Beta Blocker

The role of diuretics in heart failure is to reduce the fluid retention by diuresis (1). Patient should be monitored closely to prevent over diuresis that will subsequently lead to hypotension and renal impairment. Diuretic used is commonly associated with hypokalemia (1). Thus, additional potassium needs to be given concurrent to diuretic treatment (1). Patient’s daily weight must be recorded and aimed for reduction of body weight >4.5 kg in 5 days after treatment (7). Angiotensin converting enzyme inhibitor (ACE-I) is a first line agent in treating heart failure, especially when there is evidence of reduced in ejection fraction <40% as it improve survival rate of patient (1). Patient needs to be advised regarding side effects of the drug which are, dry cough, hypotension, renal insufficiency, hyperkalemia and angioedema. Antihypertensive agents that can be given in patient with heart failure are beta blocker, ACE-I and aldosterone antagonist. If the blood pressure is persistently high despite treatment with beta blocker, ACE-I and ARB, calcium channel blocker such as amlodipine can be added as this drugs has negative inotropic effect

The concern regarding the use of anti-hypertensive medication as a treatment procedure for hypertension has mainly been centered on the optimal choice of these agents. The other factors include the side effects of these drugs on a hypertensive patient, especially coughing. While three categories of these drugs are linked with cough as a side effect, they have varying casual explanations though angiotensin-converting enzyme (ACE) inhibitors play a crucial role (Van Amburgh, 2011). The main objective for the use of anti-hypertensives in dialysis patients is to obtain and sustain an optimal blood pressure or lessen it by the least intrusive measures possible. While this is not

Recommendations: 1. Discontinue the standing albuterol, and making it every 6 hours, as needed (prn). 2. STAT electrocardiogram (EKG) to rule out cardiac ideologies. The physician agreed with my recommendations and gave new orders to change the albuterol to as needed and ordered a STAT EKG.

Beta-blockers have been recently reported to decrease mortality in heart failure patients. Mortality and hospitalization rates for patients with the disease are high and continue to rise. Despite the magnitude of the problem, treatment of congestive heart failure is often inadequate. Primary care physicians care for most patients with heart failure. Beta-blocker therapy is appropriate in patients with NYHA class II or class III symptoms resulting from left ventricular systolic dysfunction. Unless contraindicated, beta-blockers should be considered a mainstay of therapy in these patients to improve symptoms and mortality and to decrease hospitalizations. Beta-blockers should not be administered to patients with heart failure who have bradycardia, heart block or hemodynamic instability.

Varying patients may present to their clinician or the emergency department for treatment with heart failure. It is important to understand that there is more than one type of heart failure; primarily the focus is placed on diastolic heart failure and systolic heart failure. Depending upon the cause of heart failure and what areas are affected dictates the treatment plan needed. While there are similarities with both kinds of heart failure, there are also differences that can help the clinician distinguish the diagnosis needed to fit the patient. Once a diagnosis is made the clinician can move forward in determining if the patient is at risk for use of diuretics and then look towards prescribing ACEIs, ARBs, and beta-blockers.

Pharmacological treatments with diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or aldosterone antagonist, and beta-blockers are essential for the treatment of heart failure and are effective in improving symptoms of heart failure and patient well-being. Diuretics are administered to help get rid of the excess fluid that helps improve breathing associated with shortness of breath, at rest or on exertion. Diuretics provide relief from symptoms and signs of pulmonary and venous congestion by promotion of fluid loss through the kidneys. Diuretics, for example, Furosemide helps improve breathing status, but monitoring patients for dehydration and kidney problems is crucial. Patient education is essential to ensuring medication adherence and early identification of adverse effects and potential for drug interactions.

