PG Diploma / MSc in Clinical Pharmacy

PMY7035: Therapeutics for clinical pharmacists 2

Topic: CARDIOVASCULAR DISEASE 2

Student: Name:

Student Number:

Address:

Date received by The School of Pharmacy

Date returned to The student

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Comments / Mark (%)

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Please place a word count at the end of each answer. Students who exceed the word limit
of 1500 words will be penalised. Answers should be divided into sections and subsections
(e.g. using bullet points or tabulated information where possible). Answers should be word
processed and referenced correctly.

Mrs PP is a 75-year-old patient who has been admitted via A&E with sporadic retrosternal
chest pain radiating to the jaw over the past 2 weeks. This has progressed to sustained chest
pain at rest.

She has received S/L GTN in A&E and is now pain free.

Medical history
Atrial fibrillation
Rheumatoid arthritis
Hypertension
Diabetes

Medication history (2 sources; patient and GP)

Bisoprolol 7.5mg mane
Ramipril 7.5mg mane
Apixaban 5mg bd
Metformin 500mg bd
Naproxen 250mg bd

Social history
Retired ballet dancer
Mother of 12
Lives alone with 4 cats and 3 dogs
Family history of CHD unknown
Social smoker and drinker

Investigations
Investigation Result Investigation Result
HR 95 beats/min AF Hb 100g/L
ECG ST depression in Total cholesterol 6mmol/L
lateral leads
BP 130/95mmHg SrCr 115µmol/L
Weight 62Kg eGFR 36ml/min
Height 5’0’’ Troponin T (hs) 14ng/L (>14ng/L)
Random 12mmol/L
glucose

– °cardiac murmurs
– lung fields are clear
– °oedema
– peripheral pulses are normal bilaterally.
– ECG; ST-seg depression in lateral leads
– Chest X-ray shows a normal cardiac silhouette, with no infiltrates and no pleural effusions

After initial assessment in A&E, the doctor diagnoses Mrs PP with an NSTEMI and admits her
to the cardiology ward for observation.
Question 1 (10 marks)

Indicate Mrs PP’s risk factors for coronary heart disease (CHD) and any issues that you
would need to clarify.

Question 2 (5 marks)

Using the table below (based on Framingham), establish her cardiac risk.

Other risk
Normal SBP High normal Grade 1 SBP Grade 2 SBP Grade 3 SBP
factors and
120-129 or SBP 130-139 140-159 or 160-179 or > 180 or DBP
disease
DBP 80-84 or DBP 85-89 DBP 90-99 DBP 100-109 > 110
history

< 15% 10 year 15 – 20% 10

No risk factors Average risk Average risk 20 – 30%
risk year risk

One or two
< 15% < 15% 15 – 20% 15 – 20% > 30%
risk factors

3 or more or
TOD or
15-20% 20 – 30% 20 – 30% 20 – 30%30% > 30%
diabetes
mellitus

Associated
clinical 20 – 30% > 30% > 30% > 30% > 30%
conditions
Key:
Risk factors for CHD: cholesterol above ideal levels, family history of CHD, smoking, men age> 55,
women > 65, abdominal obesity, CRP > 1mg/L.

TOD: target organ damage, LVH, ultrasound evidence of arterial disease, raised serum Creatinine,
microalbuminuria.
Associated conditions: Cerebrovascular disease inc TIA, angina or MI, CHF, renal impairment,
proteinuria, PVD, advanced retinopathy.

Question 3 (5 marks)

Comment on the value you have determined – what does this mean for the patient?

Question 4 (30 marks)

Based on her risk, propose a management strategy including both acute and long-term
pharmacotherapy. Include the evidence base for your proposal(s).

Question 5 (50 marks)

a) Develop a pharmaceutical care plan for Mrs PP using the following template:

List anticipated outcomes,

Identify the problem or risk
involving medication or
disease state
monitoring requirements
Therapeutic goal
and further action, if
necessary
Answers:

Word count:
References: