29F bp trends

[2/23, 2:21 PM] +91 95427 37908: Sir now bp is 143 by 93

[2/23, 2:21 PM] Dr.DK Sir@GM KIMS: Ok

[2/23, 2:21 PM] +91 95427 37908: Mrng 11.00 ap bp is 123 by 73

[2/23, 2:22 PM] Dr.Rakesh Biswas Sir@GM KIMS: Morning what time, how much dose of what BP medicine taken?

[2/23, 2:22 PM] +91 95427 37908: Mrng 8.10  ki nic. Tab veskunna

[2/23, 2:23 PM] +91 95427 37908: Nicardia retard -20

[2/23, 2:23 PM] +91 95427 37908: At 8.10 am

[2/23, 2:24 PM] +91 95427 37908: Sir....3 time s bp tablet cheptha annaru kada sir....

[2/23, 2:27 PM] Dr.Rakesh Biswas Sir@GM KIMS: When is the next tablet? 

Currently only one type of BP tablet?

[2/23, 2:29 PM] +91 95427 37908: Yes sir... present I'm using only one type of bp tablet which is nicardia 20 at mrng 8 am and evening 6.30 pm sir

[2/23, 3:02 PM] +91 95427 37908: 3 time s cheptharaa sir

[2/23, 4:20 PM] Dr.Rakesh Biswas Sir@GM KIMS: Let us see your ten BP readings today and then decide what time do add another tablet

[2/23, 4:57 PM] +91 95427 37908: Ok sir

[2/23, 5:15 PM] +91 95427 37908: 5.10 pm bp is 166 by 110 sir

[2/23, 6:18 PM] +91 95427 37908: 6.15 pm bp is 183 by 122

[2/23, 6:19 PM] Dr.DK Sir@GM KIMS: Ok.

[2/23, 7:43 PM] Dr.Rakesh Biswas Sir@GM KIMS: Did she take another nicardia at this time?

[2/23, 7:46 PM] Dr.Rakesh Biswas Sir@GM KIMS: From tomorrow let her take Tablet Telma 40mg after lunch at 1:00 PM and let her take another nicardia tonight after dinner

[2/23, 7:47 PM] Dr.Rakesh Biswas Sir@GM KIMS: Lasix at what time?

[2/23, 8:05 PM] +91 95427 37908: Sir 8.00pm bp is 186 by 121

[2/23, 8:06 PM] +91 95427 37908: 6.15 pm ki nic.tab veskunna sir

[2/23, 8:07 PM] +91 95427 37908: Mrng 8 am and afternoon after lunch 1 pm

[2/23, 9:24 PM] Dr.Rakesh Biswas Sir@GM KIMS: From tomorrow BP tablets and timing:

Tablet nicardia 20 mg 8:00 AM 

Tablet Lasix 40 mg 9:00 AM 

Tablet Telma 40mg before lunch 12:00 PM 

Tablet lasix 20 mg 2:00 PM 

Tablet Nicardia 20 mg 4PM

Tablet Nicardia 20 mg 10 PM

[2/23, 9:25 PM] Dr.DK Sir@GM KIMS: @⁨~Chamanthi😃⁩ Okasari potassium chuskondi 15 days tarvatha ... already mee potassium 5.8 undhi.

[2/23, 9:25 PM] Dr.Rakesh Biswas Sir@GM KIMS: Also check BP hourly at random intervals for as many times possible (10-20 times)

[2/23, 9:27 PM] Dr.Rakesh Biswas Sir@GM KIMS: For hyperkalemia it would need to be checked on the same day. I guess that was presumed to be due to Pseudohyperkalemia during blood drawing. Also I guess she can only get these tests when she comes here to visit?

[2/23, 9:28 PM] Dr.DK Sir@GM KIMS: Ok sir.

[2/23, 9:42 PM] +91 95427 37908: Ok sir

[2/23, 9:42 PM] +91 95427 37908: Repu ha sir

[2/23, 9:59 PM] +91 95427 37908: Now 10.00 pm bp is 113 by 59 sir

[2/23, 9:59 PM] Dr.DK Sir@GM KIMS: Ok 👍

[2/23, 10:00 PM] +91 95427 37908: Repati nundi ivvi follow avvalaa sir

[2/23, 10:00 PM] Dr.DK Sir@GM KIMS: Yes repati nundi ivi follow avvali !

[2/23, 10:03 PM] +91 95427 37908: Ok sir

[2/23, 10:13 PM] Dr.Rakesh Biswas Sir@GM KIMS: When was your last BP medicine taken today?

[2/23, 10:14 PM] +91 95427 37908: Sir the exact time is 6.15 pm

[2/23, 10:17 PM] Dr.Rakesh Biswas Sir@GM KIMS: @⁨Dr.DK Sir@GM KIMS⁩ that means the nifedepine action started after 3-4 hours?

