1. As there is Dilated Cardiomyopathy
, F/H/O CAD thus Clopidogrel
(Clopilet) should be given to prevent blood clots, moreover she is a K/C/O Bronchial Asthma
thus Aspirin is Contraindicated in such patients because of tendency to cause Bronchospasm
and difficulty in breathing, thus it is an alternative to patient in whom Aspirin is needed but is CI, thus if it is not given it may result in formation of blood clots in heart and blood vessels resulting in Stroke, MI or any major obstruction.
2. decision regarding the dosage rest upon the clinical outcome i.e. if Renal Function Test are good, there is no need of Reduction, but if S. Creatinine or GFR is impaired one has to adjust the dose accordingly. regular check up and follow up with Physician is necessary.
3. Lanoxin (Digoxin): slows the ventricular rate in Atrial fibrillation
, also increases the cardiac output and decreases the heart size (Dilated Cardiomyopathy is there)
4. There is Sinus Bradycardia
52/min, it can be due to Digoxin Adverse effect or due to Hypothyroidism
, so before going for Eltroxin, make sure Digitalis toxicity is ruled out, and dose of digoxin has to be reduced till her hypothyroidism is cured.
5.As also taking cordarone (Amiodarone) this increases plasma digoxin concentration and amy cause AV block in some patients (probably that is why it is reduced)
6. Calaptin (Verapamil) causes increase in serum Digoxin Concentration resultin in signs and symptoms of Digitalis Toxicity, thus again dose of digoxin has to be readjusted.
7. The Attending Physician is the best Judge in this case and have full faith in him.
8. still want to continue: Go Low Go Slow.