Medication Management for Heart Failure: A Comprehensive Review of Mr. Akana’s Prescribed Medications

QUESTION

Case study
Keola Akana is a 70-year-old male with a history of heart failure. He was admitted to the
medical-surgical unit early on Monday morning for medication adjustment, monitoring, and
cardiac rehabilitation. On assessment the client is sitting in bed. He is complaining of headache,
fatigue, blurred vision, and yellow halos around the lights in the room. He is cooperative with all
interventions and answers all questions directly and completely. Lab results have just returned;
serum potassium and digoxin levels are not in therapeutic range. The client is also complaining
of increasing shortness of breath on exertion and orthopnea over the past 2 weeks.
Past Medical History
• Hypertension
• High cholesterol
Physical examination findings
• Vital signs: BP 98/57 mmHg, Pulse 54/min irregular, RR 22/min and laboured, SaO2 92% on
2L O2 vis nasal cannula, Temp 36.9 0C
Respiratory
• shortness of breath on exertion
• No nasal flaring, use of accessory muscles.
• Chest with bibasilar crackles on auscultation
• Productive cough with white phlegm
• Orthopnea reported
Cardiac
• Slightly irregular; S1, S2 & S3. Managing with digoxin3Scenario adopted from Elsevier-modified & edited by Nazool Alli
Abdomen
• no abdominal distention
• bowel sounds present
Neck
• distended neck veins
• JVD with jugular venous pressure >4cm
• no bruits noted on auscultation
Extremities
• 2+ bilateral pre-tibial pitting edema and also in feet and ankles
• Palpable pedal pulses
Integumentary
• Pale, cool and clammy
• Slightly diaphoretic
Genitourinary
• nocturia (voiding more than once at night)
Laboratory Results
Tests Results Normal value
Red blood cell count 4.9 million/mm3 4.4 – 5.7 X 1012/L
White blood cell count 11.0 × 109 /L 4.0-10.0 × 109 /L
Troponin <0.01 μg/L < 0.01 μg/L
B-type natriuretic peptide
(BNP).
>400 pg/ml
HF very likely
<100 pg/ml
sodium 133 mmol/L 135-145 mmol/L
potassium 3.0 mmol/L 3.5-5.0 mmol/L
Digoxin level 3.2 ng/mL 0.6 – 1.2 ng/mL
**HF= Heart Failure4Scenario adopted from Elsevier-modified & edited by Nazool Alli
Diagnostic test
• Chest x-ray confirmed pulmonary congestion with cardiomegaly.
Cardiac monitor ECG rhythm
Admitting Diagnosis
Mr. Akana was admitted to medical-surgical unit with congestive heart failure (CHF). On
admission he was ordered the following medications in addition to his usual routine scheduled
medications:
• atenolol (Tenormin®) 50 mg po OD.
• furosemide (Lasix®) 80mg IV BID
• digoxin (Lanoxin®) 0.25 mg po TID

Explain each medication in detail (indications for use, mechanism of action and effects)
in treating Mr. Akana heart failure.

ANSWER

Medication Management for Heart Failure: A Comprehensive Review of Mr. Akana’s Prescribed Medications

Introduction

Congestive heart failure (CHF) is a chronic condition that requires careful management to improve cardiac function, alleviate symptoms, and enhance the patient’s quality of life. This essay provides an in-depth analysis of the medications prescribed to Mr. Keola Akana for his heart failure, including atenolol, furosemide, and digoxin. Each medication’s indications, mechanism of action, and effects in treating heart failure will be explored.

Atenolol (Tenormin®)

Indications for Use: Atenolol is a beta-blocker prescribed for various cardiovascular conditions, including hypertension and heart failure. In Mr. Akana’s case, atenolol is used to manage his heart failure and control his blood pressure.

Mechanism of Action: Atenolol selectively blocks beta-1 adrenergic receptors in the heart, reducing the effect of sympathetic stimulation on cardiac tissue. By doing so, atenolol lowers heart rate and myocardial contractility, reducing the workload on the heart and improving its efficiency.

Effects in Treating Heart Failure: Atenolol helps to decrease the heart’s oxygen demand, improving its oxygen supply-demand balance. By reducing cardiac workload and improving cardiac output, atenolol alleviates symptoms such as shortness of breath and fatigue in heart failure patients.

Furosemide (Lasix®)

Indications for Use: Furosemide is a loop diuretic used to manage fluid retention in various conditions, including heart failure. It is prescribed to reduce edema and fluid overload in heart failure patients like Mr. Akana.

Mechanism of Action: Furosemide inhibits the reabsorption of sodium and chloride in the ascending loop of Henle, promoting diuresis and subsequent loss of excess fluid. This leads to decreased blood volume and reduced preload on the heart.

Effects in Treating Heart Failure: By promoting diuresis, furosemide effectively reduces fluid overload, relieving symptoms of congestion such as dyspnea and peripheral edema. The medication helps to improve cardiac output by reducing the heart’s workload and enhancing its contractility.

Digoxin (Lanoxin®)

Indications for Use: Digoxin is a cardiac glycoside prescribed to patients with heart failure to enhance cardiac contractility and control heart rate.

Mechanism of Action: Digoxin inhibits the sodium-potassium ATPase pump, leading to an increase in intracellular calcium levels within cardiac cells. This results in improved myocardial contractility, a positive inotropic effect, and a negative chronotropic effect, reducing heart rate.

Effects in Treating Heart Failure: Digoxin strengthens the heart’s contractions, improving its pumping ability and enhancing cardiac output. It helps to control heart rate in patients with atrial fibrillation or rapid ventricular response, which is common in heart failure.

Conclusion

The combination of atenolol, furosemide, and digoxin in Mr. Akana’s medication regimen plays a crucial role in managing his heart failure. Atenolol reduces the heart’s workload and controls blood pressure, furosemide promotes diuresis to reduce fluid overload, and digoxin enhances cardiac contractility and controls heart rate. Together, these medications help improve Mr. Akana’s heart function, alleviate symptoms, and enhance his overall well-being. Proper monitoring and adherence to the prescribed treatment plan are essential to ensure optimal therapeutic effects and patient safety.