Question

I.W., aged 62, is a male who is new to your practice. He is reporting shortness of breath on exertion, especially after climbing steps or walking three to four blocks. His symptoms clear with rest. He also has difficulty sleeping at night (he tells you he needs two pillows to be comfortable). He tells you that 2 years ago, he suddenly became short of breath after hurrying for an airplane. He was admitted to a hospital and treated for acute pulmonary edema. Three days before the episode of pulmonary edema, he had an upper respiratory tract infection with fever and mild cough. After the episode of pulmonary edema, his blood pressure has been consistently elevated. His previous physician started him on a sustained-release preparation of diltiazem 180 mg/d. His medical history includes moderate prostatic hypertrophy for 5 years, adult-onset diabetes mellitus for 10 years, hypertension for 10 years, and degenerative joint disease for 5 years. His medication history includes hydrochlorothiazide (HydroDIURIL) 50 mg/d, atenolol (Tenormin) 100 mg/d, controlled-delivery diltiazem 180 mg/d, glyburide (DiaBeta) 5 mg/d, and indomethacin (Indocin) 25 to 50 mg three times a day as needed for pain. While reviewing his medical records, you see that his last physical examination revealed a blood pressure of 160/95 mm Hg, a pulse of 95 bpm, a respiratory rate of 18, normal peripheral pulses, mild edema bilaterally in his feet, a prominent S3 and S4, neck vein distention, and an enlarged liver.

Diagnosis: Heart Failure Class II

Answer the following questions. Include two references, cited in APA style.

List specific goals of treatment for I.W. What drug(s) would you prescribe? Why?

What are the parameters for monitoring the success of your selected therapy?

Discuss specific patient education based on the prescribed therapy.

Describe one or two drug–drug or drug–food interactions for the selected agent(s).

List one or two adverse reactions for the selected agent(s) that would cause you to change therapy.

What would be the choice for the second-line therapy?

What over-the-counter or alternative medications would be appropriate for this patient?

What dietary and lifestyle changes should be recommended for I.W.?

Answer 1

Specific goals of treatment for I.W with Heart failure includes ,
1.relieve symptoms and improve quality of care
2.slow disease progresion
3.reduce the risk of hospitalization.
Drugs to be prescribed are
*angiotensin -converting enzyme inhibitors(ACE)-(enalapril)-to treat high blood pressure.
*beta blockers( Lopressor)-to reduce risk of abnormal heart rhythms
*Diuretics (Lasix)- to decrease fluid in lungs and helps to urinate more frequently and keeps fluid from collecting in your body.

Parameters for monitoring the success of the therapy includes serum potassium, serum creatinine,heart rate,blood pressure,serum drug levels.

Patient education includes-
-stop smoking-smoking damges blood vessels.
-weight control -weight gain may mean that,retaining fluids in the body
-check ankles,legs and feet for swelling
-eat a healthy diet
-restrict sodium in diet
-limit saturated fats in diet
-regular execises
-reduce stress

Adverse reactions of agents
1.ACE-Cough,hyperkalemia,headache,dizziness,fatigue,nausea and renal impairement.
2.beta blockers-bronchospasm,prolonged hypoglycemia,bradycardia,abdominal cramps,nausea ,vomiting
3.Diuretics -increased urination,thirst,muscle cramps,itching or rash,weakness,dizziness,