This document discusses various pharmacologic interventions for congestive heart failure, cardiomyopathy, and valve disease. It describes the mechanisms of action, therapeutic effects, adverse effects and nursing implications of several classes of heart failure medications including: ACE inhibitors, angiotensin receptor blockers, beta blockers, loop diuretics, thiazide diuretics, potassium sparing diuretics, nitrates, digoxin, milrinone, morphine, nesiritide, sacubitril/valsartan, and ivabradine. The document provides details on specific drugs within each class and how they are used to treat symptoms and improve outcomes for patients with heart failure.
CHRONIC ASPIRIN AND STATIN THERAPYIN PATIENTS WITH IMPAIRED RENAL FUNCTIONA...Vishwanath Hesarur
Chronic use of aspirin and statin may reduce the risk of subsequent MI and improve outcome in patients with documented IHD or in patients at high risk of a first cardiovascular event.
Moreover, previous aspirin & statin therapy may interfere with the clinical presentation of acute MI, with a higher incidence of NSTEMI as compared to STEMI.
This document discusses the challenges of managing diabetes in patients with chronic kidney disease (CKD). It notes that diabetes is a leading cause of CKD progression and that CKD increases mortality risk in diabetes patients. Managing glucose levels in CKD patients is difficult due to risks of hypoglycemia from insulin clearance issues and need to adjust oral medications for kidney function. The CARMELINA trial demonstrated the renal safety of the DPP-4 inhibitor linagliptin in high cardio-renal risk patients, showing no increase in sustained decrease in eGFR or other renal outcomes compared to placebo over 2 years.
This document discusses treatment of chronic kidney disease (CKD). It aims to slow progression to end-stage renal disease (ESRD) and prepare for ESRD. The most effective treatment is controlling blood pressure with angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), which work by blocking the renin-angiotensin-aldosterone system (RAAS). Glycemic control in diabetes also seems to slow progression. While other potential treatments target various pathways and processes, more research is still needed due to the limited proven effective therapies currently available to treat CKD.
Beta blockers in SIHD: Yes, all patients should receive them !cardiositeindia
A presentation made by Dr. Akshay Mehta on the topic- Beta blockers in SIHD: yes, all patients should receive them !.
This was presented at the SIHD conference, Mumbai, 2015.
This document discusses uric acid metabolism and its role in health and disease. It covers normal uric acid levels, foods and substances that can affect levels, and the pathways of purine breakdown. It then examines abnormal uric acid metabolism and how this can lead to hyperuricemia and conditions like gout, kidney stones, and chronic kidney disease. It reviews the evidence that chronic hyperuricemia is an independent risk factor for hypertension, cardiovascular disease, and kidney disease. Treatment of asymptomatic hyperuricemia is debated, with some guidelines recommending treatment to prevent non-gout related diseases.
Nearly 1.4 million individuals suffer from traumatic brain injury (TBI) each year, leaving many survivors with significant deficits. Early and adequate nutrition support is challenging but may improve outcomes for TBI patients. The document discusses the metabolic and immune alterations caused by TBI and recommends enteral nutrition over parenteral nutrition when possible. It emphasizes starting nutrition within 48 hours and achieving full caloric needs by day 7 to prevent protein breakdown and support recovery. Barriers to providing nutrition like feeding intolerance are also reviewed.
- Acute kidney injury (AKI) is a risk factor for developing chronic kidney disease (CKD), even in cases where renal function appears to recover. More severe episodes of AKI are linked to more severe CKD.
- Development of CKD after AKI is associated with increased risks of death, cardiovascular disease, and other adverse health outcomes. Overt CKD may be delayed following AKI.
- Recognition of CKD development after AKI is challenging, as is arranging adequate long-term follow-up for patients. However, follow-up is important for treating CKD risk factors and avoiding further kidney injury.
CHRONIC ASPIRIN AND STATIN THERAPYIN PATIENTS WITH IMPAIRED RENAL FUNCTIONA...Vishwanath Hesarur
Chronic use of aspirin and statin may reduce the risk of subsequent MI and improve outcome in patients with documented IHD or in patients at high risk of a first cardiovascular event.
Moreover, previous aspirin & statin therapy may interfere with the clinical presentation of acute MI, with a higher incidence of NSTEMI as compared to STEMI.
This document discusses the challenges of managing diabetes in patients with chronic kidney disease (CKD). It notes that diabetes is a leading cause of CKD progression and that CKD increases mortality risk in diabetes patients. Managing glucose levels in CKD patients is difficult due to risks of hypoglycemia from insulin clearance issues and need to adjust oral medications for kidney function. The CARMELINA trial demonstrated the renal safety of the DPP-4 inhibitor linagliptin in high cardio-renal risk patients, showing no increase in sustained decrease in eGFR or other renal outcomes compared to placebo over 2 years.
This document discusses treatment of chronic kidney disease (CKD). It aims to slow progression to end-stage renal disease (ESRD) and prepare for ESRD. The most effective treatment is controlling blood pressure with angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), which work by blocking the renin-angiotensin-aldosterone system (RAAS). Glycemic control in diabetes also seems to slow progression. While other potential treatments target various pathways and processes, more research is still needed due to the limited proven effective therapies currently available to treat CKD.
Beta blockers in SIHD: Yes, all patients should receive them !cardiositeindia
A presentation made by Dr. Akshay Mehta on the topic- Beta blockers in SIHD: yes, all patients should receive them !.
This was presented at the SIHD conference, Mumbai, 2015.
This document discusses uric acid metabolism and its role in health and disease. It covers normal uric acid levels, foods and substances that can affect levels, and the pathways of purine breakdown. It then examines abnormal uric acid metabolism and how this can lead to hyperuricemia and conditions like gout, kidney stones, and chronic kidney disease. It reviews the evidence that chronic hyperuricemia is an independent risk factor for hypertension, cardiovascular disease, and kidney disease. Treatment of asymptomatic hyperuricemia is debated, with some guidelines recommending treatment to prevent non-gout related diseases.