The algorithm begins with an indication that is used for adults over the age of 18 and noted that lifestyle interventions should be continued throughout management. Goal blood pressures are separated by age and presence of chronic disease. The goal for patients over 60 is SBP < 150 mmHg and DBP < 90 mmHg. The goal for patients under 60 is < 140 mmHg and DBP < 90 mmHg. Different goal values are presented for patients with chronic conditions. Treatment with medication is categorized by: general population nonblack, general population black, chronic conditions black, and chronic condition all races. Based on the algorithm black patients should only be prescribed thiazide type diuretics and/or calcium channel blockers. While non-black patients can take all of the medications listed in JNC 8 (thiazide type diuretics, ACEI, ARB, and/or CCB). If patient does not reach goal blood pressure then three strategies are listed, along with lifestyle adherence. The algorithm also explains not to use ACEI and ARB together. The final option for patients not at goal blood pressure includes additional medications and/or referral to physician with an expertise in hypertension

The study shows that disease-modifying medications were prescribed significantly more often in 2000 than in 1995, particularly in patients younger than 65 and in those aged 75 to 84 (Saczynski et al., 2009, p. 3). The study indicates that Beta-blockers and ACE inhibitors have been shown to improve survival and reduce hospitalizations in patients with Heart Failure. The second article mentioned about the elderly patients who have CHF not on or under dosage of Angiotensin Converting Enzyme (ACE) inhibitors. According to this article ACE inhibitors should be given for patients diagnosed asymptomatic left ventricular systolic dysfunction (LVSD) (EF<40%) and symptomatic heart failure with systolic dysfunction associated with other heart problems such as myocardial infarction, pulmonary hypertension. The suggested dosage for the CHF patients mentioned in the article and due to age-related changes in pharmacokinetic drugs, it also recommended the initial dosage must be half the standard dose and gradual increase after assessing renal function. After studying a group of elderly CHF patients revealed that higher or standard dose of ACE inhibitors reduce the risks of major clinical events. Results from the research display a decrease of hospitalizations due to cardiovascular reason, heart failure, and ischemic events in the standard-dose group. The study also found out that the adverse effects of high doses can be managed by reducing the dosage or by changing

Beta blockers, also known as beta-adrenergic blocking agents, are medications that reduce your blood pressure. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. When you take beta blockers, your heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels open up to improve blood flow. Examples of Beta Blocker include; Metoprolol (Lopressor), Atenolol (Tenormin) and Carvedilol (Coreg).

Beta Blockers are known as a medicine that used to treat a person who has a blood pressure. By blocking the effect of adrenaline and noradrenaline, this drug can lower blood pressure, slow down the heart rate and lessen the force of the blood impelled in the body. While taking this drug, it requires to check the pulse daily and when it is slower than it was supposed to be, ask the doctor if the medication needs to take that day. Sometimes, the beta blocker doesn’t work right while the person is also using another drug. The person who is taking this medication should avoid caffeine and alcohol and for those whom this drug may not work with them are older people and people with asthma, for those who has a low blood pressure, and person who has

For years health care providers have been using drugs like beta blockers or ACE inhibitors to treat patients with heart failure, but with cardiovascular disease still being a leading cause of death, it is evident that current treatments have been lacking the ability to produce adequate results. However, with the newest heart failure drug on the market a positive change has finally come for heart failure patients. The new heart failure drug reigns far more superior when compared to the treatments healthcare professionals already use and can potentially alter the foundation of heart failure treatments altogether.

| Ensuring therapeutic effects:Continue frequent assessments as described earlier for therapeutic effects.(Blood pressure and pulse should be within normal limits or within parameters set by health care provider. If drug is given for angina and /or dysrhythmias, significant improvement in reports of pain, palpitations, or ECG demonstrates improvement)

No more than 2 percent of hypertensive patients can be treated surgically. There are basically four groups of drugs a physician would prescribe a hypertension patient:DiureticsThis is usually the first choice a doctor would prescribe. It helps by increasing the rate you body eliminates urine and salt. However, this can also increase your cholesterol level, make you urinate more frequently, and may cause a loss of potassium.Beta-Adrenergic BlockersThese drugs are usually prescribed if a diuretic does not help bring your blood pressure down, and sometimes are used in combination with diuretics. Beta-adrenergic blockers work by blocking the effects of adrenaline in your body.

Subjective: “I learned about that one in class too. Is that the one that keeps me from getting blood clots?”

The antihypertensive effects of Atacand was similar in men and women in patients older and younger than 65 (www.rxlist.com). Atacand HCT or the combination (Candesartan celexetil and hydrochlorothiazide) resulted in placebo adjusted decreases in sitting systolic and diastolic blood