A 72-year-old male has a past history of heart failure with reduced ejection fraction, chronic kidney disease, hypertension, diabetes, intermittent claudication, and osteoarthritis.
His current medication regimen includes:
- Aspirin 81 mg daily
- Cilostazol 100 mg twice daily
- Furosemide 40 mg twice daily
- Amlodipine 10 mg daily
- Lisinopril 10 mg daily
- Carvedilol 6.25 mg twice daily
- Metformin 500 mg BID
- Ibuprofen 400 mg PRN
The heart failure and a few of his medications is my top concern given the limited information.
Cilostazol is contraindicated in heart failure and because of this, I’d like to reassess the risk versus benefit of continuing with this medication. There isn’t a really good alternative to cilostazol. It would be nice to get a little more history on his claudication history.
In addition to the cilostazol, ibuprofen and amlodipine could contribute to the heart failure risk. One of the first questions I’d ask this patient is how much ibuprofen are they taking?
With the potential negative impact of edema from amlodipine, I’d like to know if he has tried higher doses of the lisinopril or carvedilol. In addition to the benefit of trying to reduce the amlodipine, trying to maximize the beta-blocker and ACE inhibitor could be beneficial for this patient’s heart failure.
Increasing the ACE inhibitor could exacerbate renal function and we’d like to know where the heart rate is at if considering increasing the carvedilol.
What other questions would you ask in with this scenario?
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