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PBL CVS, Interactions (DRUG), lead to, deu to, DRUG - Coggle Diagram

- - - - Selective serotonin and norepinephrine reuptake inhibitor antidepressant (SSNRI)
    - - Furosemide
      - FOOD
        
        Alcohol
      - Valsartan
      - Nitro-glycerine
      - Meloxicam
      - ranitidine
  - - - To relieve symptoms of rhinitisfever or other types of allergies
        
        No worrying interaction with other drugs
        
        ADR
        
        diarrhoea
  - - - A short-acting insulin,replacing the insulin that is normally produced by the body,stops the liver from producing more sugar
        
        Intreactions and ADR are the same as Detemir
  - - - (NSAID) that is used to treat pain and inflammation and stiffness of the joins in rheumatic diseases and osteoarthritis
    - - DRUGS
        
        Aspirin
        
        valsartan
        
        Carvedilol
        
        Duloxetine
        
        furosemide
      - FOOD
        
        Alcohol
    - - diarrhea
      - constipation
      - shortness of breath or difficulty breathing
      - unexplained weight gain,
      - swelling in the abdomen, ankles, feet, or legs
  - - - A long-acting insulin,replacing the insulin that is normally produced by the body,stops the liver from producing more sugar
        
        Interactions (DRUG)
        
        Aspirin
        
        Duloxetine
        
        insulin (aspart)
        
        Furosemide
        
        Alcohol
        
        Carvedilol
  - - - Dizziness, hypotension and fatigue being the most common effects from this drug. Less common adverse reactions consist of patients experiencing diarrhea, bradycardia and occurrence of oedema in patient that consumes the same drug.
    - - Rifampin (Rifadin), Cimetidine (Tagamet), cytochrome P450 2D6 isoenzyme inhibitors, insulin, meloxicam
    - - A beta-blocker drug that functions of the drug itself is to inhibit the renin-angiotensin system by non-selective β-blockade and decreases peripheral vascular resistance through selective α1 receptor blockade.
  - - - A powerful diuretic (water pill) that works by preventing sodium, chloride, and water from being absorbed from the filtered fluid in the kidney tubules, resulting in a significant rise in urine output (diuresis).
    - - Contraindications involve patients with anuria or furosemide hypersensitivity. Precautions consist of monitoring blood sugar levels and potassium concentration. Excessive diuresis can cause dehydration and blood volume loss.
    - - Aminoglycoside antibiotics, Ethacrynic acid, nephrotoxic drugs, aspirin, antihypertensive drugs, NSAIDS and acetylsalicylic acid
  - - - Headaches, dizziness, renal impairment, syncope, upper abdomen discomfort
    - - Renin-angiotensin system blockers, potassium-sparing diuretics, lithium, aspirin, NSAIDS, COX-2 inhibitor and meloxicam
    - - Treat hypertension and reduce blood pressure by blocking angiotensin II's binding to AT1 receptors, effectively blocking angiotensin I-induced vasoconstriction, aldosterone and catecholamine secretion, arginine vasopressin release, water intake, and hypertrophic responses.
  - - - Nitroglycerins are used to reduce chest discomfort (angina) in patients with a certain cardiac ailment, and they help relax and dilate blood vessels to improve blood flow to the heart.
    - - Bloating
      - Rapid weight gain
      - Tightness in the chain
      - Nausea or vomiting
    - - Aspirin, duloxetine, furosemide, valsartan, meloxicam,
- - - - Scar tissue > heart can't pump blood effectively
        
        Worsen the heart condition
  - - - CHF prevalence increase with age
  - - - Low estrogen
        
        Increase heart disease
- - - - Weak myocardium > blood often backs up and fluid can build up in the lungs > DYSPNEA
      - Weak myocardium > low blood supply to the lungs > instability in gas exchange > DYSPNEA
  - - - Lack of blood flow to the digestive system > bowel issue > nausea/ vomit / diarrhea (HPI)
        
        Current treatment for diarrhea : fiber supplement
        
        softening stools > PREVENT CONSTIPATION
  - - - Congestion, or fluid overload
        
        Leg Swelling (HPI)
      - Peripheral Edema (fluid excess)
        
