What is the best treatment approach for a middle-aged adult with a past medical history (PMH) of mild congestive heart failure (CHF), hypertension (HTN), and hyperlipidemia, presenting with mild edema in both legs and a recent laceration on the right forearm with continued pain?

Prescription for Mild CHF with Bilateral Leg Edema and Post-Laceration Pain

Start furosemide 20 mg orally once daily for edema management, and prescribe hydrocodone/acetaminophen 5/325 mg (not 3/325 mg, as this formulation does not exist) with a quantity of 9 tablets for 3 days of as-needed pain control.

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Furosemide Prescription for Edema

Rationale for Loop Diuretic Therapy

• Loop diuretics are the cornerstone of decongestion therapy in heart failure, producing symptomatic benefits more rapidly than any other heart failure medication 1
• Furosemide is FDA-approved for treatment of edema associated with congestive heart failure 2
• The American Heart Association recommends starting furosemide at 20-40 mg once or twice daily for patients with mild CHF and fluid retention 1

Specific Prescription Details

Medication: Furosemide 20 mg tablets
Dose: 20 mg orally once daily in the morning
Quantity: 30 tablets
Refills: 2
Instructions: Take one tablet by mouth every morning. Weigh yourself daily at the same time and call if weight increases by more than 2-3 pounds in one day or 5 pounds in one week.

Critical Dosing Principles

• Starting at 20 mg daily is appropriate for mild edema in a patient with mild CHF who has relatively normal vitals 1
• The dose can be titrated upward to achieve 0.5-1.0 kg daily weight loss if edema persists 1
• Appropriate diuretic dosing is essential for the success of all other heart failure therapies; inappropriately low doses can cause persistent fluid retention 1

Essential Combination Therapy Warning

• Diuretics must never be used alone in heart failure management and should be combined with ACE inhibitors or ARBs and beta-blockers 1
• Given this patient's medication non-compliance, strongly counsel on the importance of taking ALL prescribed heart failure medications, not just the diuretic 1

Monitoring Requirements

• Daily weight monitoring at home to detect early fluid accumulation 1
• Check basic metabolic panel in 3-5 days after starting diuretic to monitor for electrolyte abnormalities and renal function 3
• Dietary sodium restriction to 2-3 grams daily to minimize fluid retention 1, 4

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Hydrocodone/Acetaminophen Prescription for Laceration Pain

Formulation Correction

• Norco 3/325 does not exist as a commercial formulation (general medical knowledge)
• Available formulations are 5/325 mg, 7.5/325 mg, or 10/325 mg
• For mild-to-moderate post-laceration pain, hydrocodone/acetaminophen 5/325 mg is appropriate

Specific Prescription Details

Medication: Hydrocodone/Acetaminophen 5/325 mg tablets
Dose: 1 tablet orally every 6 hours as needed for pain
Quantity: 9 tablets (sufficient for 3 days at maximum dosing of 3 tablets per day)
Refills: 0
Instructions: Take one tablet by mouth every 6 hours as needed for pain. Do not exceed 3 tablets in 24 hours. Do not drive or operate machinery while taking this medication.

Rationale for Quantity

• For a 3-day supply with as-needed dosing, 9 tablets allows for up to 3 doses per day [@general medical knowledge@]
• This quantity is reasonable for acute post-procedural pain from a sutured laceration [@general medical knowledge@]
• As-needed dosing is appropriate since pain is described as "continued" but not severe [@general medical knowledge@]

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Common Pitfalls to Avoid

Diuretic Management

• Do not stop diuretics prematurely if mild hypotension or slight creatinine elevation occurs, as long as the patient remains asymptomatic 5
• Excessive concern about mild azotemia leads to underutilization of diuretics and refractory edema 3
• Continue diuresis until all clinical evidence of fluid retention is eliminated 3

Medication Adherence

• Address the patient's self-reported non-compliance directly, as this significantly impacts outcomes in CHF 1
• Emphasize that diuretics alone are insufficient; ACE inhibitors/ARBs and beta-blockers are essential for mortality reduction 1
• Consider simplifying the medication regimen or addressing barriers to adherence [@general medical knowledge@]

Opioid Prescribing

• Limit to short-term use only for acute pain [@general medical knowledge@]
• Counsel on risks of sedation, constipation, and respiratory depression [@general medical knowledge@]
• Ensure patient understands this is not for chronic pain management [@general medical knowledge@]