Identify the therapeutic problem(s) where the pharmacist¶s intervention maybenefit the patient
.LM is a stage 1 (mild) hypertension patient is managed with an ACE inhibitor, enalapril.She has the signs and symptoms of congestive heart failure (CHF) namely by loss of appetite,constipation, ankle edema and slight hepatomegaly, indicative of right ventricular dysfunction. The incidence of CHF also increases markedly with age in this case; LM is an80 year old, black female. Plan treatment initiated by her physician is beneficial with acardiac glycoside or other positive inotropic agent and a diuretic, furosemide. Since ACEinhibitor is somewhat less effective in black patients (produce relatively lesser renin) inhypertension management, diuretic is used in combination. Digoxin is the only cardiacglycoside extensively reviewed because of its predominant use in clinical medicine.
Identify and prioritize the patient specific factors that must be considered toachieve the desired therapeutic outcomes.
LM has congestive heart failure and high blood pressure is controlled by an ACEinhibitor in reducing the generation of a potent vasoconstrictor, angiotensin II. ACEinhibitor prolonged the survival of severe CHF patients and produce regression of leftventricular hypertrophy. Positive inotropic drugs are in use to increase cardiac outputin CHF patient.
LM¶s a black female patient may be of less effectiveness with the use of ACEinhibitor. Increase dosage of ACE inhibitor or use diuretic in combination for hypertension management.
The underlying reduction in cardiac output in CHF stimulates compensatorymechanisms, leading to sodium and water retention and increased sympatheticactivity; liberating symptom of ankle edema. Systemic congestion of hepatomegalyoccur secondary to failure of the right ventricle. Restriction of fluid is vital to preventfurther congestions. Loop diuretic may help excrete most fluid.
eneralized visceral edema may also occur, causing constipation, nausea (loss of appetite) and abdominal distension.
Age-related decreases in renal and hepatic function are normal in old people; mayrequire dose of drugs adjustment which are extensively metabolized by hepaticenzymes and/ or renal excreted.