Digitalis Toxicity and Loop Diuretics

Digitalis Toxicity and Loop Diuretics

Loop diuretics: are diuretics that act on the ascending loop of Henle in the kidney.
MAO:
Loop diuretics act on the Na+-K+-2Cl- symporter (cotransporter) in the thick ascending limb of the loop of Henle to inhibit sodium and chloride reabsorption
Examples of loop diuretics:
Furosemide, Bumetanide, Ethacrynic acid, Torsemide

A hypertensive patient taking a loop diuretic has an increased risk of developing electrolyte imbalances, particularly hypokalemia. If your patient also has heart failure and is taking a digitalis glycoside, such as digoxin, and a loop diuretic, he has an increased risk of developing digitalis toxicity.

Be alert for the following signs and symptoms of digitalis toxicity:

1)Abdominal pain,anorexia, nausea, vomiting and diarrhea

2)Atrial or ventricular arrhythmias, heart block, accelerated junctional rhythms, and atrial tachycardia with atrioventricular block.

3)Headache, seizures,restlessness, irritability, depression, personality changes, lethargy, confusion, disorientation, insomnia and psychosis.

4)Blurred vision, flickering lights, white borders around dark objects, and colored dots.

Also, obtain your patient’s baseline serum potassium level and monitor his serum potassium and digitalis levels.

*Obtain the sample at least 8 hours after the last dose, preferably before administering a daily oral maintenance dose.

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Categorization

Categorization: Hypertension in Adults

1. Blood Pressures for Hypertensive Patients
1. Hypertension without Co-morbidity: <140/90
2. Diabetes Mellitus: <130/80
3. Congestive Heart Failure: <130/80
4. Renal Insufficiency: <130/80
5. Renal Failure and >1g Proteinuria/24 hours: <125/75

2. JNC-7 Blood Pressure definitions
1. Optimal Blood Pressure: <115/80
2. Normal Blood Pressure: <120/80
3. Pre-Hypertension: 120-139/80-89
4. Stage 1 Hypertension: 140-159/90-99
5. Stage 2 Hypertension: >160/100
3. Stages eliminated in JNC-7
1. Stage 3 Hypertension: 180-209/110-119
2. Stage 4 Hypertension: >210/120
4. Isolated Systolic Hypertension
1. Systolic Blood Pressure: >140 mmHg
2. Diastolic Blood Pressure: <90 mmHg

Categorization: Hypertension in Adolescents

1. Age 16-18 years
1. Significant Hypertension: BP> 142/92
2. Severe Hypertension: BP> 150/98
2. Age: 13-15 years
1. Significant Hypertension: BP> 136/86
2. Severe Hypertension: BP> 144/92

Categorization: Hypertension in Children

1. Age 10-12 years
1. Significant Hypertension: BP> 126/82
2. Severe Hypertension: BP> 134/90
2. Age 6-9 years
1. Significant Hypertension: BP> 122/78
2. Severe Hypertension: BP> 130/86
3. Age 3-5 years
1. Significant Hypertension: BP> 116/76
2. Severe Hypertension: BP> 124/84

Categorization: Hypertension in Infants (Age <2 years)

1. Significant Hypertension: BP> 112/74
2. Severe Hypertension: BP> 118/82

Categorization: Hypertension in Newborns

1. Age 8-30 days
1. Significant Hypertension: SBP> 104
2. Severe Hypertension: SBP> 110
2. Age <7 day old
1. Significant Hypertension: SBP> 96
2. Severe Hypertension: SBP> 106

Monotherapy Of Hypertension

Monotherapy:

(i). Standard initial monotherapy preferences.
(a). Diuretics such as Hydrochlorothiazide.
* Secondly used diuretic if not possible first.
* Excellent adjunct to other antihypertensives.
* Lisinopril and Amlodipine are less effective so they are better.
*Decrease risk of Cardio vascular arythemia , Myocardial Infarction, Congestive heart failure comparitive to other agents.

(b). Beta Blocker (Propanalol, Atenol etc)
(c). Angiotensin Converting Enzyme Inhibitor (ACE)
(c). Angiotensin Receptor Blocker (ARP)

(ii). Reasons compiling for other antihypertensive
(a). AntiHypertensives for Specific Comorbid Diseases
(b). Antihypertensives for Specific Populations

(iii). Avoid the following agents for monotherapy.
(a). Alpha blockers
(b). Hydralazine
(c). Minoxidil
(d). Calcium Channel Blockers

(iv). Avoid in low compliant patients bcoz of rebound Hypertension.
(a). Beta Blockers
(b). Clonidine

Hypertension "A Silent Killer"

Hypertension rightly said "Silent Killer". A symptomless (almost) but fatal , if not properly controlled or managed, a health problem.One of the most important topic of research medicine is hypertension and heart disease.

Hypertension (high blood pressure): A known highly prevalent risk for heart disease and cardiovascular complications.It is a established increasing longevity and prevalence of contributing factors such as obesity. According to research in medicine proves, proper management of hypertension cause a decline in the cases of cardiovascular disease and increase and enhance the quality and span of life.so, heart disease and hypertension are correlated and important area in research medicine

Hypertension simply increase intravascular pressure, defined as a elevated blood pressure exceeding 140 over 90 mm Hg -- a systolic pressure above 140 with a diastolic pressure above 90.

Etiology of Hypertension:
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1. Pri: – 90-95% of cases – also termed “essential” of “idiopathic”
2. Sec: – about 5% of cases
3. Renal or renovascular disease
4. Endocrine disease
5. Phaeochomocytoma
6. Cusings syndrome
7. Conn’s syndrome
8. Acromegaly and hypothyroidism
9. Coarctation of the aorta
10. Iatrogenic
11. Hormonal / oral contraceptive
12. NSAIDs

Few Investigation of the New Hypertensive:
1. History and examination
2. Exclude secondary Hypertension
3. Urea and electrolytes
4. FBP and ESR
5. ECG
6. Lipid profile
7. Chest x-ray no longer routinely indicated

Management:
Monotherapy and Multi drug therapy.


Monotherapy:

(i). Standard initial monotherapy preferences.
(a). Diuretics such as Hydrochlorothiazide.
* Secondly used diuretic if not possible first.
* Excellent adjunct to other antihypertensives.
* Lisinopril and Amlodipine are less effective so they are better.
*Decrease risk of Cardio vascular arythemia , Myocardial Infarction, Congestive heart failure comparitive to other agents.

(b). Beta Blocker (Propanalol, Atenol etc)
(c). Angiotensin Converting Enzyme Inhibitor (ACE)
(c). Angiotensin Receptor Blocker (ARP)

(ii). Reasons compiling for other antihypertensive
(a). AntiHypertensives for Specific Comorbid Diseases
(b). Antihypertensives for Specific Populations

(iii). Avoid the following agents for monotherapy.
(a). Alpha blockers
(b). Hydralazine
(c). Minoxidil
(d). Calcium Channel Blockers

(iv). Avoid in low compliant patients bcoz of rebound Hypertension.
(a). Beta Blockers
(b). Clonidine

Also Visit : www.researchmedicinestomachulcer.blogspot.com

Stomach ulcer