[2/23, 10:19 PM] Dr.DK Sir@GM KIMS: Yes sir...it took 3 hours.

[2/23, 10:19 PM] +91 95427 37908: 6.15 pm ki bp check cheskunna tharvatha tablet veskunna sir

[2/23, 10:26 PM] Dr.DK Sir@GM KIMS: Ok

[2/24, 9:04 AM] +91 95427 37908: Today mrng 8 am bp is 159 by 123 sir

[2/24, 9:04 AM] +91 95427 37908: Then take nicardia 20 tablet...

[2/24, 9:09 AM] Dr.Asma@Pharma KIMS: amlodipine given once daily is at least as effective as nifedipine tablets given twice daily in patients with essential hypertension.

[2/24, 9:59 AM] +91 95427 37908: 10 am bp is 112 by 66 sir

[2/24, 9:59 AM] Dr.DK Sir@GM KIMS: Ok

[2/24, 10:06 AM] Dr.DK Sir@GM KIMS: *Yesterday* : 23/2/22- Thursday.

8:10 AM: BP not seen - Tab Nicardia 20mg -taken.

11 AM- 123/73

14:20 -143/93

5:10PM : 166/110

6:15PM : 183/122( tab Nicardia 20mg was taken )

8pm : BP: 186/121

10pm : 113/59 .

[2/24, 10:06 AM] Dr.DK Sir@GM KIMS: @⁨~Chamanthi😃⁩ ..ninna night BP tablet esukunnara ??

[2/24, 10:07 AM] Dr.DK Sir@GM KIMS: Night 10 pm tarvatha tablet gurinchi em update ledhu.

[2/24, 10:25 AM] Dr.Vamshi Sir@GM KIMS: Same thing we observed in our patient here sir

23/2/22- Thursday.

8:10 AM: BP not seen - Tab Nicardia 20mg taken.

11 AM- 123/73

14:20 -143/93

5:10PM : 166/110

6:15PM : 183/122 - Tab Nicardia 20mg was taken 

8pm : BP: 186/121

10pm : 113/59 .

[2/24, 11:12 AM] +91 95427 37908: Ninna evng 6.15 pm ki tablet veskuntunna sir

[2/24, 11:12 AM] +91 95427 37908: And today mrng 8 am ki veskunna sir

[2/24, 11:16 AM] +91 95427 37908: 11: 10 am bp is 125 by 76 sir

[2/24, 11:17 AM] +91 95427 37908: Nyt 10 pm tharvatha tablet veskoledu sir

Today mrng 8 am ki veskunna sir

[2/24, 12:50 PM] Dr.DK Sir@GM KIMS: Ok

[2/24, 1:06 PM] +91 95427 37908: 1:00 pm bp is now 150 by 98 sir

[2/24, 1:10 PM] Dr.DK Sir@GM KIMS: Ok

[2/24, 1:11 PM] Dr.DK Sir@GM KIMS: Tab Telma 40 mg vesukunnara ??

[2/24, 1:11 PM] +91 95427 37908: Ledu sir

[2/24, 1:11 PM] +91 95427 37908: Ippudu veskunta

[2/24, 1:14 PM] Dr.DK Sir@GM KIMS: Ok

[2/24, 1:38 PM] +91 95427 37908: Exactly 1:30 ki telma 40 veskunna sir

[2/24, 3:01 PM] +91 95427 37908: 3:00 pm bp is 152 by 96 sir

[2/24, 3:02 PM] Dr.DK Sir@GM KIMS: Ok

[2/24, 3:05 PM] Dr.Rakesh Biswas Sir@GM KIMS: Let's list the medications timing and BP for today again @⁨Dr.DK Sir@GM KIMS⁩

[2/24, 4:28 PM] +91 95427 37908: 4:30 pm bp is now 154 by 98 sir...

[2/24, 4:45 PM] Dr.DK Sir@GM KIMS: *Today -* 24/02/23- Friday 

8am- 159/123- Tab .Nicardia 20mg 

10am- 112/66

11am- 125/76

1pm-150/98- Tab .Telma 40mg 

3pm-152/96

4:30pm- 154/98 .

Sorry for the delay sir...i was in journey.

[2/24, 4:49 PM] Dr.Rakesh Biswas Sir@GM KIMS: Thanks

[2/24, 4:53 PM] Dr.Dinesh Datta: Can we give telma AM(40/10) OD and Nicardia 20 OD?@⁨Dr.Rakesh Biswas Sir@GM KIMS⁩

[2/24, 4:56 PM] Dr.Rakesh Biswas Sir@GM KIMS: Looking at these data @⁨Dr.Asma@Pharma KIMS⁩ @⁨~Dr.Meera Shabnam 🤍⁩ @⁨+91 81065 35815⁩ Shall we add the Amlodipine 5mg to her schedule tonight at 10:00 PM before sleep? 

