Status - uncontrolled
Drug therapy problem - indication: needs additional drug therapy - CD does not have the optimal medication regimen for chronic heart failure.
Drug therapy problem - safety: adverse drug reaction - CD is experiencing frequent falls and dizziness, this may due to his lisinopril.
Rationale: Based on the 2013 ACC/AHA guideline for diagnosis and management of heart failure, the goal of patients has heart failure with reduced ejection fraction (HFrEF) (NYHA Class II, EF 40%) are controlling symptoms, preventing hospitalization, preventing mortality indefinitely. The recommended medications to use include diuretics, ACEI or ARB, beta blockers and aldosterone antagonists.
CD currently takes furosemide and lisinopril for chronic heart failure. He has no symptoms for edema, so the furosemide dose is suitable. Based on the guideline, a beta blocker is indicated because he has chronic heart failure with EF 40%, using a beta block may reduce mortality, the therapeutic options include metoprolol, atenolol, nebivolol. Metoprolol targets beta 1 receptor in the heart and is …show more content…
Changing Lisinopril to an ARB might be helpful to prevent the dizziness and falls. The therapeutic options include candesartan, losartan, and valsartan. Losartan is widely available and covered by many insurance plans. The initial dose is 25 to 50 mg orally once daily, titrate as tolerated to a maximum dose of 50 to 150 mg once daily. His CrCl is 41.8 ml/min based on Cockcroft-Gault equation, starting at 25 mg would be appropriate. The chance of experiencing dizziness from losartan is reported to be 3%, which is less than its for lisinopril. So discontinue lisinopril and initial losartan would be recommended. Closely monitoring should be aware of by the patient and his family as
Drug therapy problem - indication: needs additional drug therapy - CD does not have the optimal medication regimen for chronic heart failure.
Drug therapy problem - safety: adverse drug reaction - CD is experiencing frequent falls and dizziness, this may due to his lisinopril.
Rationale: Based on the 2013 ACC/AHA guideline for diagnosis and management of heart failure, the goal of patients has heart failure with reduced ejection fraction (HFrEF) (NYHA Class II, EF 40%) are controlling symptoms, preventing hospitalization, preventing mortality indefinitely. The recommended medications to use include diuretics, ACEI or ARB, beta blockers and aldosterone antagonists.
CD currently takes furosemide and lisinopril for chronic heart failure. He has no symptoms for edema, so the furosemide dose is suitable. Based on the guideline, a beta blocker is indicated because he has chronic heart failure with EF 40%, using a beta block may reduce mortality, the therapeutic options include metoprolol, atenolol, nebivolol. Metoprolol targets beta 1 receptor in the heart and is …show more content…
Changing Lisinopril to an ARB might be helpful to prevent the dizziness and falls. The therapeutic options include candesartan, losartan, and valsartan. Losartan is widely available and covered by many insurance plans. The initial dose is 25 to 50 mg orally once daily, titrate as tolerated to a maximum dose of 50 to 150 mg once daily. His CrCl is 41.8 ml/min based on Cockcroft-Gault equation, starting at 25 mg would be appropriate. The chance of experiencing dizziness from losartan is reported to be 3%, which is less than its for lisinopril. So discontinue lisinopril and initial losartan would be recommended. Closely monitoring should be aware of by the patient and his family as