week 5- pharm

Week 4 Discussion

Chest Pain

CP is a 64-year-old male who presents to the emergency department (ED) via ambulance for chest pain. He was out shoveling snow from his driveway when he developed left anterior chest pain, pressure-type, radiating to his jaw and shoulder. Despite the cold weather, he was sweating. He also noted palpitations and shortness of breath, although he thought it was just because he was a little out of shape. He was afraid that something was wrong, so he asked his wife to call 911. 

Past Medical History 



Diabetes mellitus

  Gout Medications 

Hydrochlorothiazide, 25 mg once daily 

Allopurinol, 300 mg once daily 

Social History 

Retired factory worker 

Smokes one pack of cigarettes per day 

Drinks about six beers per day (sometimes more) 

Physical Examination 

Well-developed obese man in moderate distress 

Height: 69 inches; weight: 252 lbs.; blood pressure: 172/110; pulse: 92; respiration rate: 16; temperature: 98.7 F 

Lungs: Scattered bilateral wheezes 

Heart: Regular with grade II/VI systolic murmur 

Extremities: No edema 

Labs and Imaging 

Complete blood count with mild leukocytosis (WBC 12.9k) 

Potassium: Low at 2.9 mEq/L 

Glucose: 252 mg/dL 

Troponin I: 1.7 ng/L 

Uric acid: 11.1 mg/dL 

EKG: ST segment depression with T-wave inversion over lateral leads; no pathologic Q waves Next Steps 

CPs admitting diagnoses are non-ST segment elevation acute coronary syndrome, hypertension, diabetes mellitus, obesity, alcohol abuse, hyperuricemia, and smoker 

Discussion Questions 

1. What medications should be instituted for CP? 

2. What medications should be continued after discharge? 

3. What lifestyle modifications can be recommended for CP?