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.
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.
low salt diet
The patient suffers frommoderate visionimpairment.
Chemistry and CBC
Tests and Procedures
Fasting Blood glucose
Review of Systems
– conscious, oriented, sleepy, fatigued,
: blurred vision
: shortness of breath
: nausea, vomiting and diarrhea
CV – freeAbd – Soft,non-distended; no massesor obvious tenderness,nausea, vomiting anddiarrhea.
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
(held on 25/9)
(held on 23/9)
(held on 23/9,
Pharmacist care plan for current medications
Treatment Related Issue
Follow up and monitoring
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
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