Do you feel the action of telmisartan hasn't begun yet till 4:30 PM? Also 8:00 AM nicardia action peaked at 11:00 AM and then stopped working so ideally it's duration of action looks just three hours? @⁨Dr.DK Sir@GM KIMS⁩ Is this an SR preparation of nifedipine? 

@⁨Dr.Dinesh Datta⁩ combinations increase patient adherence aka concordance but they are difficult to titrate

[2/24, 6:19 PM] +91 95427 37908: 6.15 pm bp is now 193 by 119 sir

[2/24, 6:20 PM] +91 95427 37908: Now I'm intake nicardia 20 tablet

[2/24, 6:29 PM] Dr.DK Sir@GM KIMS: Initially she was on Cilinidipine 10mg ...but her bp was not controlled , so she was started on tab.nicardia by treating team.

[2/24, 6:41 PM] +91 81065 35815: Could you put a picture of the tablets you have taken since morning

[2/24, 6:43 PM] +91 95427 37908: Ok sir

[2/24, 6:43 PM] +91 81065 35815: Telma has been taken at 1pm but still the action hasn't begun yet. Telmasartan action usually begins within 1-2 hrs of intake.

[2/24, 6:57 PM] Dr.Rakesh Biswas Sir@GM KIMS: Thanks. So @⁨Dr.Asma@Pharma KIMS⁩ @⁨+91 81065 35815⁩ @⁨~Dr.Meera Shabnam 🤍⁩ This is giving us an opportunity to realize how a lot of what has been recorded about certain pharmacological actions need to be reunderstood and rewritten?

[2/24, 6:59 PM] Dr.Asma@Pharma KIMS: Following oral administration, peak concentrations (Cmax) of telmisartan are reached in 0.5-1 

hour after dosing. Food slightly reduces the bioavailability of telmisartan, with a reduction in the 

area under the plasma concentration-time curve (AUC) of about 6% with the 40 mg tablet and 

about 20% after a 160 mg dose. The absolute bioavailability of telmisartan is dose dependent. 

At 40 and 160 mg the bioavailability was 42% and 58%, respectively. The pharmacokinetics of 

orally administered telmisartan are nonlinear over the dose range 20-160 mg, with greater than 

proportional increases of plasma concentrations (Cmax and AUC) with increasing doses. 

Telmisartan shows bi-exponential decay kinetics with a terminal elimination half life of 

approximately 24 hours. Trough plasma concentrations of telmisartan with once daily dosing are 

about 10-25% of peak plasma concentrations. Telmisartan has an accumulation index in plasma 

of 1.5 to 2.0 upon repeated once daily dosing

[2/24, 7:11 PM] Dr.Asma@Pharma KIMS: https://pubmed.ncbi.nlm.nih.gov/1534713/ 

It has high oral bioavailability (60-80%) and accumulates to a steady-state with once-daily administration over a period of 1-1 1/2 weeks. Fluctuation of plasma drug concentration between doses is between 20 and 25% when once-daily dosing is used. Onset of effect is gradual after oral administration which is due, in part, to an intermediate rate of drug absorption (peak plasma drug concentration occurs 6-8 h after dosing) and perhaps also to the physicochemical characteristics of the drug-cell membrane-receptor interaction. The pharmacodynamic profile of the drug in hypertensive patients is consistent with the disposition of the drug. After single doses, blood pressure decreases gradually over 4-8 h and may slowly return to baseline over 24-72 h. No change in heart rate is noted after the dose as the onset is gradual and physiological reflexes are not activated.

[2/24, 7:18 PM] Dr.Asma@Pharma KIMS: Pharmacodynamics 

In normal volunteers, a dose of telmisartan 80 mg inhibited the pressor response to an 

intravenous infusion of angiotensin II by about 90% at peak plasma concentrations with 

approximately 40% inhibition persisting for 24 hours.

Plasma concentration of angiotensin II and plasma renin activity (PRA) increased in a dose￾dependent manner after single administration of telmisartan to healthy subjects and repeated 

administration to hypertensive patients. The once-daily administration of up to 80 mg 

telmisartan to healthy subjects did not influence plasma aldosterone concentrations. In multiple 

dose studies with hypertensive patients, there were no clinically significant changes in 

electrolytes (serum potassium or sodium), or in metabolic function (including serum levels of 

cholesterol, triglycerides, HDL, LDL, glucose, or uric acid). 

In 30 hypertensive patients with normal renal function treated for 8 weeks with telmisartan 80 

mg or telmisartan 80 mg in combination with hydrochlorothiazide 12.5 mg, there were no 

clinically significant changes from baseline in renal blood flow, glomerular filtration rate, 

filtration fraction, renovascular resistance, or creatinine clearance.

