Appendix Table 1.

Medication

Class and indication Anticoagulants, Antiplatelets & Fibrinolytics (Thrombolytics) / Nonst eroidal AntiInflammatory Drugs (NSAIDs) Dyslipidemia agent -Mixed dyslipidemia

Drug and function TAB Aspirin 75mg, OD -It inhibits cyclooxygenase, which is responsible for the synthesis of prostaglandin and thromboxane. It also inhibits platelet aggregation.

Side effect and adverse reaction GI disturbances; prolonged bleeding time, rhinitis, urticaria and epigastric discomfort; angioedema, salicylism, tinnitus; bronchospasm

Drug nutrient interaction Vitamin-rich foods increase urinary excretion.

TAB Lovastatin 40mg, at night -Inhibits HMG-CoA reductase, which lowered LDL cholesterol concentration

Headache, flatulence, diarrhea, nausea, vomiting, aneroxia

Avoid alcohol, grapefruit juice and related citrus. Do not take some with high doses of niacin. Separate fiber, pectin and oat bran from drug by several hours.

Anti-Anginal Drugs / Calcium Antagonists -Hypertension, Prinzmetal's angina, Stable angina

Antidiabetic Agent -Type 2 DM

TAB Amlodipine 5 mg, OD - Relaxes peripheral and coronary vascular smooth muscle. It produces coronary vasodilation by inhibiting the entry of Ca ions into the voltage-sensitive channels of the vascular smooth muscle and myocardium during depolarization. TAB Metformin SR 850mg, BD Reduce glucose absorption from the GI tract, reduce gluconeogenesis and enhance insulin sensitivity by increasing peripheral glucose uptake and utilisation.

Headache, peripheral oedema, fatigue, somnolence, nausea, abdominal pain, flushing, dyspepsia, palpitations, dizziness. Rarely pruritus, rash, dyspnoea, asthenia, muscle cramps. Anorexia, nausea, vomiting, diarrhoea, wt loss, flatulence, occasional metallic taste; weakness; hypoglycaemia; rash, malabsorption of vit B12. Chest discomfort, flushing, palpitation, chills, headache, lightheadedness, indigestion, abdominal discomfort.

Avoid natural licorice. Limit caffeine. Decreased sodium and calcium intake may be advised.

Metformin should

be taken with a meal to limit gastrointestinal side effects. Metformin may cause malabsorption of vitamin B12, which may result in B12 deficiency and subsequent anemia.

ACE Inhibitors/Direct TAB Enapril 5mg, OD Renin Inhibitors -Used in the treatment of cardiovascular disease

Prevention and treatment of angina pectoris due to coronary artery disease

TAB Isordil 10mg, tds Relaxation of vascular smooth muscle and consequent dilatation of peripheral arteries and veins

Dizziness, headache, fatigue, asthenia, hypotension, syncope, nausea, diarrhea, muscle cramps, rash & cough. Headache, hypotension

Avoid consuming excessive potassium in foods

Alcohol may interact with Isordil and produce a swift decrease in blood pressure, possibly causing dizziness and fainting.
May be taken with or without food. Only drug-drug interactions available

Analgesics (Opioid) -Used to relieve pain.

IV Tramadol 50mg, tds Tramadol inhibits reuptake of norepinephrine, serotonin and enhances serotonin release. It alters perception and response to pain by binding to mu-opiate receptors in the CNS.

Sweating, dizziness, nausea, vomiting, dry mouth, fatigue, asthenia, somnolence, confusion, constipation, flushing, headache, vertigo, tachycardia, palpitations, miosis, insomnia, orthostatic hypotension, seizures, CNS stimulation e.g. hallucinations.

Discharge plan. Meal planning Table 2. Energy Distribution Carbohydrate 50/100 x 1600 = 800 kcal 800 kcal/4 = 200g 200g/15 = 13 exchanges Protein 20/100 x 1600 = 320 kcal 320 kcal/4 = 80g 80g/7 = 11 exchanges Fat 30/100 x 1600 = 480 kcal 480 kcal/9 = 53.3g 53.3g/5 = 11 exchanges

Table 3. Meal Exchange Table Group Fruit Cereal Low fat milk Meat Fish Fat Total Exchange 2 10 2 3 3 4 24 CHO (g) 30 150 24 204 Protein (g) 20 16 21 21 78 Fat (g) 5 10 12 3 20 50 Calorie (kcal) 120 750 250 195 105 180 1600

Percentage Table 4. Meal Distribution Table Group Fruit Cereal Low fat milk Meat or poultry Fish Fat Exchange 2 10 2 3 3 4 BF 2 1 1 1

51%

20%

28%

LN 1 2

AT 2

DNR 1 2

SPR 2 1

2 2 2

Table 5. Sample Menu Meal Breakfast (7.30 am) Sandwich Bread Egg Low fat milk Lunch (1.00 pm) Rice Porridge Fried Fish (mashed) Stir fried vegetable Apple Plain water Afternoon Tea (4.00 pm) Bread @ biscuit Plain water Dinner (7.00 pm) Rice Porridge Chicken soup (minced) Stir fried vegetable Lai Plain water Supper (10.00 pm) Bread @ biscuit Low fat milk Portion 2 pieces 1 whole 1 cup 2 cups 1 piece 1 cup 1 whole Exchange Cereal = 2 exchanges Low fat milk = 1 exchange Meat/poultry = 1 exchange Cereal = 2 exchanges Fish = 3 exchanges Fat = 2 exchanges Fruit = 1 exchange

2 pieces @ 6 pieces

Cereal = 2 exchanges

2 cups 1 piece 1 cup 1 whole

Cereal = 2 exchanges Meat = 2 exchanges Fruit = 1 exchange Fat = 2 exchanges

2 pieces @ 6 pieces 1 cup

Cereal = 2 exchanges Low fat milk = 1 exchange

Low fat milk is encouraged rather than Nutren Diabetik since patients socio-economic status is considered low in order to reduce patients burden to get Nutren Diabetik which is expensive.