Respond to the following post in two different replies. Your responses should be in a well-developed paragraph (300-350 words) to each peer. Integrating an evidence-based resource that is different than the one you used for the initial post.
Respectfully agree and disagree with your peers’ responses and explain your reasoning by including your rationales in your explanation.
APA format, Cites three or more references, using at least one new scholarly resource .
1st POST ( PLEASE RESPOND)
The purpose of this discussion post is to review ML’s new diagnosis and potential treatment options. For ML, her new diagnosis of stage A heart failure does not mean she has any structural abnormality with her heart. The pathophysiology of this condition includes the fact that ML has preexisting conditions that increase her risk of developing heart failure in the future, if left untreated. The conditions that would cause ML to be diagnosed with stage A heart failure and potentially lead to further heart failure staging if left untreated include hypertension, coronary artery disease, or diabetes mellitus (Woo & Robinson, 2020). The main goal with stage A heart failure includes managing comorbidities to prevent heart failure development (Tanaka, 2018). The main goal of this belongs with consistent blood pressure management.
For ML, the main goal in her treatment therapy will include good blood pressure control. According to Woo and Robinson (2020), ACE inhibitors are typically the first line of treatment, as research has displayed these medications to improve patient symptoms, decrease mortality, and increase life expectancy. As these medications are typically shown to reduce the mechanisms that lead to heart failure, this would be the recommended drug of choice for ML to prevent her progression of stage A heart failure. Due to the fact that digoxin has not been shown to present a mortality benefit, although it may improve quality of life in patients with congestive heart failure, this would not be the first choice of treatment for ML. If, however, this was chosen for ML to treat her stage A heart failure and she was experiencing halos, this would be a sign of digoxin toxicity (Cummings & Swoboda, 2020). If ML has any renal impairment, she would be at increased risk for developing digoxin toxicity. To evaluate for toxicity, a random digoxin level should be checked as well as confirming when the last dose was taken by ML. Once an EKG and basic lab values are obtained, Digibind is an antidote that will assist with eliminating the toxicity, especially in life-threatening instances (Cummings & Swoboda, 2020).
If digoxin is chosen to be the treatment for ML, special consideration should be taken if ML is an older adult or has renal impairment (Woo & Robinson, 2020). Along with this, digoxin was associated with increased risk of death and worsening heart failure in women compared to men (Jackson, 2015). Due to these risks and potential complications, ACE inhibitors will remain to be the drug class of choice for ML. Due to the risk of hypotension, a low-dose ACE inhibitor should be initiated, with a gradual increase in dose occurring to improve exercise tolerance and to relieve any potential symptoms. While doing this, BP and renal function should be closely monitored. Along with this, due to the risk of increased potassium levels, serum electrolyte levels should be regularly monitored. Lastly, one potential side effect that is typically the primary cause for discontinuation amongst patients is the risk of a persistent dry cough (Woo & Robinson, 2020). Ideally, with proper treatment and close monitoring, ML’s stage A heart failure will not progress to additional stages.
2ND POST (PLEASE RESPOND)
The purpose of this post is to discuss heart failure and the implications of using digoxin as a treatment option
Pathophysiology of Stage A heart failure. According to Cleveland Clinic (2021), Stage A heart failure is where though one is not having heart failure, the risks are high due to family history or other health medical conditions such as diabetes, hypertension, alcohol use, cardiomyopathy, drug use, coronary artery diseases, metabolic syndrome, rheumatic fever, and others. This means that the patient has a high risk for heart failure, but they do not have symptoms or structural heart diseases
Digoxin is the rational drug choice for treatment of this individual because it does not affect contractility. In addition to that is for maintenance as it does not cure heart failure. As stage A is just a risk and not fully heart failure, there is no need to alter the function of the heart. According to American Heart Association (2021) women need to get low dose digoxin, the advantage to this is, the low doses are beneficial hemodynamic, neurohormonal, and in clinical effect (Gheorghiade, 2017).
The patient’s concern about halos should digoxin be prescribed is a legit concern. When a patient has digoxin toxicity, there are a myriad of side effects and some are visual which include the haloes. If that happens, the patient should notify the provider immediately and get blood work to assess the serum level, tapering may be the first option that complete discontinuance of the medication (Pincus, 2016).
There are gender considerations related to medication treatment as women have increased mortality rates than men. One of the reasons is due to the hormone interaction and digoxin. Progestin increases the serum digoxin levels as it causes the reduction of digoxin excretion through the kidneys (Rathore, 2018).
Digoxin monitoring is very important as it has a very narrow safety range and to ensure therapeutic levels are met. Blood work is done as recommended especially after a few hours from last dose taken. The results will aid in adjusting medications or maintaining the regimen. In addition to that blood work is essential as it will monitor magnesium and potassium levels that can alter digoxin levels. Lastly if there is digoxin toxicity, there is an antidote that can be given to prevent adverse issues (Lab tests, 2020)
RESPOND TO EACH POST WITH 300-350 WORDS.