[2/24, 8:08 PM] +91 95427 37908: 8.00 pm bp is now 152 by    103 sir

[2/24, 8:37 PM] Dr.Rakesh Biswas Sir@GM KIMS: @⁨Dr.DK Sir@GM KIMS⁩ Please update the BP chart here again in single text along with the drug timings

[2/24, 9:01 PM] Dr.DK Sir@GM KIMS: *Today -* 24/02/23- Friday 

8am- 159/123- Tab .Nicardia 20mg 

10am- 112/66

11am- 125/76

1pm-150/98- Tab .Telma 40mg 

3pm-152/96

4:30pm- 154/98 .

8pm- 152/103.

[2/24, 9:08 PM] Dr.Vamshi Sir@GM KIMS: @⁨~Chamanthi😃⁩ 

Regarding your query 'index must be in ok range'

It is all about selecting the proper cuff size for accurate bp recordings

[2/24, 9:09 PM] Dr.Rakesh Biswas Sir@GM KIMS: Thanks. Well searched 👏👏

@⁨Dr.Dinesh Datta⁩ I was unable to search and find this. 

Now @⁨Dr.Vamshi Sir@GM KIMS⁩ or @⁨Dr.Dinesh Datta⁩ Can you explain it to the patient in Telugu?

[2/24, 9:12 PM] Dr.Rakesh Biswas Sir@GM KIMS: So that OK was about cuff length and perhaps not width if we again look at the image shared by the patient advocate?

[2/24, 9:12 PM] Dr.Rakesh Biswas Sir@GM KIMS: He did. But I thought you too were GM

[2/24, 9:34 PM] +91 95427 37908: 9.30 pm bp is now 115 by 65 sir

[2/24, 10:25 PM] +91 95427 37908: 10;20 pm bp is now 121 by 78 sir

[2/24, 10:32 PM] Dr.Rakesh Biswas Sir@GM KIMS: With what? 

Did the telmisartan start working now?

[2/24, 10:36 PM] Dr.Rakesh Biswas Sir@GM KIMS: OK thanks. 

So the BP came down due to the nicardia taken at 6:15 PM 

Can your patient take Tablet Amlodipine 5 mg now and daily every night?

[2/25, 9:35 AM] +91 95427 37908: Today 8:00 am bp is 162 by 126 sir

[2/25, 9:36 AM] +91 95427 37908: Then take nicardia 20 tablet...

[2/25, 9:40 AM] Dr.Rakesh Biswas Sir@GM KIMS: Did you take the Amlodipine 5 mg last night? I guess you couldn't purchase it at night yesterday. Please purchase and keep one strip of ten tablets of Amlodipine 5 mg please. 

@⁨Dr.DK Sir@GM KIMS⁩ @⁨Dr.Deepika@GM KIMS⁩  @⁨Dr.Ajay GM Jnr⁩ Please share the list of antihypertensives with timings and BP recordings taken yesterday in one single text message like yesterday

[2/25, 9:48 AM] +91 95427 37908: No sir....

Amlodipine veskoledu

[2/25, 10:07 AM] +91 95427 37908: 10:00 am bp is 126 by 74  sir

[2/25, 11:16 AM] +91 95427 37908: Amlodipine veskoledu sir

[2/25, 11:17 AM] +91 95427 37908: Veskomani cheppaledu kada sir

[2/25, 11:17 AM] +91 95427 37908: 11:15 am bp is 124 by 75 sir

[2/25, 11:22 AM] Dr.Vinay Sir@GM KIMS: @⁨Dr.Rakesh Biswas Sir@GM KIMS⁩ already she has amlodipine tablets sir. She hasn't took the tablet yesterday night sir.

[2/25, 1:08 PM] +91 95427 37908: 1:00 pm bp is 139 by 92 sir

[2/25, 1:08 PM] +91 95427 37908: Telma 40 veskunna sir

[2/25, 1:41 PM] Dr.DK Sir@GM KIMS: Ninna nicardia night eskunnara or evening eskunnara ??

[2/25, 1:43 PM] +91 95427 37908: Ninna 6:20 pm ki nicardia veskunna sir

[2/25, 1:43 PM] +91 95427 37908: Nyt veskoledu

[2/25, 1:43 PM] Dr.DK Sir@GM KIMS: Ok

[2/25, 1:48 PM] Dr.DK Sir@GM KIMS: *Yesterday -* 24/02/23- Friday 

8am- 159/123- *Tab .Nicardia 20mg* 

10am- 112/66

11am- 125/76

1pm-150/98- *Tab .Telma 40mg* 

3pm-152/96

4:30pm- 154/98 .

