Demographic and Administrative Information Name (abbreviated): G.S.M. 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: Diet: 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 Resp.Rate Random Blood glucose 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 Indication 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 Pharmacotherapy Recommendations (Pharmacological, Follow up and monitoring Problem or health care Questions: 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 hypertension? 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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Demographic and Administrative Information
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.
Resp.Rate
CV – freeAbd – Soft,non-distended; no massesor obvious tenderness,nausea, vomiting anddiarrhea.
(held on 25/9)
Pharmacist care plan for current medications
Questions:
Participant information