Nearly 1.4 million individuals suffer from traumatic brain injury (TBI) each year, leaving many survivors with significant deficits. Early and adequate nutrition support is challenging but may improve outcomes for TBI patients. The document discusses the metabolic and immune alterations caused by TBI and recommends enteral nutrition over parenteral nutrition when possible. It emphasizes starting nutrition within 48 hours and achieving full caloric needs by day 7 to prevent protein breakdown and support recovery. Barriers to providing nutrition like feeding intolerance are also reviewed.
- Acute kidney injury (AKI) is a risk factor for developing chronic kidney disease (CKD), even in cases where renal function appears to recover. More severe episodes of AKI are linked to more severe CKD.
- Development of CKD after AKI is associated with increased risks of death, cardiovascular disease, and other adverse health outcomes. Overt CKD may be delayed following AKI.
- Recognition of CKD development after AKI is challenging, as is arranging adequate long-term follow-up for patients. However, follow-up is important for treating CKD risk factors and avoiding further kidney injury.
Acute kidney injury (AKI) is common after surgery and associated with increased mortality and long-term renal dysfunction. Major surgery can lead to AKI through hypotension, blood loss, inflammation, and use of nephrotoxic substances. Identifying at-risk patients preoperatively and maintaining adequate perfusion and cardiac output intraoperatively through fluid management and treatment of hypotension may help prevent postoperative AKI. Ongoing studies aim to determine optimal fluid strategies, but current evidence suggests avoiding starch and maintaining hemodynamic targets with balanced fluids and vasopressors.
Perinatal asphyxia and hypoxic-ischemic encephalopathy (HIE) result from inadequate oxygen delivery to the brain near birth, leading to compromised brain metabolism. The main causes are failure to initiate or maintain breathing at birth, or impaired blood gas exchange. This can cause hypoxemia, ischemia, and ultimately neuronal cell death through mechanisms like excitotoxicity, oxidative stress, inflammation, and apoptosis. HIE is a major cause of neonatal mortality and morbidity in Kenya, with over 30% of neonatal deaths attributed to birth asphyxia and HIE. Risk factors include preeclampsia, abnormal heart rate during labor, meconium staining, and operative deliveries.
ICN VIctoria: John Botha on Critical Care Renal FailureGerard Fennessy
Professor John Botha from Frankston Hospital in Melbourne talks at the April 2014 Victorian Intensive Care Network meeting on Renal Failure in Critical Care
HTN among ESRD patients Current ReviewJAFAR ALSAID
This document discusses hypertension among patients with end-stage renal disease (ESRD) who receive dialysis. It defines key terms like chronic kidney disease (CKD) and ESRD. It then examines the epidemiology of hypertension in dialysis patients, challenges in measuring their blood pressure, and strategies for management. Home blood pressure monitoring is recommended over measurements just before or after dialysis, as home readings better predict health outcomes. Ambulatory blood pressure monitoring for 44 hours between dialysis sessions is also discussed as the gold standard for evaluation.
This document discusses the relationship between kidney disease and cardiovascular disease. It notes that chronic kidney disease (CKD) is an independent risk factor for mortality in patients with coronary artery disease. Even mild elevations in creatinine are associated with increased risk of cardiovascular events. Acute kidney injury, including contrast-induced nephropathy (CIN), is the third leading cause of in-hospital acute renal failure. CIN risk increases with factors like diabetes, older age, decreased kidney function, and higher contrast volume. CIN is linked to worse clinical outcomes like longer hospital stays, increased mortality, and progression to chronic kidney disease. Prevention strategies aim to reduce CIN risk through measures like hydration and medications like sodium bicar
The document provides biographical and credential information for Dr. Martin Siegfried, including his medical education, specialties in cardiovascular disease, and interests. It then covers various topics related to atrial fibrillation including post-operative AF, prevention strategies, associations with obstructive sleep apnea and hyperthyroidism, and considerations for anticoagulation in elderly patients with fall risk.
The document is a clinical practice guideline for acute kidney injury (AKI) published by Kidney Disease: Improving Global Outcomes (KDIGO) in 2012. It contains recommendations on defining and classifying AKI, evaluating patients at risk, preventing AKI, treating AKI with renal replacement therapy, and managing specific causes of AKI like contrast-induced nephropathy. The guideline includes sections on introduction and methodology, definition of AKI, prevention and general treatment of AKI, contrast-induced AKI, and dialysis interventions. It provides tables summarizing recommendation statements and clinical practice recommendations supported by evidence reviews.
1. Radiocontrast agents, also known as contrast media, are substances used to improve the visibility of internal organs and structures during medical imaging. The most common types are iodine-based agents used for computed tomography and angiography, and gadolinium-based agents used for magnetic resonance imaging.
2. Contrast-induced nephropathy (CIN) refers to acute kidney injury caused by radiocontrast agents in patients with underlying renal impairment or risk factors. Preventing CIN involves identifying at-risk patients, minimizing contrast volume, using iso-osmolar or low-osmolar agents, intravenous hydration before and after exposure, and holding nephrotoxic drugs like metformin.
