Pharmaceutical Care of people with heart failure. Course activities
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1 Pharmaceutical Care of people with heart failure Course activities
2 Pharmaceutical Care of people with heart failure Course activities page 3 Case Study 1 5 Case Study 2 7 Case Study 3 9 Case Study 4
3 Case Study 1 Mrs Helen Green has been a regular patient at your community pharmacy. She is currently being treated for hypertension and her most recent prescription has been for bendroflumethiazide 2.5mg daily and amlodipine 5mg daily. Hello,, how are you? Well, I ve been to see Dr J and he wanted me to have some more tests. She tells you that she has been to the hospital for some tests since she had noticed that she has been more breathless than usual and that her ankles have been swollen. What did they find out? Apparently my heart isn t working as well as it should and that I need to go on more tablets What are they? I don t really know. I have a new prescription here and I need to start them now. Did they tell you what to do about the tablets you are already on? No. Do you think I need to keep taking them? Let me have a look at your new prescription. She shows you a prescription for: furosemide 40mg daily enalapril 2.5mg daily 3 Pharmaceutical care of people with heart failure Course activities
4 Discussion points - Case Study 1 What needs to be done about the previous prescription? Comment on the new prescription and s future medication. How should s new medication be monitored? What lifestyle changes may have to make? 4 Pharmaceutical care of people with heart failure Course activities
5 Case Study 2 has continued to come to your community pharmacy since being diagnosed with heart failure. Hello, new prescription? Yes, they ve started a new tablet Her medication now consists of: furosemide 40mg daily enalapril 10mg twice daily bisoprolol 1.25mg daily I hope they aren t going to start any more Well it depends how you get on. They may also want to increase the strength of some of the tablets. How will they know what the right strength is? We will need to do some tests and this will tell us whether you are getting the right dose for you and that there are no serious side effects. 5 Pharmaceutical care of people with heart failure Course activities
6 Discussion points - Case Study 2 Devise an ongoing monitoring regimen for. What elements of this monitoring regimen do you think it is feasible for you to do? What elements of this monitoring regimen do you think it is feasible for her to do? Would you make any changes to her medication, and if so, how? 6 Pharmaceutical care of people with heart failure Course activities
7 Case Study 3 Mr Jack Hill has been coming to your community pharmacy for many years. His past medical history includes angina, type-2 diabetes and osteoarthritis. Despite this he still manages to work night-shifts as a security guard in a local office block. His current medication consists of: aspirin 75mg daily simvastatin 40mg daily atenolol 25mg twice daily Avandamet 2mg/1g twice daily ramipril 5mg daily soluble co-codamol 2 tabs four times a day GTN spray as required Mr Hill Mr Hill Hello Jack, how are you today? Well I ve been told that I now have heart failure to go along with all my other problems although I don t really know what that means. I ve also been told that I have to take these water tablets because I get swollen ankles. Yes, I see they have started you on a tablet called furosemide. You need to take one of these each morning. The doctor also said something about changing some of my other medicines, but I can t remember what he said. Do you think they are going to start more, or change the ones I m on? That will depend on a number of things. It really depends on how you re responding to the medicines we have you on already. 7 Pharmaceutical care of people with heart failure Course activities
8 Discussion points - Case Study 3 What further changes may need to be made to Jack s medication? What additional information would be useful to help make decisions about Jack s future medication needs? What factors may affect the design of his medication regimen? 8 Pharmaceutical care of people with heart failure Course activities
9 Case Study 4 Mrs Jean McDonald has a long history of heart failure resulting from a myocardial infarction 8 years ago. In addition to being cared for by one of the local GPs, she also attends a heart failure clinic at the local hospital. She is currently on: furosemide 120mg daily enalapril 20mg twice daily carvedilol 12.5mg twice daily Slow-K 1 tab three times a day aspirin 75mg daily simvastatin 40mg twice daily Hello, how did your appointment at the clinic go? Well as you know I ve been getting a lot more breathless recently and my legs are more swollen than usual. When they checked me out they also thought that I had some fluid in my lungs. What are they planning to do? Well I ve been told to increase the number of water tablets I take to four a day for now and see how I get on. 9 Pharmaceutical care of people with heart failure Course activities
10 Discussion points - Case Study 4 What advice can you give regarding the increased dose of diuretic? Later that week comes in to your pharmacy again. Hello, how are you getting on with the extra water tablets? Not so bad, but my ankles don t seem to be going down. How s your breathing? Well I find it a bit more difficult to do things and I m not sleeping as well as I usually do. Have you spoken to anyone at the clinic about what to do? No, but I have another appointment in two weeks. What advice can you give regarding the increased dose of diuretic? 10 Pharmaceutical care of people with heart failure Course activities
11 Hello, did you get in touch with someone at the clinic? Yes. They spoke to Dr Young and got him to start a new tablet. Did they tell you what it is? They did tell me but it was such a long name that I can t remember. I ve got the prescription here. What are the possible options for the new medicine? For each of the options, what are: The likely doses The ongoing monitoring The length of treatment For each of the options, what advice would you offer? 10 Pharmaceutical care of people with heart failure Course activities
12 NHS Education for Scotland (Pharmacy) 3rd Floor, 2 Central Quay 89 Hydepark Street Glasgow G3 8BW Tel: Fax:
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