        COMPENSATORY PHYSIOLOGYCAL RESPONSES
        
        Activation of RAAS
        
        Weak myocardium > less cardiac output > less blood in organ (kidney) > production of renin > angiotensin I > angiotensin II > high aldosterone > FLUID RETENTION (high Na+)
  - - - Pt have been taken for years, we suggest that it causes kidney problems
- - - - 3 forms of CHF
        
        Left Sided
        
        Systolic HF
        
        • Decrease contractility of left ventricle >> decrease CO (due to SV decrease) >> decreased ejection fraction >> during diastole, blood returns + leftover blood >> increase end-diastolic volume & pressure (as increase blood left after each heartbeat)
        
        • There are some volume of blood left in LV
        
        Diastolic HF
        
        • Happens due to impaired ventricular relaxation and filling as the ventricle becomes stiff and myocardium is not compliant
        
        Left heart failure
        
        • Most common cause: Systemic hypertension
        
        pulmonary edema
        
        fluid accumulation in the lungs: pulmonary capillaries have high pressure inside them>> fluid will move out from the pulmonary interstitium >> fluid enter the alveoli >> SOB or dyspnea
        
        Crepitation in the base of the right side of the lung
        
        pink frothy sputum
        
        • Left Ventricle needs to generous more force>> sarcomeres need to increase thickness >> parallelly adding up themselves leading to hypertrophy >> Left Ventricle becomes less compliance >> reducing the filling of ventricle >> Stagnation of blood
        
        Fluid accumulation >> harder for gas exchange >>
        
        Dyspnea
        
        Orthopnea
        
        Paroxysmal nocturnal dyspnea
        
        Extra fluid in lungs >> crackles (rales) on auscultation
        
        Fluid retention good for increasing EDV and contractility but for long term >> pulmonary edema and peripheral edema
        
        Auscultation
        
        CXR of pulmonary edema:
        Base of the right lung contains fluid accumulation
        
        Right Sided
        
        Right heart failure
        
        Main cause: Left heart failure
        Increase pressure in pulmonary artery >> harder for right ventricle to pump blood into it
        
        Portal hypertension (increased in portal vein pressure) can lead to ascites > Portal venous congestion > Hepatosplenomegaly
        
        Blood backs up to body >> congestion in veins of systemic circulation >>
        
        Pitting edema
        
        Congestive hepatopathy
        
        Jugular venous distention
        
        Both Sided (Biventricular)
        
        Combines the symptoms of both left and right heart failure.
      - Define HF
        
        Impaired ability of the heart to adequately fill with and/or eject blood.
      - Define Congestive
        
        Abnormal increases in blood volume and interstitial fluid,
    - - Define Acute Decompensated
        
        New or worsening signs or symptoms, usually caused by volume overload and/or hypoperfusion and lead to the need for additional medical care.
      - Worsening signs
        
        Dyspnea
        
        At rest
        
        Walking (activity)
        
        Lying Flat
        
        Weight Gain
        
        Edema
      - Classify
        
        Classifies patients on the basis of the clinical presence or absence of hypoperfusion (cold vs warm) and of congestion at rest (wet vs dry)
      - The most prevalent causes of HF hospitalization.
        
        worsening of chronic obstructive pulmonary disease with or without pneumonia
        
        Comorbidity
        
        uncontrolled hypertension,
        
        ischemia,
        
        Noncompliance with medications or dietary restrictions,
        
        arrhythmias
- - - - Pitting edema
        
        Excess fluid composed of water
        
        +2 grade shows 3-4 mm of depression, reboudning in 15 sec or less
      - All pulses palpable
        
        Shows throbbing of blood flow
    - - Coronary artery gets blocked
      - Cuts off oxygen-rich blood to heart muscle
      - Body uses more energy to supply blood and cool down itself
      - Hearts difficult to pump
    - - Crackles sound in lungs
        
        Tiny pleural effusions bilaterally
        
        Fine crackling, crunching or creaking sound at end inspirational and early expiration
        
        Heart doesn't pump to body properly
        
        Fluid build up in body and leaks into pleural space
    - - High blood pressure
        
        CHF compensatory mechanisms
      - High respiratory rate
        
        Sensation of shortness of breath
    - - Jugular vein distension
        
        Bulging neck vein