Case study on Congestive

Cardiac Failure
Chandana
Y14PHD0117
II/VI Pharm.D
What Is Heart Failure?
What Causes Heart Failure?
What Are the Symptoms of Heart Failure?
What Are the Types of Heart Failure?
How Is Heart Failure Diagnosed?
Is There a Treatment for Heart Failure?
Stages of Heart Failure
SOAP Note
Subjective Findings
SOB Grade 4 associated with orthopnea since days

Swelling of both lower limbs since one month

Ankle swelling
Objective Findings
RBS - 199 mg/dl

ECG - Abnormal PQRS complex

BP - 170/100 mmHg

Blood Urea - 7.2 mg/dl

Hb - 8.8 gm

Serum Creatinine - 1.8 mg/dl

Right & left pleural effusion

Assessment
Diagnosis - CCF with HTN & DM

Etiology - HTN & DM

Drugs
1. Furosemide

Class : Antihypertensive (loop diuretic)

Dose : 20-80 mg/day orally

MOA : Inhibit the reabsorption of Na and Cl ions at proximal & distal renal tubules and
loop of henle, thereby increasing the urine output.

ADRs : Hyperuricemia, Hypokalemia, Nausea.

Monitoring Points: Serum electrolyte, Creatinine levels are monitored frequently for the
first few months.

Improvement in Edematous condition and Wt loss are indications of efficacy.

2. Amlodipine

Class : CCB

Dose : 2.5-10 mg/day orally

MOA : Block the calcium channel & inhibit the transmembrane influx of extracellular Ca
ions across membrane of myocardial cells & vascular smooth muscles thereby dilating
coronary & systemic arteries.

ADRs : Dizziness, Peripheral edema, Headache.

Monitoring Points: Bp and Serum electrolyte levels need to be monitored.

3. Deriphyllin (Etophylline + Theophylline)

Class : Xanthines

Dose : 1-2 ampules/2-3 times daily.

MOA : Etophylline- Potent bronchodilator, acts on bronchial smooth muscle.

Theophylline- Inhibits phosphodiesterase, results in increased uptake of cellular AMP
thereby smooth muscle relaxation.

ADRs : Nausea, Vomiting, Diarrhoea.

Monitoring Points: Toxicity.

4. Duolin

Class : Anticholinergic

Dose : 2 inhalations 4 times/day, Max 12 inhalations.

MOA : Suppresses the increase of cGMP levels due to interaction of acetylcholine with
muscarinic receptor on bronchial smooth muscle, prevents secretions of serous and
seromucous glands in nasal mucosa.

ADRs : Tremors, nervousness, hypokalemia, dry mouth, tachycardia, dizziness,

headache.

Monitoring Points: Pulmonary function tests, Proper inhalation techniques. Relief in the
symptoms of rhinorrhea and asthma are indications of efficacy.
5. Budecort

Class : Corticosteroid

Dose : 360 mg via oral inhalation 2 times daily, 180 mg twice/day initially may be
sufficient in some patients.

MOA : Exhibits broad range of active inhibition against multiple cell type and mediators
involving allergic and non-allergic mediated inflammation.

ADRs : Diarrhoea, Nausea, Headache, Nasal stinging, RT infection

Monitoring Points: Asthma, Ulcerative colitis, Perennial allergic rhinitis.

6. Augmentin

Class : Penicillin

Dose : usually 250mg

MOA : Semisynthetic antibiotic that binds to penicillin-binding proteins within the

bacterial cell wall and inhibits its synthesis,in addition clavulanate inhibits b-lactamase
produing bacteria, allowing amoxicillin to have extended spectrum of action.

ADRs : Nausea, Vomiting, Diarrhoea.

Monitoring Points: Monitor for anaphylactic reactions, hepatic toxicity, superinfection,

skin rash.
7. Iron-Folic acid

Class : Vitamins

Dose : Iron-66mg, Folic acid-1mg

MOA : Iron- Essential component in formation of Hb,serves as cofactor of several

essential enzymes, including cytochromes involved in ETC. Folic acid-

ADRs : Constipation, Diarrhoea, Nausea, Dark stool

Monitoring Points: Accidental overdose of iron leads to fatal poisoning in children<6yrs

of age.
8. Calcium

Class : Fat soluble vitamins

Dose : 1gm/day, Max 2.5gm

MOA : Prevents or treats negative calcium balance.

ADRs : Anorexia, Constipation,Vomiting.

Monitoring Points: Use with caution in patients having history of kidney stones.
Plan
General Goals Patient Specific
- To decrease pulmonary complications. -To reduce BP

- To control blood sugar levels.

- Increase cardiac function.
- To prevent renal complications.
- Decrease morbidity conditions.
- To reduce left & right pleural effusion.
- Prevent hospitalization.
Monitoring

Therapeutic Monitoring - BP,

Blood sugar,

Renal function tests,

SOB,

ECG.
1. Furosemide Hypokalemia Electrolytes monitoring,
Dehydration

2. Amlodipine Edema Electrolytes monitoring

Headache

3. Deriphyllin Nausea Toxicity,

Vomiting

4. Duolin Bronchospasm Pulmonary function

tests

Sinusitis

5. Budecort Diarrhoea Electrolyte monitoring

Nausea
Points to Physician Points to Patient

- ACE's or ARB's are prefeerred than - Consume low fat food.

CCB's as the patient has HTN+DM
- Exercise regularly.
- Suggest to give drugs for DM (insulin).
- Reduce hih salt intake
- Dose of Furoseide must b reduced.
- Increase iron rich food & nutrient
- Need to add ARB's & K sparing intake.
diuretics as there is no decrease in BP.