6:15pm- 193/119 , *Tab Nicardia 20mg* 

8pm-152/103

9:30pm- 115/65

10:20pm- 121/78

[2/25, 2:46 PM] Dr.Rakesh Biswas Sir@GM KIMS: 👆@⁨Dr.Vinay Sir@GM KIMS⁩ @⁨Dr.DK Sir@GM KIMS⁩ We asked her patient to take the Amlodipine here yesterday night but it was understandably late.

Let her take it from today 9:00 PM?

[2/25, 2:48 PM] Dr.Rakesh Biswas Sir@GM KIMS: Going by yesterday's BP and intervention timeline the telmisartan didn't act at all? @⁨Dr.Vinay Sir@GM KIMS⁩ @⁨Dr.DK Sir@GM KIMS⁩ @⁨Dr.Asma@Pharma KIMS⁩ @⁨+91 81065 35815⁩ @⁨~Dr.Meera Shabnam 🤍⁩

[2/25, 2:59 PM] +91 95427 37908: Yes sir

[2/25, 2:59 PM] +91 95427 37908: 3:00 pm bp is 146 by 100 sir

[2/25, 3:01 PM] +91 95427 37908: Amlodipine a time ki veskovali sir

[2/25, 3:02 PM] Dr.Rakesh Biswas Sir@GM KIMS: 9:00 PM

[2/25, 3:04 PM] +91 95427 37908: Mari nicardia eppudu veskovali sir

[2/25, 3:04 PM] +91 95427 37908: Nicardia

Telma 40

Amlodipine

Ivvi 3 veskovala sir e roju nundi

[2/25, 3:05 PM] Dr.Rakesh Biswas Sir@GM KIMS: Ninna taken same time : 6:30 PM

[2/25, 3:05 PM] Dr.Rakesh Biswas Sir@GM KIMS: Once the tablet Amlodipine starts working we shall try to slowly remove the nicardia

[2/25, 3:06 PM] +91 95427 37908: Ok sir

[2/25, 3:06 PM] +91 95427 37908: Ok sir

[2/25, 3:58 PM] Dr.DK Sir@GM KIMS: Ok sir.

[2/25, 5:02 PM] +91 95427 37908: 5:00 pm bp is 163 by 108 sir

[2/25, 5:03 PM] +91 95427 37908: Nicardia veskunna sir

[2/25, 5:03 PM] +91 95427 37908: Now

[2/25, 5:05 PM] Dr.Rakesh Biswas Sir@GM KIMS: 👆@⁨Dr.DK Sir@GM KIMS⁩ Should have taken nicardia here at 3:00 PM

[2/25, 6:17 PM] Dr.DK Sir@GM KIMS: Yes sir...i thought of same.

[2/25, 6:29 PM] +91 95427 37908: 6:30 pm bp is 130 by 84 sir...

[2/25, 7:33 PM] +91 95427 37908: 7:30 pm bp is 113 by 69 sir...

[2/25, 7:36 PM] Dr.DK Sir@GM KIMS: Ok

[2/25, 8:36 PM] Dr.Rakesh Biswas Sir@GM KIMS: Let her take the Amlodipine 5 mg now

[2/25, 10:07 PM] +91 95427 37908: 10:00 pm bp is 134 by 86 sir...

[2/25, 10:07 PM] +91 95427 37908: Amlodipine veskunna sir...

[2/25, 10:53 PM] Dr.DK Sir@GM KIMS: Ok

[2/26, 12:11 PM] +91 95427 37908: Bp machine koncham problem vachindi sir

[2/26, 12:12 PM] +91 95427 37908: So today bp check cheskoledu sir

[2/26, 12:12 PM] +91 95427 37908: But....mrng nicardia veskunna sir

[2/26, 12:40 PM] Dr.Rakesh Biswas Sir@GM KIMS: Tab Amlodipine was taken twice yesterday?? 😳😨 8:30 PM and 10:00 PM!!

[2/26, 12:42 PM] Dr.Rakesh Biswas Sir@GM KIMS: As per this chart Telma didn't work at all even yesterday? How many days does it take to start working? What can be the reasons for it's not working at all? @⁨Dr.DK Sir@GM KIMS⁩ @⁨Dr.Vamshi Sir@GM KIMS⁩ @⁨Dr.Vinay Sir@GM KIMS⁩ @⁨~Dr.Meera Shabnam 🤍⁩ @⁨Dr.Asma@Pharma KIMS⁩

[2/26, 12:54 PM] +91 95427 37908: No sir.... yesterday 8:30 pm ki Amlodipine veskoledu sir

[2/26, 12:55 PM] +91 95427 37908: Nyt 10:10 pm ki Amlodipine veskunna sir

[2/26, 1:40 PM] Dr.DK Sir@GM KIMS: Yesterday - 25/02/23- *Saturday*

 *8am-* Bp-162/126.(Tab Nicardia 20mg ) 

 *10am-* 126/74 

 *11:15am -* 124/75

 *1pm*- 139/92- tab Telma 40mg 

 *3PM-* 146/100.

