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Pharmaceutical care - Patient profile

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Introduction

Middle

The loading can be given as two doses of 500 microgram tablets given six hours apart. A predicted digoxin level can be determined using the following equation: Cpdes= DosexSxF = 1000x0.62x1 = 1.75 ?g/Litre. Vd 353.96 The accepted therapeutic range for digoxin is 1 to 2 ng/ml. Hence the loading dose of 1 milligram will give a serum concentration of 1.75 ?g/ml, which is within the therapeutic range. The maintenance dose can also be determined using the following equations: Clearance: 0.06Creatinine Clearance + 0.02Weight 0.06x141+0.02x65 = 9.76 litres/hour Maintenance Dose: Clearance x Cpss x ? SxF 234.24 L/day x 1.5 microgram/Lx1day 1.0 x 0.62 = 566.7 micrograms/day Hence 500 micrograms daily would provide a serum concentration of 1.5 ?g/L. However because of the patient's mild renal impairment a dose reduction is required. According to the Renal Drug handbook, in mild renal impairment the dose range of digoxin that can be used is 125 to 250 micrograms. Instead based on the patient's impaired renal impairment and age 125 micrograms daily was prescribed. Digoxin is a drug with a narrow therapeutic range therefore therapeutic drug monitoring is required to ensure that the serum drug levels are within the therapeutic range. A level was determined 8 hours after the fourth dose (i.e second maintenance dose), a level of 1.2 ng/ml was determined. ...read more.

Conclusion

His calcium levels also began to decrease quite quickly, once corrected, his calcium levels were below the lower limit. I again suggested that more frequent calcium levels be performed before commencing treatment to supplement his calcium. Unfortunately on starting my next rotation I was told that the patient had died, after his stats continued to fall (i.e albumin, pulse rate continued to be erratic,) and a tumour had been located on one of his kidneys. This is the first patient I have looked after who has died. I was upset because at one point he seemed to be improving and returned to his usual jolly self. SUMMATIVE PATIENT MEDICATION PROFILE Medicine Mode of Action Indication Efficacy/Safety Parameters Counselling Points Metoprolol Beta-blocker. Metoprolol is used to treat high blood pressure as well as controlling how quickly your heart beats. It works by relaxing blood vessels so the heart doesn't have to pump as hard. Atrial fibrillation * dizziness * lightheadedness * excessive tiredness * cold hands and feet Cardioprotective properties To be taken regularly. Do not stop taking unless advised by your doctor. Digoxin Controls the rate at which your hearts contract and hence should stop the palpations you are experiencing. Atrial Fibrillation Report promptly: Visual disturbances, weight loss or loss of appetite, nausea vomiting or tremor. Do not stop taking without medical advice. Venita Hardweir Page 1 13/08/2004 ...read more.

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