,#rf

INR.aPlTe'iety b hours until largei Iben e'nery M houis;dai!yCfiC: pliielel count every ?-3 days fiomday4 lo 14 until htfJa'in fc nffipecl tmUMnuu pieferahly every ilay) Clinkjl 5l^Jn^oíblL■,«íi^lg,; t»yjinc CK pMUkltniil, 5Cr, aPTT anil INK; (liil-y CHj: .. No lOUtinf playlet i rtir.l nYinilO iinj IflltH nucunt UFH (less 1han 100 day^l (hen baMi™ and wiliwi 2+ hours. SOdaity

Clinical s*gnsof blee-rfing"; baseline C6C and platelet count, SGraPn

.lrHjINRjiUilytet HindSO Clinical signs ol batting"; basolino CBC jnd p1altHetiou«H, SCr.aPTf

¿rtdlNR;iliilyC0C jridSG Clinkal sians of bleeding* baseline C6C plalelef count, IhFl and aPTT; initial itshfCVtty ? "J^ rft ci ¡rrflrdfiafinal hiincirj toge;

dally CBC

Clinii ,sl ygnjof bliv^Jing*; twwlinr CDC. pUHi.l count; 5Cr:;1.iily tBC:

plalelei count at 2-4 tour* after mutation then daily Bf and Hft every i hours

BP, RP, HR. 12 leud KG and (. Jink J signs cfl lifjpt Ijilun.'L'viiry 5-mirnjt« diiiifig l»hfi iKiiii^i BR I'li. I 111 iriij tlinitai signs of tveflf t fallun? every shil during adminnlralion during hOiplurujibalhifi BPjnd HR(rv(.iy6 rnwuihi. following twipiul <JiSihiiiie

¡W end Hit every sJ-irli during csl adrrinistrjliori during tiospiialirnliori then L'^'ry a nncdufo fallowing hospxial ili^clui^ tlenn: eu^m and Eeth cloning every 6 monthi Bl" ev^ry-shift dijiiriQ cval idiv-iN'.tratiofKitjririri hoipiralifjtioft, i(w every 6 months follovving hosp4al di^chatge;dental e»amand hwtli ui«nini}evefy 6 ntsnrhi Bi e-iiery / hours it J for lirst dose, then every ihit during orjl jd mi r;:'.trHi I ion during I.: /.il!:ir'. Ih^n onw^^Jii mon(h% folkMjng hospital dinehai go baseline iO and poiassiuirt daily ^r and polassium while hospitalised 1hen e"ieryii months for 3-i weeks ,if(n h mlgiiiTk'nl ilcm1 tituitkm^ L knci rn4ini[Lirinc| im^ilieixJ id stl«ied patients using spironolactone or eplerenone of If renal ins«lliciency: counsel palient on throat, (ongue. and facial svrt?lling Rf and HRffdWy snifl duiing (*al adnrmistralmn during hospitahri1k«\ thou OrtCft twry 6 rtWIlffliii tjJitlirrt SCr Si<ur»l pyij^iiuril ((internritioiK 5ti ind powsilum ¿1 4?- Ixjgr!, iT 7diy5, Chen monthly for 1 moMta, then evefy 1 month; (hereafter Allowing liosiiitiidiiirhiiiae SP and flfl 5 minules-after each bolus dose

A£E angbterislnHjOfwertlng eraytr^ aPTT. acttvalpd parslal fhrorntioplailiritirina; ARft, angiotensirnecepior bbeker; 6P, blood pwsiure, CBC, "implolp blood tuunc ECditectiorjfdogianv Hfl, h^ut rjtii.1 INIf, Iniiinoliorial HtMMbed RaloiiflP, respujtoiyrjle; SCi, sefuncuMliii.iv?. TTfi ihriimhaik' i Hftirhocytofwnk flurpufar t'Fl 1, unfurl i^uted hep^in.

r'nt.ii ^qrv. cfbfa^dtnj i™ imic ¡iiuutiy sk>oIs. mdent hemtturli, himaknvjis bniMn^wdoHlDgliaii siterblef wnow puni tuv s*b fiOiii-ifKlller VI, de-Ueftlft^. At^Hi-CiMiUVSry Synjiomei, In; LJiPilO Jl. filtiirl PL VlW GC. ft . («lij PS*mS00tJ»rip)p A PathophyiiolMjc Approach. Ah ed. New Ywt. i^cCffliv-HiH JOOH; i'U, with permiwlon.

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