Pharmaceutical care on a patient with heart failure

BAI Ying; WANG Jia-wei

Abstract：One 58-year-old female patient with atrial fibrillation, pulmonary infection and chronic hepatitis C was hospitalized because of aggravation of heart failure. The patient received torasemide (20 mg, iv) and deslanoside (0.4 mg, iv) for heart failure therapy, moxilfoxacin (0.4 g, qd, ivgtt) for anti-infection and amiodarone (150 mg, iv) for atrial ifbrillation control. But the liver function and coagulative function of patient were aggravated. The alanine aminotransferase (ALT) was 1052 IU·L-1, aspartate aminotransferase (AST) was 2784 IU·L-1 and international normalized ratio (INR) was 13.18. The clinical pharmacists suggested to withdraw the moxifloxacin and amiodarone. Considering that moxifloxacin and amiodarone could lead to the deterioration of liver and coagulative function and amiodarone could promote the anticoagulation of warfarin, clinical pharmacists advised that moxilfoxacin and amiodarone should be stopped, while fresh frozen plasma, meropenem and hepatoprotective therapy should be given to the patient. On 9th day of drug withdrawal, INR was 1.31 and on 13th day with drug withdrawal, ALT was 51 IU·L-1, AST was 29 IU·L-1. During the pharmaceutical care, pharmacists and doctors communicated timely, pharmacists assisted doctors to optimize the therapeutic regimens to ensure the drug safety of patient.