3
This document provides guidelines for the prevention and management of perioperative stroke. It begins with definitions of perioperative stroke and outlines contents to be covered. These include preoperative, intraoperative, and postoperative sections. In the preoperative section, it discusses evaluation and risk factors, timing of surgery after stroke, anticoagulant management, and use of beta-blockers and statins. The intraoperative section addresses anesthetic techniques, blood pressure control, ventilation, hemorrhage management, glycemic control, and beta-blockade. The postoperative section focuses on the need for a coordinated team approach and protocols for rapid assessment and intervention. It provides mortality rates for perioperative stroke and reviews studies on various prevention strategies discussed in the
Cardio renal care-An integated best Practice Approchdrucsamal
This document provides information about a continuing medical education (CME) activity on cardio-renal syndromes (CRS). It begins with a declaration of disclosure stating the National Kidney Foundation's policy to ensure independence and manage any conflicts of interest among activity planners and faculty. The document then outlines the learning objectives, agenda, and pre-program questions. It also includes an overview of CRS, defining the different subtypes and discussing the bidirectional relationship between cardiac and renal dysfunction. Two case studies are presented to illustrate examples of acute cardiorenal syndrome type 1 and acute renocardiac syndrome type 3.
This document provides an overview of osteoarthritis (OA), including its definition, risk factors, clinical features, diagnosis, treatment options, and management goals. OA results from cartilage failure induced by genetic and biomechanical factors. It is diagnosed based on symptoms like pain and stiffness, along with physical exam findings and radiographic evidence. Treatment includes non-pharmacological options like exercise, braces, and weight loss as well as pharmacological options like acetaminophen, NSAIDs, and corticosteroid injections. Surgical options like joint replacement are considered if conservative treatments fail to control pain and functional limitations. The overall goals of treatment are to reduce pain and disability, improve quality of life, and prevent disease progression.
Cardiovascular disease is a major risk for those with diabetes.
1) Studies like the Framingham Heart Study and UKPDS found diabetes to be a significant risk factor for cardiovascular mortality and events like heart attacks.
2) Having diabetes poses similar risks as having a heart attack, with endothelial dysfunction, dyslipidemia, and other factors increasing cardiovascular risks.
3) Lifestyle changes like diet, exercise, weight loss and optimal control of blood pressure, cholesterol and blood sugars can help prevent premature cardiovascular events for those with diabetes.
Cardiovascular disease is the leading cause of death in patients with chronic kidney disease and those undergoing dialysis. The risk of CVD is increased by traditional risk factors like hypertension, diabetes, dyslipidemia, and smoking, as well as kidney disease-related factors such as anemia, calcium-phosphate metabolism abnormalities, inflammation, and electrolyte imbalances caused by loss of renal function. Patients on dialysis have greatly increased rates of cardiovascular events and mortality compared to the general population. Common cardiovascular problems in dialysis patients include sudden cardiac death, ischemic heart disease, arrhythmias like atrial fibrillation, valvular heart disease, congestive heart failure, stroke, and peripheral vascular disease.
This document discusses recent advances in acute kidney injury (AKI). It summarizes that novel biomarkers like cystatin C and NGAL are being studied to detect AKI earlier than serum creatinine. Intravenous fluids are beneficial for preventing contrast-induced AKI while N-acetylcysteine is less established. Diuretics help treat acute decompensated heart failure. Combination therapy with midodrine, octreotide, and albumin provides an alternative to terlipressin for hepatorenal syndrome. Fluid resuscitation in AKI patients requires caution, as overly aggressive use increases mortality risk. AKI may increase risk of chronic kidney disease, so monitoring patients with a history of AKI is important
Vns Therapy™ System For Weikong For Printcalaf0618
The document discusses VNS Therapy, a treatment for epilepsy patients who have difficulty controlling seizures through medications alone. It provides information on:
- How VNS Therapy works by electrically stimulating the vagus nerve to impact brain regions involved in seizure activity.
- Clinical evidence that VNS Therapy can significantly reduce seizure frequency in refractory epilepsy patients and improve quality of life factors like mood and alertness.
- Safety data showing the risks of VNS Therapy are low, with most side effects being mild and transient.
- High patient and clinician satisfaction rates with VNS Therapy as an effective alternative or addition to medications for difficult-to-treat epilepsy.
- Contrast-induced acute kidney injury (CI-AKI) is a common cause of hospital-acquired acute kidney injury and is caused by the vasoconstrictive effects of iodinated contrast media during imaging procedures.
- The risk of CI-AKI increases significantly with reduced kidney function and other risk factors such as diabetes, dehydration, and older age. Proper hydration helps prevent CI-AKI by increasing renal blood flow and diluting the contrast in the kidneys.
- While IV hydration with crystalloids remains the most effective preventive measure, the optimal hydration protocol has not been firmly established.
This document summarizes strategies for improving outcomes in ICU patients receiving sedation, including:
1) Using analgesia-first sedation and targeting light sedation to minimize risks of oversedation like longer duration of mechanical ventilation.
2) Regularly assessing sedation levels and pain to guide treatment. Non-benzodiazepine sedatives like dexmedetomidine may reduce risks of delirium.
3) Daily sedation interruption or awakening trials combined with early mobility can decrease duration of mechanical ventilation and length of stay.
A 69-year-old man with a history of congestive heart failure, diabetes, hypertension, and coronary artery disease is prescribed digoxin for symptomatic relief of worsening heart failure despite maximal medical therapy. Digoxin increases cardiac output in failing hearts by increasing stroke volume. It decreases sympathetic tone and increases vagal activity. Side effects include arrhythmias, nausea, and toxicity at high levels.
This document provides an overview of positive inotropic agents used to treat heart failure. It defines cardiac glycosides like digoxin, which increase the force of myocardial contraction. It also discusses phosphodiesterase inhibitors like milrinone which have positive inotropic and vasodilating effects. Side effects and nursing implications of these drugs are outlined.
Acute kidney injury (AKI) is common after surgery and associated with increased mortality and long-term renal dysfunction. Major surgery can lead to AKI through hypotension, blood loss, inflammation, and use of nephrotoxic substances. Identifying at-risk patients preoperatively and maintaining adequate perfusion and cardiac output intraoperatively through fluid management and treatment of hypotension may help prevent postoperative AKI. Ongoing studies aim to determine optimal fluid strategies, but current evidence suggests avoiding starch and maintaining hemodynamic targets with balanced fluids and vasopressors.
Perinatal asphyxia and hypoxic-ischemic encephalopathy (HIE) result from inadequate oxygen delivery to the brain near birth, leading to compromised brain metabolism. The main causes are failure to initiate or maintain breathing at birth, or impaired blood gas exchange. This can cause hypoxemia, ischemia, and ultimately neuronal cell death through mechanisms like excitotoxicity, oxidative stress, inflammation, and apoptosis. HIE is a major cause of neonatal mortality and morbidity in Kenya, with over 30% of neonatal deaths attributed to birth asphyxia and HIE. Risk factors include preeclampsia, abnormal heart rate during labor, meconium staining, and operative deliveries.
ICN VIctoria: John Botha on Critical Care Renal FailureGerard Fennessy
Professor John Botha from Frankston Hospital in Melbourne talks at the April 2014 Victorian Intensive Care Network meeting on Renal Failure in Critical Care
HTN among ESRD patients Current ReviewJAFAR ALSAID
This document discusses hypertension among patients with end-stage renal disease (ESRD) who receive dialysis. It defines key terms like chronic kidney disease (CKD) and ESRD. It then examines the epidemiology of hypertension in dialysis patients, challenges in measuring their blood pressure, and strategies for management. Home blood pressure monitoring is recommended over measurements just before or after dialysis, as home readings better predict health outcomes. Ambulatory blood pressure monitoring for 44 hours between dialysis sessions is also discussed as the gold standard for evaluation.
This document discusses the relationship between kidney disease and cardiovascular disease. It notes that chronic kidney disease (CKD) is an independent risk factor for mortality in patients with coronary artery disease. Even mild elevations in creatinine are associated with increased risk of cardiovascular events. Acute kidney injury, including contrast-induced nephropathy (CIN), is the third leading cause of in-hospital acute renal failure. CIN risk increases with factors like diabetes, older age, decreased kidney function, and higher contrast volume. CIN is linked to worse clinical outcomes like longer hospital stays, increased mortality, and progression to chronic kidney disease. Prevention strategies aim to reduce CIN risk through measures like hydration and medications like sodium bicar
The document provides biographical and credential information for Dr. Martin Siegfried, including his medical education, specialties in cardiovascular disease, and interests. It then covers various topics related to atrial fibrillation including post-operative AF, prevention strategies, associations with obstructive sleep apnea and hyperthyroidism, and considerations for anticoagulation in elderly patients with fall risk.
The document is a clinical practice guideline for acute kidney injury (AKI) published by Kidney Disease: Improving Global Outcomes (KDIGO) in 2012. It contains recommendations on defining and classifying AKI, evaluating patients at risk, preventing AKI, treating AKI with renal replacement therapy, and managing specific causes of AKI like contrast-induced nephropathy. The guideline includes sections on introduction and methodology, definition of AKI, prevention and general treatment of AKI, contrast-induced AKI, and dialysis interventions. It provides tables summarizing recommendation statements and clinical practice recommendations supported by evidence reviews.
1. Radiocontrast agents, also known as contrast media, are substances used to improve the visibility of internal organs and structures during medical imaging. The most common types are iodine-based agents used for computed tomography and angiography, and gadolinium-based agents used for magnetic resonance imaging.
2. Contrast-induced nephropathy (CIN) refers to acute kidney injury caused by radiocontrast agents in patients with underlying renal impairment or risk factors. Preventing CIN involves identifying at-risk patients, minimizing contrast volume, using iso-osmolar or low-osmolar agents, intravenous hydration before and after exposure, and holding nephrotoxic drugs like metformin.
3
This document provides guidelines for the prevention and management of perioperative stroke. It begins with definitions of perioperative stroke and outlines contents to be covered. These include preoperative, intraoperative, and postoperative sections. In the preoperative section, it discusses evaluation and risk factors, timing of surgery after stroke, anticoagulant management, and use of beta-blockers and statins. The intraoperative section addresses anesthetic techniques, blood pressure control, ventilation, hemorrhage management, glycemic control, and beta-blockade. The postoperative section focuses on the need for a coordinated team approach and protocols for rapid assessment and intervention. It provides mortality rates for perioperative stroke and reviews studies on various prevention strategies discussed in the
Cardio renal care-An integated best Practice Approchdrucsamal
This document provides information about a continuing medical education (CME) activity on cardio-renal syndromes (CRS). It begins with a declaration of disclosure stating the National Kidney Foundation's policy to ensure independence and manage any conflicts of interest among activity planners and faculty. The document then outlines the learning objectives, agenda, and pre-program questions. It also includes an overview of CRS, defining the different subtypes and discussing the bidirectional relationship between cardiac and renal dysfunction. Two case studies are presented to illustrate examples of acute cardiorenal syndrome type 1 and acute renocardiac syndrome type 3.
This document provides an overview of osteoarthritis (OA), including its definition, risk factors, clinical features, diagnosis, treatment options, and management goals. OA results from cartilage failure induced by genetic and biomechanical factors. It is diagnosed based on symptoms like pain and stiffness, along with physical exam findings and radiographic evidence. Treatment includes non-pharmacological options like exercise, braces, and weight loss as well as pharmacological options like acetaminophen, NSAIDs, and corticosteroid injections. Surgical options like joint replacement are considered if conservative treatments fail to control pain and functional limitations. The overall goals of treatment are to reduce pain and disability, improve quality of life, and prevent disease progression.
Cardiovascular disease is a major risk for those with diabetes.
1) Studies like the Framingham Heart Study and UKPDS found diabetes to be a significant risk factor for cardiovascular mortality and events like heart attacks.
2) Having diabetes poses similar risks as having a heart attack, with endothelial dysfunction, dyslipidemia, and other factors increasing cardiovascular risks.
3) Lifestyle changes like diet, exercise, weight loss and optimal control of blood pressure, cholesterol and blood sugars can help prevent premature cardiovascular events for those with diabetes.
