Disclaimer; i DON'T know this patient, doctor or pharmacist personally.
I have only analysed the script to bring out teachable medical tutes.
This thread speaks mainly to medics and its not a substitute for any patient management.
Every case is unique.
A cursory look at the script reveals a diagnosis of Atrial fibrillation, heart failure and hypercholesterolemia in this patient.
- Treating HF without having done an ECHO at any stage is suboptimal treatment. Its necessary in disease classification.
- Theyre generally well tolerated, but care must be taken in asthmatics.
- An ARB e.g Losartan is important in HF and hypertension, it has prognostic benefit especially when the E.F is less than 45%.(HFrEF)
- An added benefit in diabetics is the slowing of CKD.
- A sudden drop in renal function after starting an ARB should trigger a thought of renal artery stenosis. A renal ultrasound is key.
- ARB are generally avoided with ACEI combined.
- It also has a mortality benefit in HF not just symptom control.
-Best give morning and midday.
- It has no mortality benefit in HF and just helps with symptoms.
- Rash is a very common neglected side effect.
- Amiodarone is used in AF, for rhythm control, its good but problematic in long term.
- Its unique as a drug in that it can cause both hypo and hyper thyroidism, lung fibrosis and affect liver function test also.
- Muscle aches and pains especially in females remains a common side effect.
- It has no antiplatelet effect and bleeding risk increases when combined with aspirin.
End.