 *5PM-* 163/108- Tab Nicardia 20mg .

 *6:30pm -* 130/84

 *7:30pm* -113/69

 **10pm* -*134/86- Tab Amlodipine 5mg.

[2/26, 4:14 PM] +91 95427 37908: 4:10 pm bp is 141 by 99 sir

[2/26, 6:42 PM] +91 95427 37908: 6:40 pm bp is 172 by 110 sir...

[2/26, 6:42 PM] +91 95427 37908: Nicardia 20 veskunna sir

[2/26, 8:30 PM] Dr.Rakesh Biswas Sir@GM KIMS: Should have taken it at 4:10 PM 

@⁨Dr.DK Sir@GM KIMS⁩ @⁨Dr.Asma@Pharma KIMS⁩  Theoretically based on past reports when can we expect tablet Amlodipine to start working?

[2/26, 8:58 PM] Dr.DK Sir@GM KIMS: Sir ,Shall we start on tab Nicardia 20mg at 4pm and stop tab Nicardia at 1pm sir ??

[2/26, 9:05 PM] Dr.Rakesh Biswas Sir@GM KIMS: 👆She didn't take nicardia at 1PM?

[2/26, 9:06 PM] Dr.DK Sir@GM KIMS: @⁨~Chamanthi😃⁩ ..eeroju madyanam em eskunnaru ??

[2/26, 9:14 PM] +91 95427 37908: Telma 40 veskunna sir

[2/26, 9:15 PM] +91 95427 37908: Ninna,monna e roju afternoon telma 40 veskunna sir

[2/26, 9:49 PM] Dr.DK Sir@GM KIMS: Today morning,she didn't check her BP...

Sir, i think Removing tablet Telma and starting nicardia 20mg at 2pm and if morning BP is ok..shall we .continue  tab amlong 5mg in the night ??

[2/26, 9:50 PM] Dr.Rakesh Biswas Sir@GM KIMS: Let her check her BP the whole day tomorrow then before we make any changes to what you have already listed above for yesterday

[2/26, 9:50 PM] Dr.DK Sir@GM KIMS: Ok sir.

[2/26, 10:01 PM] Dr.Asma@Pharma KIMS: In a study comparing telmisartan 40–120 mg with the long-acting calcium channel blocker amlopidine 5–10 mg, both treatments produced comparable reductions in clinical blood pressure after 12 weeks in patients with mild-tomoderate hypertension (Lacourcière et al 1998). Clinic measurements revealed that both telmisartan and amlodipine reduced trough blood pressure, with no significant difference between the two treatments. 

[2/26, 10:05 PM] Dr.Rakesh Biswas Sir@GM KIMS: What was the mean time of onset of action for both these drugs ?

What was the time range for their onset of action?

[2/26, 10:24 PM] Dr.Asma@Pharma KIMS: Telmisartan onset of action is 3 hrs sir. 

Amlodipine peak plasma conc is 6-8hrs

[2/26, 10:35 PM] +91 95427 37908: 10:30 pm bp is 116by 71 sir

[2/26, 10:35 PM] +91 95427 37908: Ippudu Amlodipine veskovalaa vodda sir

[2/26, 10:35 PM] +91 95427 37908: Inka veskoledu

[2/26, 11:00 PM] Dr.DK Sir@GM KIMS: Veskondi

[2/27, 8:09 AM] Dr.Rakesh Biswas Sir@GM KIMS: Looks like both these drugs haven't worked at all for her till now although we may not be having properly captured data to infer that perhaps but @⁨Dr.Asma@Pharma KIMS⁩ what do you think would be the reason someone may not respond to either of these drugs? In your review of literature how many patients could you find who didn't respond to these drugs at all and what were the hypothesis postulated for these non responses?

[2/27, 8:10 AM] Dr.Rakesh Biswas Sir@GM KIMS: @⁨Dr.DK Sir@GM KIMS⁩ Ask her to monitor her BP hourly for these few days while we are trying to adjust the optimal combination for her

[2/27, 8:23 AM] Dr.DK Sir@GM KIMS: @⁨~Chamanthi😃⁩ ..ninna night amlodipine vesukunnara??

Oka 2-3 days , konchem hourly bp chudara.

[2/27, 8:29 AM] +91 95427 37908: Ninna nyt Amlodipine veskoledu sir

[2/27, 8:30 AM] Dr.DK Sir@GM KIMS: Endhuku veskoledhu ??

[2/27, 8:30 AM] Dr.DK Sir@GM KIMS: Ninna morning and evening oka nicardia theskunnaru

[2/27, 8:30 AM] Dr.DK Sir@GM KIMS: Tarvatha madyanam oka telam anthena

[2/27, 8:30 AM] Dr.Asma@Pharma KIMS: Yeah sir msgd u take the medicine also.

