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PostSubject: dioreticescoy therapy idea   Fri Apr 06, 2007 5:19 pm

Because in the future to transfer the patient to receive the drug inside, it is recommended to begin treatment with intravenous digoxin; 3. combining HSN with mertzatelna aritmiei, trepetaniem predserdy should appoint digoxin, izolanid-means slower atrioventrikuljarnuu conductivity; 4. of the appointment of glikozida and obtain therapeutic effect should be transferred to the patient support doses of the same drug. Heart glycosides is not always adequate to achieve the desired therapeutic effect, particularly in patients with severe heart failure (heart disease, cardiomyopathy, postinfarknetary cardiosclerosis). Often cures poisoning (nausea, vomiting, loss of appetite, ectopicescie adults); They do not fit in bradikardii, violations conductivity (especially atrioventrikuliarna). It should be noted that the cordial glycosides are most effective in patients with HSN with a tahiaritmicescuu times. Normalization of water sharing is the appointment mochegonnah drugs. There are different groups of drugs, the use of which depends on the extent ХСН and individual responses to the patient. In stage I dioretiki not appointed. When HSN investigated the use tiazidnye (dihlotiazid or gipotiazid) or netiazidnye (klopamid or brinaldix) drugs. Frequent use of these funds might disrupt электролитный exchange (гипокалиемия and гипонатриемия), and for this purpose combine these drugs with триамтереном (птерофен) means providing мочегонный effect through the exchange of ions in the sodium, potassium ions and hydrogen in the distal part канальца нефрона that is the body of potassium. Combined product triampur (12.5 gipotiazida mg and 25 mg triamterena) on the effect of such action is appropriate for patients with HSN teams stage. He is forced диуреза and do not result in significant shifts in электролитном exchange. If such mochegonnaya therapy is not effective enough, it should appoint furosemide (lazix) or etakrinovu acid (uregit). Doses dioretikov should not be too large, it can cause big diureza and the emergence of secondary giperaldosteronizma . The start with small doses : furosemide 20 mg / day, uregit-25 mg / sut. When HSN IIB stage accompanied expressed otecnam syndrome and difficult to therapy should be used furosemide uregit or in combination with drugs kalisberegatmi (triamteren, verospiron). If such a combination mochegonnah prove to be insufficient effective, it must be combined with furosemide uregitom and with the same kalisberegatmi drugs. In refractornom oternm syndrome decisive factor could be the inclusion of therapy osmoticeskih dioretikov (mannit or mannitol), blocking reabsorbqiyu sodium and water in the proksimalna Channel nefrona to reduce resistance kidney receptacles advanced kidney bloodstream. Increasing "load" sodium downhill divisions nefrona, they increase the effectiveness of other dioretikov (primarily furosemida and uregita). The synergy between mochegonnah drugs should appoint drugs potassium and move towards supporting dioreticescoy therapy idea is that the number of the liquid is equal to the number of available (weight should remain stable). In recent years, for the treatment of HSN started using β-adrenoblokatora, blocking CVC and indirectly RAAS, which makes pathogenetic justified their use.

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