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Demographic and Administrative Information
Name (abbreviated):
Gender: male
Weight (kg): 90
Height (cm): 176 cm
Admission Date: 23/9/2011
Marital Status: widower
Case summary
Past Medical
A.W.M., a 68 years old male is a known case of DM, HTN, A-fib, HF and IHD. He is admitted to the hospital complaining of shortness of breath and severe abdominal distension of one week duration and is diagnosed as a case of decompensated heart failure with ascitis and digoxin toxicity. The patient underwent paracentesis on 25/9/2011.
On admission the patient suffered from decompensated HF, subset II, and acute kidney Note: Upon the interview it appeared that A.W.M. took double the dose of digoxin and carvedilol because of his vision problem.
Life style:
low salt diet
Family History
ETOH: none
Caffeine: Occasional
Physical Activity: Minimal
Smoking: Non smoker
The patient suffers frommoderate visionimpairment.
Chemistry and CBC
Tests and Procedures
Normal values
Random Blood
Fasting Blood glucose

Digoxin Level
Review of Systems
Allergies -NKDA
General – conscious, oriented, sleepy, fatigued,
Physical exam:
Eye-Ear-Throat: blurred vision
Dermatology –mild bruises
Respiratory: shortness of breath
Gastroenterology: nausea, vomiting and diarrhea
Neurology: dizziness
CV – freeAbd – Soft,non-distended; no massesor obvious tenderness,nausea, vomiting anddiarrhea.
PTA Medication
Carvedilol 25 mg PO ½ x2 (since 3 months)
Digoxin 0.25 mg PO ½ x1 (since 3 months)
Amiodarone 200 mg PO 1x1 (since 2 weeks)
Current Drug Therapy
Drug Name/Dose/Strength/Route
Duration Start–Stop
Prescribed Schedule
(held on 25/9)
(held on 23/9)
(held on 23/9,
restarted 25/9)

Pharmacist care plan for current medications
Treatment Related Issue
Recommendations (Pharmacological,
Follow up and monitoring
Problem or
health care
1) What are the advantages and disadvantages of the new oral anticoagulant
dabigatran in comparison to warfarin?

2) Is it rational to replace amiodarone with the less lipophilic drondarone in
this patient? Justify your answer.
3) What are the advantages and disadvantages of the renin inhibitor
Aliskiren in comparison to ACEIs and ARBs in the treatment of

Participant information
1. Full name (as in passport)______________________________
2. Age _____
3. Professional Degree ____________________________________
4. Institution ___________________________________
5. Country _________________________
6. E-mail address _________________


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