In the discussion about advanced pharmacology, we’re dealing with a patient who has moderate to severe left ventricular heart failure, which is a condition where the heart can’t pump blood properly. One important measure to assess heart function is the ejection fraction (EF), which is normally between 55% and 70%. However, the patient’s EF is very low at 30%, indicating a significant problem.
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To improve her condition, changes need to be made to her medication. One option is to increase the dosage of HCTZ to 25mg daily or add furosemide at a dose of 20-40 mg daily. Furosemide is more effective for heart failure, as it helps remove excess fluid from the body, making it easier for the patient to breathe. This is because loop diuretics like furosemide are better suited for heart failure compared to thiazide diuretics like HCTZ.
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It’s important to note that the patient should stop taking ibuprofen for her knee pain since it’s an NSAID, which can lead to sodium retention and reduce the effectiveness of diuretics. Instead, she should use Tylenol.
The patient is currently taking verapamil, but this medication is not suitable for individuals with any degree of heart failure. Therefore, the verapamil should be discontinued, and hydralazine, a more appropriate medication, should be prescribed. Hydralazine is known to reduce mortality in certain heart failure patients.
To monitor the effects of HCTZ, kidney function should be checked every six months, as HCTZ could potentially harm the kidneys. Regarding Tylenol, the patient should only take the minimum dose necessary to relieve her knee pain to avoid liver problems.
In addition to these medication changes, there are some non-pharmacological recommendations. It’s essential to educate the patient about her condition and the reasons behind these changes. Encouraging her to lose weight, increase physical activity, and reduce sodium intake can significantly benefit her. If she smokes or drinks alcohol, she should consider reducing or quitting these habits to improve her heart health. The ultimate goal is to manage her condition effectively, prevent exacerbation, and reduce the likelihood of hospital readmissions.
References:Biondi-Zoccai, G., Borges, A.R., Resende, E.S., & Roever, L. (2017). Drugs used to treat heart failure with reduced ejection fraction. Current Trends in Cardiology, 1(1), 8-11. https://doi.org/10.35841/cardiology.1.1.8-11
Ghandi, D., Mansukhani, R., Shah, A., Shah, K.J., & Srivastava, S. (2017). Heart failure: A class review of pharmacotherapy. Pharmacy and Therapeutics, 42(7), 464-472.
Inamdar, A. A. & Inamdar, A.C. (2016). Heart Failure: Diagnosis, management and utilization. Journal of Clinical Medicine, 5(7), 62. https://doi.org/10.3390/jcm5070062
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