Cardiovascular disease is the leading cause of death in patients with chronic kidney disease and those undergoing dialysis. The risk of CVD is increased by traditional risk factors like hypertension, diabetes, dyslipidemia, and smoking, as well as kidney disease-related factors such as anemia, calcium-phosphate metabolism abnormalities, inflammation, and electrolyte imbalances caused by loss of renal function. Patients on dialysis have greatly increased rates of cardiovascular events and mortality compared to the general population. Common cardiovascular problems in dialysis patients include sudden cardiac death, ischemic heart disease, arrhythmias like atrial fibrillation, valvular heart disease, congestive heart failure, stroke, and peripheral vascular disease.
This document discusses recent advances in acute kidney injury (AKI). It summarizes that novel biomarkers like cystatin C and NGAL are being studied to detect AKI earlier than serum creatinine. Intravenous fluids are beneficial for preventing contrast-induced AKI while N-acetylcysteine is less established. Diuretics help treat acute decompensated heart failure. Combination therapy with midodrine, octreotide, and albumin provides an alternative to terlipressin for hepatorenal syndrome. Fluid resuscitation in AKI patients requires caution, as overly aggressive use increases mortality risk. AKI may increase risk of chronic kidney disease, so monitoring patients with a history of AKI is important
Vns Therapy™ System For Weikong For Printcalaf0618
The document discusses VNS Therapy, a treatment for epilepsy patients who have difficulty controlling seizures through medications alone. It provides information on:
- How VNS Therapy works by electrically stimulating the vagus nerve to impact brain regions involved in seizure activity.
- Clinical evidence that VNS Therapy can significantly reduce seizure frequency in refractory epilepsy patients and improve quality of life factors like mood and alertness.
- Safety data showing the risks of VNS Therapy are low, with most side effects being mild and transient.
- High patient and clinician satisfaction rates with VNS Therapy as an effective alternative or addition to medications for difficult-to-treat epilepsy.
- Contrast-induced acute kidney injury (CI-AKI) is a common cause of hospital-acquired acute kidney injury and is caused by the vasoconstrictive effects of iodinated contrast media during imaging procedures.
- The risk of CI-AKI increases significantly with reduced kidney function and other risk factors such as diabetes, dehydration, and older age. Proper hydration helps prevent CI-AKI by increasing renal blood flow and diluting the contrast in the kidneys.
- While IV hydration with crystalloids remains the most effective preventive measure, the optimal hydration protocol has not been firmly established.
This document summarizes strategies for improving outcomes in ICU patients receiving sedation, including:
1) Using analgesia-first sedation and targeting light sedation to minimize risks of oversedation like longer duration of mechanical ventilation.
2) Regularly assessing sedation levels and pain to guide treatment. Non-benzodiazepine sedatives like dexmedetomidine may reduce risks of delirium.
3) Daily sedation interruption or awakening trials combined with early mobility can decrease duration of mechanical ventilation and length of stay.
A 69-year-old man with a history of congestive heart failure, diabetes, hypertension, and coronary artery disease is prescribed digoxin for symptomatic relief of worsening heart failure despite maximal medical therapy. Digoxin increases cardiac output in failing hearts by increasing stroke volume. It decreases sympathetic tone and increases vagal activity. Side effects include arrhythmias, nausea, and toxicity at high levels.
This document provides an overview of positive inotropic agents used to treat heart failure. It defines cardiac glycosides like digoxin, which increase the force of myocardial contraction. It also discusses phosphodiesterase inhibitors like milrinone which have positive inotropic and vasodilating effects. Side effects and nursing implications of these drugs are outlined.
The document discusses guidelines for blood pressure targets in patients with chronic kidney disease (CKD) and diabetes from several major organizations. The KDIGO guidelines recommend a target of ≤140/90 mmHg for non-diabetic CKD patients if normoalbuminuric, and ≤130/80 mmHg if microalbuminuric or macroalbuminuric. For diabetic CKD patients the targets are ≤140/90 mmHg if normoalbuminuric and ≤130/80 mmHg if microalbuminuric or macroalbuminuric. The document also discusses pharmacological treatments including ACE inhibitors, ARBs, diuretics, calcium channel blockers, and beta blockers.
Chronic Kidney Disease: An Update (Part II) provides information on:
1. The pathophysiology, signs and symptoms, disease progression, and treatment interventions for chronic kidney disease.
2. Treatment strategies for chronic kidney disease including screening for risk factors, slowing disease progression through treatment of comorbid conditions, and preparing for renal replacement therapies like dialysis and transplant as kidney function declines.
3. The role of controlling cardiovascular risk factors like blood pressure, cholesterol, and blood sugar in treating chronic kidney disease and preventing associated complications like cardiovascular disease. Intensive treatment can help slow kidney disease progression.
This document provides information on ischemic heart disease (IHD), also known as coronary artery disease (CAD). It defines IHD as a condition caused by atherosclerosis of the coronary arteries, leading to inadequate blood flow to the heart muscle. Risk factors include dyslipidemia, family history, smoking, hypertension, diabetes, age, and obesity. The management of IHD involves identifying risk factors, lifestyle modifications, medical treatments like nitrates, beta-blockers, and calcium channel blockers, and possible revascularization procedures.
Role of beta blockers in the management of cardiovascular diseasesPHAM HUU THAI
Beta-blockers play an important role in the management of cardiovascular diseases by reducing sympathetic nervous system activation, balancing myocardial oxygen supply and demand, increasing the threshold for ventricular fibrillation during ischemia, and reducing myocardial oxygen consumption. They are indicated for hypertension, ischemic heart disease, arrhythmias, congestive heart failure, and other conditions. Studies show beta-blockers reduce mortality and cardiovascular events in heart failure and post-myocardial infarction more than other drug classes.