[2/27, 8:30 AM] Dr.DK Sir@GM KIMS: ??

[2/27, 8:30 AM] +91 95427 37908: Today 8:10 am bp is 157 by 111 sir

Nicardia veskunna sir

[2/27, 8:31 AM] Dr.DK Sir@GM KIMS: Reply ichanu kada

[2/27, 8:31 AM] +91 95427 37908: Mimmalni adigaka veskundam ani aginaa sir.....

But... sorry for that sir

Meeru reply iche lope padukunna sir

[2/27, 8:33 AM] +91 95427 37908: Ninna mrng 8:10 am and evng 6:45 pm...

Two times nicardia veskunna sir

[2/27, 8:33 AM] +91 95427 37908: Ninna 3 times veskunna sir

[2/27, 8:36 AM] +91 95427 37908: Ninna total 3 bp tablet s veskunna sir

[2/27, 8:37 AM] +91 95427 37908: Only night Amlodipine is missing sir...

[2/27, 8:43 AM] +91 95427 37908: Sorry sir...ninna mis chesanu....

[2/27, 8:43 AM] Dr.DK Sir@GM KIMS: Ok👍..no problem.

[2/27, 9:26 AM] +91 81061 77663: How about her salt intake in various forms?

[2/27, 9:27 AM] +91 95427 37908: Salt avoid chesaa sir....

Salt veskovatledu...

[2/27, 10:15 AM] +91 95427 37908: 10:15 am bp is 105 by 61 sir

[2/27, 10:19 AM] Dr.Rakesh Biswas Sir@GM KIMS: 8AM nicardia 20 is working now. 

Going by theory vs this patient's data that can be scrolled above ,when do you think she would need the next dose of nifedipine 20? @⁨Dr.Asma@Pharma KIMS⁩ @⁨+91 81065 35815⁩ @⁨Dr.DK Sir@GM KIMS⁩ 

Let's increase her tablet telmisartan to 80mg from today in the morning

[2/27, 10:24 AM] Dr.Asma@Pharma KIMS: Sir for today 1pm TELMA 80 we will start and 4pm NIFEDIPINE 20mg and 8pm AMLODIPINE 5mg

[2/27, 10:24 AM] Dr.Asma@Pharma KIMS: Will that be fine sir?

[2/27, 10:26 AM] Dr.Rakesh Biswas Sir@GM KIMS: Yes but let's wait for the hourly BP values which hopefully the patient should share to decide the exact time of the next drug but for now the above is a good plan except that I may want to delay the 4PM nifedepine to understand if Telma 80 is working at all

[2/27, 11:17 AM] +91 95427 37908: 11:15 am bp is 113 by 69 sir

[2/27, 12:27 PM] +91 95427 37908: 12:30 pm bp is 121 by 81 sir

[2/27, 1:05 PM] +91 95427 37908: 1:00 pm ki telma 40 veskunna sir

[2/27, 1:15 PM] Dr.Asma@Pharma KIMS: not TELMA 40, sir told TELMA 80mg

[2/27, 2:43 PM] +91 95427 37908: 2:40 pm bp is 137 by 91 sir

[2/27, 4:01 PM] +91 95427 37908: 4:00 pm bp is 141 by 94 sir..

[2/27, 4:31 PM] Dr.Rakesh Biswas Sir@GM KIMS: మీరు ఈరోజే Telmisartan 80 mg తీసుకుంటే బాగుండేది

Mīru īrōjē Telmisartan 80 mg tīsukuṇṭē bāguṇḍēdi

[2/27, 4:32 PM] +91 95427 37908: Afternoon veskovalaa sir idi.....

[2/27, 4:33 PM] +91 95427 37908: Repati nundi veskunta sir...

[2/27, 4:34 PM] Dr.DK Sir@GM KIMS: Ok

[2/27, 5:01 PM] +91 95427 37908: 5:00 PM bp is 151 by 102 sir...

[2/27, 5:07 PM] Dr.Asma@Pharma KIMS: U had to take NIFEDIPINE 20mg no now... did'nt you take?

[2/27, 5:08 PM] Dr.Rakesh Biswas Sir@GM KIMS: Telma 40 is not working. Please take nifedepine 20 mg now

[2/27, 5:15 PM] +91 95427 37908: Naku antha confused ga undi sir.....

[2/27, 5:16 PM] +91 95427 37908: Repati nundi em veskovalo oka paper meda rasi pettandi sir

[2/27, 5:16 PM] +91 95427 37908: Avvi theppinchukoni repati nundi follow avutha sir

[2/27, 5:17 PM] +91 95427 37908: Amlodipine and nicardia vodda sir mari

[2/27, 5:31 PM] Dr.DK Sir@GM KIMS: 8am- tab Nicardia 20mg 

1pm - Tab Telma 80mg 

5pm - Tab Nicardia 20mg 

9pm- Tab Amlodipine 5mg .

