Age: 85 years Gender: male diagnosis: HTN+CHF Rx Indapamide 2.5 mg daily Bisoprolol 5 mg bid...

Age: 85 years

Gender: male

diagnosis: HTN+CHF

Indapamide 2.5 mg daily

Bisoprolol 5 mg bid

Digoxin 0.25 mg bid

Aspirin 81 mg od

Nifedipine 10 mg od

Note: if bisoprolol not available in your pharmacy , what in the alternative?

according to this prescription find the mistakes, the interaction, dose , the toxicity level , antidotes , the counselling and what the suitable medication for this patient ?

Solutions

Expert Solution

Metoprolol can be used if bisoprolol is not available as bith are beta blockers.

Interactions- digoxin is not given with beta blockers as additive depressent effect on sa and av nodes can precipitate av block. Thiazides like indapamide cause hypokalemia so it potentiates digoxin toxicity.

Aspirin by inhibihing prostaglandin synthesis leads to sodium and water retention so decrease efficacy of antihypertensive and thiazides.

Antidotes-Digibind is digoxin antibodies used in severe case of digoxin toxicity. Potassium chloride is also used.

Counselling- patient should take drugs after food for slow absorption.

Patient should avoid stress as it can worsen the condition.

Yoga and meditation are highly recommended for betterment of condition.

High lipid food like potato chips,fast food should be avoided.

More salt should also be avoided as it worsen hypertension.

Fruits,salads and juice are recommended.

More strenous activities should be avoided as they increase load on heart.

Thus lifestyle changes can improve prognosis of patient.

Suitable medications for patient can be indapamide and digoxin.

Nifedipine shouldn't be used in ccf.

Nightingale answered 1 year ago

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