This document discusses hypertension (high blood pressure), including its definition, global prevalence, classification, risk factors, complications, treatment recommendations, and prevention strategies. Some key points include:
- The global prevalence of hypertension was estimated to be 26.4% in 2000 and is expected to exceed 30% by 2025.
- Hypertension is classified into stages based on systolic and diastolic blood pressure readings, ranging from normal to severe.
- Risk factors include age, family history, obesity, diet, smoking, and physical inactivity.
- Complications can include damage to the heart, blood vessels, brain, kidneys, and other organs if left untreated.
- Treatment involves lifestyle changes and may require
This document summarizes a symposium on heart failure held on January 23rd, 2013 sponsored by Servier Laboratories. The full-day programme consisted of two sessions with multiple speakers covering topics such as the epidemiology, diagnosis, and management of acute and chronic heart failure. New diagnostic tools and treatments discussed include biomarkers like galectin-3 and BNP, cardiac imaging modalities, device therapies, and novel drugs in development. Prognostic factors and approaches to integrated end-of-life care in heart failure were also addressed.
M. Shareef, a 65-year-old male with diabetes and coronary artery disease, presented with chest pain, breathlessness, fever and vomiting for 6 hours. He was admitted to the ICU where an ECG showed signs of a myocardial infarction. His treatment included aspirin, clopidogrel, streptokinase, morphine and metoclopramide. As a known diabetic and heart disease patient, he requires lifestyle modifications and optimized medical management to control his risk factors and prevent further cardiac complications.
M. Shareef, a 65-year-old male with diabetes and coronary artery disease, presented with chest pain, breathlessness, fever and vomiting for 6 hours. He was admitted to the ICU where an ECG showed signs of a myocardial infarction. His treatment included aspirin, clopidogrel, streptokinase, morphine and metoclopramide. As a known diabetic and heart disease patient, he requires lifestyle modifications and optimized medical management to control his risk factors and prevent further cardiac complications.
The document discusses renal supportive care and symptom management in patients with chronic kidney disease (CKD). It begins by outlining learning objectives and providing an overview of CKD classification and epidemiology. It then discusses common symptoms experienced by CKD patients like pain, fatigue, lack of appetite and itching. Non-pharmacological and pharmacological approaches for managing several symptoms are presented, including approaches for pain, itching, restless leg syndrome and nausea/vomiting. The document emphasizes the importance of comprehensive symptom assessment and control in improving quality of life for CKD patients.
Join live classes, download study aids, sell your documents, join or host your own classes online, get tutoring, tutor students, take practices tests and more at Examville.com
The document provides an overview of various cardiac medications, including their classifications, mechanisms of action, indications, and dosages. It focuses on inotropes like digoxin, chronotropes like atropine, antianginal drugs like nitroglycerin, antidysrhythmics/antiarrhythmics in the four main classes, and discusses specific drugs like quinidine, lidocaine, and flecainide. It includes questions and answers related to calculating digoxin doses and identifying positive inotropes and the preferred route for nitroglycerin during angina attacks.
The document provides an overview of various cardiac medications, including their classifications, mechanisms of action, indications, and dosages. It focuses on inotropes like digoxin, chronotropes like atropine, antianginal drugs like nitroglycerin, antidysrhythmics/antiarrhythmics in the four main classes, and discusses specific drugs like quinidine, lidocaine, and flecainide. It includes examples of classroom participation questions and answers about calculating digoxin doses and the preferred route for nitroglycerin during angina attacks.
The document provides information on the management of heart failure in 2014. It discusses two cases of patients with heart failure. The first case involves a 69-year-old man (RS) with reduced ejection fraction and multiple hospital admissions who is treated with a biventricular pacemaker and optimization of medications, resulting in improved symptoms and ejection fraction. The second case discusses a 67-year-old man (ED) admitted with breathlessness who is found to have reduced ejection fraction and severe aortic stenosis, and is treated with diuretics, beta-blockers, and ACE inhibitors along with lifestyle counseling.
The document discusses congestive heart failure (CHF), including its pathophysiology, recent advances in management, and therapeutic approaches. It describes how CHF results from the heart's inability to pump enough blood to meet the body's needs. Over time, compensatory mechanisms like increased neurohormonal activity can damage the heart further. Treatment aims to alleviate symptoms, improve quality of life, and decrease mortality through a combination of lifestyle changes, medications, and devices.
Debbie's Cardiac Meds Presentation Final Nnguestf41297
This document provides an overview of various classes of cardiac medications, including their mechanisms of action, indications, dosages, and side effects. It discusses inotropes, chronotropes, antianginal agents, antiarrhythmics, beta blockers, and calcium channel blockers. For each drug class or prototype drug, key details are provided about how it works, what it is used to treat, typical dosing, monitoring parameters, and potential adverse effects. The document also includes several class participation questions to test understanding.
1. Congestive cardiac failure (CCF) occurs when the heart cannot pump enough blood to meet the body's needs due to conditions like coronary artery disease, hypertension, or cardiomyopathy.
2. Treatment depends on the cause, severity, and patient's health, and may include medications, surgery, or lifestyle changes. Common medications include diuretics, ACE inhibitors, beta blockers, and cardiac glycosides like digoxin.
3. Surgery such as valve replacement or angioplasty may be used in some cases. Lifestyle modifications involve reducing sodium and fluid intake, exercising mildly, and taking diuretics as prescribed. Current clinical trials are investigating new treatments and comparing existing medications.
Anti anginal drugs, uses, mechanism of action, adverse effectsKarun Kumar
A presentation outlining the causes of angina, mechanism of action of various anti-anginal drugs, their uses and side effects alongwith contraindications
This document provides an overview of diabetes insipidus (DI), including defining the condition as a deficiency of antidiuretic hormone resulting in excessive thirst and urine production. It discusses the objectives of teaching about DI, risk factors, types of DI, clinical manifestations involving polyuria and polydipsia, pathophysiology of increased serum osmolality, assessment, management involving vasopressin replacement and fluid conservation, nursing management, monitoring, self-care, and references research studies on DI.
