Question

Diagnosis Atrial Fibrillation (new onset) HF, HTN, Glaucoma 128/76 90 (irregular)-20 98.4F and 98% Weight (Baseline): 146 PMH Vital Signs Current Hospital Assessment data shared with the primary care provider Lung clear Renal function within normal. She went to the Emergency Department with complaints of Shortness of Breath (SOB), palpitations, fatigue and feeling anxious. She was admitted for two days and diagnosed with new onset atrial fibrillation. She had a diagnostic work up (e.g., echocardiogram). She was initially diuresed with IV Lasix to her baseline weight. She was started on Verapamil for rate control of the atrial fibrillation with a good response. Her heart rate ranges from 80-94 and is irregular. History of Present Illness PCP visit arranged (within a week) for follow-up Her husband recently fell at home (5 days ago) while she was in the hospital. Her sister (lives nearby) was staying with him while she was in the hospital. Her husband was hospitalized with a fractured hip that required surgical repair. He is now in the hospital awaiting transfer to a Skilled Nursing Facility for rehabilitation Social History Current medications Name Dose Route Frequency Twice Daily Ophthalmic Brimonidine 1 drop to affected tartrate 0.2% and timolol 0.5% eyes 80 mg, Once daily Furosemide Oral 1 tablet 20 mg, Once daily Lisinopril Oral 1 tablet

After reviewing the patient information, what are your initial medication concerns to address with the pharmacist?

Answer 1

1. Metoprolol is contraindicated in hemodynamically unstable, heart failure, low cardiac output and increased risk of cardiac arrest. Here the patient had past medical history of heart failure and irregular heart rate. The other reason is verapamil (calcium channel blockers ) is taken with betablockers causes serious side effect like hypotension, atrioventricular block and bradycardia. If bradycardia present, never administer metoprolol. So prior to administration of metoprolol, pulse rate must be checked.