Akmal Muhammad is a 15-year-old male who was admitted to
Mrs. Gina Goddard, a 78-year-old woman with a history of heart failure with reduced ejection fraction (HFrEF), hypertension, and hypercholesterolemia, recently underwent an open reduction and internal fixation (ORIF) for a left hip fracture sustained from a fall. Prior to this, she managed her daily activities and medications independently. Upon discharge, her medications included Enalapril, Bisoprolol, Spironolactone, Furosemide, and Atorvastatin, but did not include any pain relief, as she was advised to take Ibuprofen 400mg TDS for postoperative pain. Two days post-discharge, Mrs. Goddard experienced breathlessness, severe swelling in her ankles, and difficulty using her walking frame. Despite not reporting pain, she had trouble managing her condition and had not weighed herself since leaving the hospital. Concerned about her worsening symptoms, her daughter took her to the emergency department on a Sunday. In the emergency department, Mrs. Goddard’s observations were: – BP: 190/110 mmHg – HR:120 bpm – RR:28 breaths per minute – SpO2: 96% with 6L oxygen via Hudson mask – Auscultation: Crackles in bilateral lung fields – Edema: Pitting edema in both legs She was treated with intravenous Furosemide 80mg, which helped alleviate her symptoms. Mrs. Goddard was admitted for further investigation of her heart failure exacerbation. Describe the medication management for heart failure with reduced ejection fraction (HFrEF), as prescribed for Mrs Goddard. Review the clinical scenario and identify the probable drug-to-disease interaction and/or drug-to-drug interaction that has contributed to the exacerbation of heart failure and hospital re-admission for Mrs Goddard. Support your discussion with specific clinical information from the clinical scenario, Australian clinical guidelines, and evidence-based literature.
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