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1. C O N G E S T I V E H E A R T
F A I L U R E , C A R D I O M Y O P A T H Y ,
V A L V E D I S E A S E
P H A R M A C O L O G Y I N T E R V E N T I O N S
2. Heart Failure Therapeutics
• ACE Inhibitors
• Angiotensin Receptor
• Beta Blockers
• Nitrates
• Loop Diuretic
• Thiazide Diuretic
• Potassium Sparing Diuretic
• Narcotic Analgesic
• Human B-type Natriuretic Peptide
(vasodilator)
• Angiotensin receptor
Blocker/Neprilysin
Inhibitor
• HCN Channel Blocker
• Inotropic Medications
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
3. ACE
Inhibitors:
Mechanism
of Action
Low blood volume, low sodium and high potassium-
Causes release of RENIN from kidneys-
Renin cleaves angiotensinogen (from liver) to form
angiotensin I-
Enzyme ACE converts angiotensin I to angiotensin II-
Results in blood vessel constriction and increase in BP
Also causes release of Aldosterone which causes water
and salt reabsorption-
increase blood volume and BP
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
4. ACE Inhibitor Action
Decreases
angiotensin II in
kidneys, heart, blood
vessels, brain, and
adrenals. This causes
vasodilatation lowering
blood pressure
Blocks the breakdown of
bradykinin which also leads to
vasodilatation (may cause
cough)
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
5. Therapeutic
Effect Pearl
ACE inhibitors block
production of angiotensin II
thus causing
blood vessel dilatation,
increases sodium and water
excretion,
decrease cardiac output
(CO), stroke work and stroke
volume (SV).
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
6. Benefits (and cautions) of ACE Inhibitors in
Congestive Heart Failure
Improve symptoms, clinical status,
and exercise capacity.
Improves cardiac function.
Reduces hospitalizations.
Attenuates remodeling.
Prolongs survival.
Reduces vascular events.
Can be used to treat Hypertension
and MI.
Avoid salt substitutes
Cautions
African Americans and older adults don’t
respond well and should be treated along
with a diuretic.
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
7. Common Ace Inhibitors
Enala pril (enalapril)
Capto pril (captopril)
Rami pril (ramipril)
Lisino pril (Lisinopril)
Other ACE Inhibitors:
Fosinopril
Benazepril
Quinapril
Moexepril
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
8. Side Effects
Dry
persistent
cough
Dizziness
Fatigue Hypotension
Chest pain Anorexia
Diarrhea Hyperkalemia
• Renal insufficiency
• Proteinuria
• Skin rashes
• Hyperglycemia
• Angioedema
• Monitor for Steven
Johnson Syndrome
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
9. Nursing Implications
Monitoring
BP
Renal Function
Blood Glucose
Assess urine for protein
Teaching
Change positions slowly
Avoid OTC cold medicines
Teach patient to monitor BP
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
10. Angiotensin
Receptor Blocker
(ARB)
• Candesar tan (candesartan)
• Losar tan (losartan)
• Valsar tan (valsartan)
Blocks release of aldosterone. ARB’s block angiotensin II causing vasodilation.
Used to treat hypertension and heart failure. ACEI usually first choice
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
11. Adverse Side Effects and Nursing Implications
Adverse Side
Effects
Hyperkalemia
Renal insufficiency
Hypotension
Nursing Implications
Monitor vital signs and labs
Teach patient to change
positions slowly.
Monitor for difficulty
swallowing
Teach patient about alcohol
consumption and drop in
BP.
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
12. Beta Blockers
Action/ Therapeutic Effect:
Beta Blockers reduce cardiac output by
diminishing the sympathetic nervous
system.
Continued use leads to decreased
vascular resistance and lower BP.
Can improve survival by as
much as 35%
Metopro lol (metoprolol)
Ateno lol (atenolol)
Carvedi lol (carvedilol)
Sota lol (Sotalol)
Bisopro lol ( bisoprolol)
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
13. Adverse Side Effects and Nursing Implications
Adverse side effects
Decreased heart rate
Decreased Blood Pressure
Dizziness
Fatigue
Elevated LFT’s
May cause heart failure
Nursing Implications:
DO NOT initiate in the
patient with heart failure
who is acutely
decompensating.
monitor vital signs
monitor EKG
input/output
weights
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
14. Loop Diuretics Action/Therapeutic Effects
Inhibits reabsorption of Na and Cl in the
Loop of Henley resulting in excretion of
Na, K, Cl, and water by the kidney. The
effects are decreased preload,
decreased fluid retention.
Furosemide
Bumetanide
Torsemide
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
15. Adverse Side Effects
Diarrhea, cramps
Ototoxicity
Renal
Insufficiency
Steven Johnson
Syndrome
Hypokalemia
Hyponatremia
Decreased Magnesium
Diuresis can cause hypovolemia
and hypotension and GI upset.
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
16. Nursing
Implications
Monitor BP,
input/output, and daily
weights.
Monitor electrolytes.
Monitor for signs and
symptoms of
dehydration.
Assess for hearing loss
(administer slow IV
push).
Take medication in
morning. Change
positions slowly
Take with food. Licorice
may increase
potassium (K) loss.
Loop Diuretics
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
17. Thiazide Diuretics Action/Therapeutic
Effects
Works in the distal tubules to
promote diuresis.
Decreases pre-load and after
load.
Increases urine output to treat heart
failure, edema, and hypertension.
Hydrochlorothiazide
Metollazone
Chlorothiazide
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
19. Nursing
Implication
s
Monitor electrolytes, cholesterol, and
blood sugar.
Interacts with digoxin.
