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(Baker, Burrage, Hitchings and Lonsdale, N.D.)

Ebrahim will continue taking aspirin to prevent blood clots due to a history of heart attack. He will also continue taking bisoprolol and atorvastatin to control his heart rate and cholesterol levels. His dose of ramipril will be increased gradually to better control his high blood pressure. Ticagrelor should be stopped due to the risk of bleeding from interacting with aspirin. The pharmacist will review Ebrahim's medications to ensure he takes them safely and as prescribed to prevent further health issues like continued high blood pressure or another heart attack. Regular medication reviews are important to catch any issues and ensure patients do not take high risk drugs like ticagrelor for too long.

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0% found this document useful (0 votes)
37 views2 pages

(Baker, Burrage, Hitchings and Lonsdale, N.D.)

Ebrahim will continue taking aspirin to prevent blood clots due to a history of heart attack. He will also continue taking bisoprolol and atorvastatin to control his heart rate and cholesterol levels. His dose of ramipril will be increased gradually to better control his high blood pressure. Ticagrelor should be stopped due to the risk of bleeding from interacting with aspirin. The pharmacist will review Ebrahim's medications to ensure he takes them safely and as prescribed to prevent further health issues like continued high blood pressure or another heart attack. Regular medication reviews are important to catch any issues and ensure patients do not take high risk drugs like ticagrelor for too long.

Uploaded by

Kareem Nabil
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Part 1

Ebrahim will keep on Aspirin 75mg, because he has history of myocardial infraction,
so Aspirin is needed for long term prevention of thrombosis. Also, he has no restraints
on the use of aspirin, such as peptic ulceration and aspirin hypersensitivity; therefore,
aspirin is an appropriate prescription for Ebrahim. (Baker, Burrage, Hitchings and
Lonsdale, n.d.)
According to BNF recommendations, it is advisable to stop using Ticagrelor because
there is interaction between Ticagrelor and Aspirin; thus, combining these
.medications may significantly increase the risk of bleeding
As an example, Atorvastatin is an oral tablet used to stabilize cholesterol levels;
hence, reducing the likelihood of having a heart attack; 80mg is the right prescription
as the ultimate reach is to reduce non-HDL-C levels by 40% (CKS, 2021).
Additionally, Atorvastatin functions as a preventer of the enzyme 3-hydroxy-3-
methylglutaryl coenzyme A (HMG CoA) which contributes heavily to cholesterol
synthesis (BNF, 2020). In advance of therapy, basic blood tests such as HbA1c, liver
and kidney function must be carried out in order to assure that there are no
contraindications that should prevent the patient from using this medicine (CKS,
.2021)
Ramipril belongs to a group of medicines called angiotensin-converting enzyme
(ACE) inhibitors used to treat heart failure and MI. Because Ebrhaim suffers from
high blood pressure (168/98mmHg), which is still very high, it is crucial to ensure that
the dose starts low and increases gradually. Hence, Ramipiril 1.25mg ON (Should be
increased to 2.5 mg daily); moreover, we can increase the dose until we reach the
optimal blood pressure. Renal function, Electrolyte balance and blood pressure should
be monitoring. The dose must be titrated to aim the optimal dose that has been
associated with long-term advantages seen in clinical trials. (Whittlesea and Hodson,
.n.d.)
Ebrahim will maintain the same dose of Bisoprolol and he is within the normal dosage
(60/90 bpm). Due to past medical history of myocardial infraction, a dosage of 90
Bpm can be considered high for Ebrahim; therefore, if necessary, we can increase the
dose of Bisoprolol from (1.25mg _2.5mg) to control the heartbeat rates. Additionally,
a combination of ACE inhibitor and Beata Blocker will have a cumulative effect on
Ebrahim’s high blood pressure which will result in lowering the blood pressure and
that is the ultimate goal here.
Pharmacist must review the medicines with a prescription in order to improve the
patient's experience, enhance drug outcomes and safety precautions, and to avoid any
risks that may occur to the patient such as continuous hypertension, just like the case
with Ebrahim, so that no relapse should happen to him and/or having a heart attack
again.
Part 2
Ebrahim should not be given Ticagrelor because there is interaction between Aspirin
and Ticagrelor which can cause high risk of bleeding. Also, it is not recommend using
it after 12 months. In addition, if the patient kept taking Ticagrelor, it could increase
the risk of interaction with other medications. Regarding the response to this error, I
would inform the GP that NICE guidelines simply state that Ticagrelor can only be
used for 12 months due to the risk of bleeding, minimal clinical benefits, and as a
pharmacist I will advise the patient to stop using it. However, before any
recommendations to the patient, as a professional, my job dictates conducting an audit
through scrutinizing the patients’ past records of drug prescription and medical
history so I can probably find out whether any patients were given Ticagrelor or not.
In addition, I will review how long each patient was prescribed Ticagrelor. If the
patient uses dual antiplatelet therapy (DAPT), I will advise him/her with the proper
time length for Ticagrelor. On the other hand, if the patient has been taking Ticagrelor
for more than 12 months, I should refer the patient to make an appointment with GP
to review medications.

In conclusion, the aforementioned process clarifies out the fact that it can cause huge
implication on patients’ health; thus, the risk of bleeding increases and it can cause
many problems such as elderly get anemia. Additionally, as a part of the prevention
process, it is important to review the patients’ medications on a regular basis,
personally, I would appropriately review the patients’ medication for two or three
time rather than 18 months by which the system design flag patient high risk
medication for long period of time.

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