[2/27, 5:32 PM] +91 95427 37908: Ok sir

[2/27, 6:10 PM] +91 95427 37908: 6:00 pm bp is 166 by 107 sir...

[2/27, 6:10 PM] +91 95427 37908: Nicardia 20 ippude veskunna sir

[2/27, 6:57 PM] Dr.DK Sir@GM KIMS: Ok

[2/27, 7:13 PM] +91 95427 37908: Telma 80 dorakatledu sir ma village lo...

[2/27, 7:13 PM] +91 95427 37908: Two medical shop s untayi ma village lo

[2/27, 7:14 PM] +91 95427 37908: Ekkada dorakaledu sir

[2/27, 7:23 PM] Dr.DK Sir@GM KIMS: Rendu tablets eskondi...

[2/27, 7:23 PM] Dr.DK Sir@GM KIMS: Ekkadiki ellakandi

[2/27, 8:03 PM] +91 95427 37908: Ok sir

[2/27, 8:04 PM] +91 95427 37908: 8:00 pm bp is 181 by 110 sir

[2/27, 10:00 PM] +91 95427 37908: 10:00 pm bp is 147 by 94 sir..

[2/27, 10:00 PM] +91 95427 37908: Amlodipine veskunna sir....

[2/27, 10:07 PM] Dr.Rakesh Biswas Sir@GM KIMS: @⁨Dr.Asma@Pharma KIMS⁩ @⁨Dr.DK Sir@GM KIMS⁩ Let's hope this early morning high recorded here will be taken care of by Amlodipine? Only problem is as she would be asleep and may be unable to take any further readings before tomorrow morning , we may not know when if when it starts acting

[2/28, 8:41 AM] +91 95427 37908: Today 7:15 am bp is 144 by 94 sir....

[2/28, 8:41 AM] +91 95427 37908: 8:05 am bp is 144 by 95 sir....

[2/28, 8:42 AM] +91 95427 37908: Nicardia 20 veskunna sir

[2/28, 10:35 AM] +91 95427 37908: 10:30 am bp is  100 by 57 sir...

[2/28, 11:32 AM] +91 95427 37908: 11:30 am bp is 110 by 66sir

[2/28, 11:34 AM] Dr.Rakesh Biswas Sir@GM KIMS: 👆idi pani chestundi ippudu

[2/28, 12:55 PM] +91 95427 37908: 1:00 pm bp is 125 by 76 sir

[2/28, 12:55 PM] +91 95427 37908: Ippudu telma 80 veskovalaa sir

[2/28, 1:23 PM] +91 95427 37908: Veskunna sir 👍

[2/28, 3:41 PM] +91 95427 37908: 3:40 pm bp is 135 by 87 sir..

[2/28, 5:01 PM] +91 95427 37908: 5:00 pm bp is 146 by 97 sir...

[2/28, 5:04 PM] Dr.Rakesh Biswas Sir@GM KIMS: @⁨Dr.Asma@Pharma KIMS⁩ Is Telma 80 working? Let's see

[2/28, 5:05 PM] Dr.Rakesh Biswas Sir@GM KIMS: What was 5PM BP yesterday @⁨Dr.DK Sir@GM KIMS⁩ ?

[2/28, 5:17 PM] +91 95427 37908: 151 by 102 sir

[2/28, 6:16 PM] +91 95427 37908: 6:15 pm bp is 161 by 102 sir...

[2/28, 6:16 PM] +91 95427 37908: Nicardia 20 veskunna sir

[2/28, 7:40 PM] Dr.Rakesh Biswas Sir@GM KIMS: So @⁨Dr.Asma@Pharma KIMS⁩ @⁨~Dr.Meera Shabnam 🤍⁩ @⁨Dr.DK Sir@GM KIMS⁩ Is this 5mm systolic and diastolic blood pressure reduction a result of increasing Telma 40mg to 80 mg today?

[2/28, 7:49 PM] Dr.Asma@Pharma KIMS: Looks like that only sir

[2/28, 8:03 PM] +91 95427 37908: 8:00 pm bp is 149 by 101 sir...

[2/28, 9:56 PM] Dr.Rakesh Biswas Sir@GM KIMS: 👆This is where Amlodipine started working?

[2/28, 10:05 PM] +91 95427 37908: 10:00 pm bp is 109 by 64 sir...

[2/28, 10:05 PM] +91 95427 37908: Amlodipine veskovalaaa sir??

[2/28, 10:06 PM] Dr.DK Sir@GM KIMS: Haa veskondi