Causes hypokalemia which potentiates
the action of digoxin.
Take this medication in the morning.
Take this medication with food to avoid
GI upset.
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
20. P O T A S S I U M
S P A R I N G
D I U R E T I C
S P I R O N O L A C T O N E
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
21. Action/Therapeutic
Effects.
Blocks myocardial and
vascular fibrosis , coronary
inflammation, hypertrophy.
Interferes with renin
system.
Increases urine excretion
of Na and decreases K
excretion.
Not a great effect of
diuresis.
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
22. Nursing Implications
Caution
Caution in
administering with
an ACE inhibitor.
Monitor
Monitor
electrolytes.
Take
Take medication
in the morning.
Avoid
Avoid sun
exposure.
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
23. Nitrates
Nitroglycerin
IV(Tridil)
Nitroglycerin
patch.
Nitroglycerin
paste.
Action/Therapeutic
Effects
Coronary and peripheral vasodilation.
Decreases preload and afterload.
Used to treat hypertension and increas
cardiac output.
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
25. Nursing
Implications Nitroglycerin
patch:
Nitroglycerin
Paste:
o Place patch on
in the morning
and remove in
the evening
o Ordered in
inches. Applied
to chest wall.
o Wear gloves
when applying.
IV Infusion bottle (Tridil)
can be in NS or D5W.
IV medication must be
on IV pump.
Must be on a cardiac
monitor
Titrate dose until
desired outcome.
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
27. Action/Therapeutic
Effects
• Increases force of myocardial
contraction.
• Decreases conduction through the
SA and AV node
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
28. Nursing Implications
Teach patient to
monitor heart rate.
Monitor for s/s of
digoxin toxicity
• Vision changes
• Nausea and vomiting
• Bradycardia
• Monitor digoxin levels. Digoxin
levels reserved for change in renal
function, drug interactions,
confirmation of toxicity (not for
titration).
• Do not take digoxin within 1 hour of
ingesting an antacid.
• Medication can be given IVP or po
30. Milrinone
Enhances entrance of calcium into cells to increase contractility
Adverse/Side Effects
Hypotension
Atrial fibrillation
Hypokalemia
Headache
Nursing Implications
Monitor vital signs
Monitor electrocardiogram and labs
Administer medications through IV on a
pump.
Not compatible with Lasix IV.
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
31. Narcotic Analgesic
Morphine Sulfate
Mechanism of Action:
Increases venous pooling to decrease preload. Decreases pain and
anxiety. Decreases work of breathing.
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
32. Adverse /Side
Effects
• Confusion
• Dizziness
• Constipation
• Hypotension
• Nausea and Vomiting
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
Morphine Sulfate
33. Nursing Implications
Assess level of
consciousness.
1
Assess vital signs
prior to
administration.
2
Monitor patient for
respiratory
depression.
3
Titrate dose to
patients’ response.
4
Have Narcan
available to
reverse respiratory
depression
5
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
34. Human B-type
Natriuretic Peptide
(Vasodilator)
Action/Therapeutic
effect
• Used to reduce dyspnea at rest or
with minimal activity in patients with
acute decompensated heart failure.
• Reduces percutaneous wedge
pressures (PCWP) and systemic
arterial pressure thereby decreasing
the heart’s work-load and relieving
dyspnea.
• Relaxes smooth muscle and causes
vasodilation.
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
35. Human B-type Natriuretic Peptide (Vasodilator)
Nursing Interventions:
Do not run medication in same line as bumetanide, enalapril, furosemide or heparin.
Don’t shake the vial of medication.
Monitor vital signs and electrocardiogram, lung sounds, and respirations throughout administration.
Report any changes in assessments from above.
Administer bolus first intravenously followed by continuous drip.
Weight based protocol.
Evaluation is based on improvement of dyspnea.
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
36. Valsartan/Sacubitril
• Blocks Angiotensin II
• Neprilysis inhibitor increases
availability of natriuretic peptides.
• Helps bradykinin achieve
vasodilation.
• Excretion of sodium helps lower BP.
• Used for patients in heart failure to
reduce the risk of hospitalization.
• Patients with low EVF benefit most.
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
37. Angiotensin Receptor Blocker/ Neprilysin Blocker
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
38. Valsartan/Sacubitril
Adverse/Side Effects
Hypotension
Renal failure
Hyperkalemia
Angioedema
Dizziness
Nursing Interventions
Change positions slowly.
Monitor BUN/CR.
Do not take if history of
angioedema.
Do not take Entresto for at least 36
hrs. before or after you take an
ACE inhibitor.
Recommended starting dose 49-
51mg orally twice daily and titrate
to 97-103mg in 2-4 weeks.
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
39. HCN Channel Blocker
Ivabradine
Action/Therapeutic Effects
Slows the heart rate by inhibiting a specific channel in the SA node.
Used for heart failure patients who have an ejection fraction <35% who is in
sinus rhythm with resting heart rate of >70 bpm.
Used for patients who are either on the maximally tolerated dose of beta
blocker therapy or have contraindication to it.
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
40. Ivabradine
• Bradycardia
• Dizziness
• Hypertension
• Atrial Fibrillation
• Visual Brightness
• Fetal Toxicity
Adverse/Side Effects:
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
41. • Nursing Implications:
• Contraindicated in patients with:
• Hypotension
• Sick sinus syndrome
• Pacemaker dependence
• Third degree heart block
• Hepatic impairment
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)
42. Nursing Implications
Take medication with
meals.
Avoid St. John’s wart
Avoid grapefruit
juice.
Teach patient to
check radial pulse.
Starting dose is 5mg,
can titrate up to
7.5mg with a target
heart rate of 50-60
bpm.
Monitor closely in
patients taking
digoxin or beta
blockers.
JFK Muhlenberg Harold B. and Nancy A. Snyder Schools of Nursing and Medical Imaging (2022)