Pathophysiology, Medications and Care Plan for Atrial Fibrillation Patient

This article discusses the pathophysiology, medications and care plan for a patient with atrial fibrillation. It covers the risks and benefits of Xarelto, Metformin, Jenuvia and Sevikar. The article also highlights the precautions and side effects of these medications. The nursing professionals need to be careful while administering these medications to the patient.

Running head: COMPLEX NURSING
COMPLEX NURSING
Name of the student:
Name of the university:
Author note:

1
COMPLEX NURSING
Atrial fibrillation is the quivering or the irregular heartbeat that might result in the leading to
situations like formation of blood clots, heart failures as well as other heart related complications (January
et al., 2014). The assignment is based on a case study where the patient is identified with such conditions.
It will therefore highlight the pathophysiology of the disorders, the medications used for them and the
care plan that the nurses should apply to them.
Changes in the cardiac function are seen to be intricately associated with the failure of the heart
and these results in the decreasing of the cardiac output. This ultimately results in the declining of the
stroke volume that occurs because of the systolic dysfunction, diastolic dysfunction as well as
combination of both the two. Signal transduction mechanisms mainly help in the regulation of the
ionotropy. Alterations of the signal transduction mechanisms cause loss of intrinsic ionotropy and this
situation results in systolic dysfunction (Sposato et al., 2015). Moreover, loss of viable as well as
contracting muscles occurring during the times of acute myocardial infarction can also result in systolic
dysfunction. On the other hand, ventricular filling might get impaired mainly from the situations when the
ventricle becomes less compliant and this can be referred to the situation of diastolic dysfunction. As the
ventricles are less filled, it results in decreased ejection of the blood (Yao et al., 2018). Dysfunction in
both the section ultimately results in the abnormal and higher ventricular end-diastolic pressure and this
serves as the compensatory mechanism by the utilization of the Frank-Starling mechanism. This helps in
the augmentation of the stroke volume. In many cases of the heart failure as in case of dilated
cardiomyapathy, the ventricles are seen to get dilated anatomically. This helps in the normalizing of the
preload pressures by effective accommodation of the increase in the fluid volume.
In the normal conditions in the heart, it is seen that the dominant pacemaker is mainly the
sinoatrial node. This structure is located in the junction of the superior vena-cava and that of the right
atrium. This helps in the initiation of the electrical impulses (Kotecha et al., 2014). This is mainly seen to
travel through the atria and thereby causes the left and the right atria to undergo contraction and helping
in the pumping of the blood to the ventricles. Through the atrio-ventricular node, the electrical impulse is
seen to travel from the atria to that of the ventricles (January et al., 2014). This is the effective way by
which the electrical activity between the atria and the ventricles are seen to get synchronized. This helps
in the optimal functioning of the heart. In many situations, different types of structural as well as
abnormal triggering of the impulses take place. This makes the electrical activity of the atria to become
uncoordinated as well as chaotic and this form results in the situation called the atrial fibrillation issue.
Recent studies are of the opinion that these triggers are mostly seen to be resulting from the different

2
COMPLEX NURSING
premature beats like the foci in the pulmonary veins (Melgard et al., 2015). It might also arise at other
sites like the superior vena cava. Researchers are also of the opinion that sympathetic and the
parasympathetic tone and acute atrial stretch – all can increase in the frequency of these triggers. In these
ways, the disorders can take place in different patients.
Xarelto 20 mgs. Mane
People who are suffering from the symptoms of irregular heartbeats like that of atrial fibrillation
often remain at the higher risk for developing blood clot in the heart. This can often travel to the brains
and result in the occurrence of stroke or might travel to the other parts of the body. This medication
mainly helps in the lowering of the chances of having strokes mainly by the helping of the people in
prevention of the clots from forming (Verman et al., 2016). If the patient stops taking this medication, he
might get exposed to the increased risk for forming of clot in the blood. However, the patient should be
discussed about the important side effects and the precautions he needs to take. The nurse must know that
the medication is the blood thinner and prevents formation of the blood clots. Therefore, the patient might
be exposed to the increasing chance of being bruised where he might have difficulty in stopping the
bleeding from the long time. Researchers are of the opinion that the patients might be exposed to higher
risk of bleeding and taking of certain others medications with this medicine might increase their chances
of bleeding. These medications include aspirin as well as aspirin containing products, non-steroidal anti-
inflammatory drugs called the NSAIDS, warfarin sodium as well as any medication that contains heparin.
Other similar medications that should be also avoided are the clopidogrel, selective serotonin uptake
inhibitors or serotonin noreinephrine reuptake inhibitors as well as other medicines that results in
preventions of treatment of blood clotting issues (Khakanova et al., 2017). The nursing professionals
should also be careful and analyse whether the patient is having any kidney or liver problems as it might
have fatal impacts soon them. The professional who would be administering the medication to the
patients should also need to check out whether the medication would be allergic to the patient or not. This
would be helping the nurse in the case study to administer the dose safely to the female patient and would
help her to relieve her from the symptoms of atrial fibrillation.
Metformin 1.5 Grams BD
Metformin is one of the drugs that is often prescribed by the healthcare professionals in
decreasing the hepatic liver glucose production. This helps in the decreasing of the GI glucose absorption
and helps in the increasing of the target cell-insulin sensitivity. This medication is always provided to the
patient in adjunct with that of the diet and the exercises along with that of the lifestyle changes. This
might include weight loss for improvement of the glycemic control in adults who are suffering from that

3
COMPLEX NURSING
of type 2 diabetes. A large numbers of the different side effects are associated with the medications and
therefore the nurses have two important duties - to educate the patient about the side effects and observe
and monitor the ways the health of the patient is reacting with the administration of the disorder. If any
negative outcomes are observed from the monitoring by the nurses, the professionals need to think of
some of the other kinds of medication. The different side effects are the physical weakness called asthenia
as well as diarrhoea. Gas or flatulence as well as symptoms of weakness and muscle pain or myalgia
might also result (Forslund et al., 2015). This medication is also seen to have different upper respiratory
tract infection, low blood sugar level as well as many different types of abdominal complaints. Lactic
acidosis, low blood levels of vitamin B12 as well as nausea and vomiting might also result in the
individuals who take medication. Side effects of child, dizziness as well as bloating, heartburn,
constipation and similar others might result. Moreover, the healthcare professionals also need to consider
the medications that might interact with this medication. These might include contrast media that is
iodinated as well as ethanol and the loversal. The different types of contraindications that should be also
considered are hypersensitivity, chronic heart failures, diabetic ketoacidossis, and metabolic acidosis with
or without coma. Different types of other chances of contraindications are the several types of renal
disorders, septicaemia, and abnormal creatinine clearance (Petrie et al., 2017). Others are the myocardial
infarction as well as lactations. Researchers are of the opinion that this medication should be used with
caution in the patients who suffer from congestive heart failures, surgery, trauma. Elderly people, patients
with renal impairment as well as hepatic impairment. The nursing professionals in this case study is
caring for a patient with heart disorder and needs to be very careful while administering this medication
as it might cause severe side effects.
Jenuvia 100mgs. Mane
This medication can be described as the dipeptidyl peptidase-4 (DPP-4) inhibitor, which works,
by the increasing amount of the insulin that is released by the body and by the decreasing of the amount
of the sugar that is prepared by the body. This is mainly used in the treatment of the patients, suffering
from the type2 diabetes that are not able to control their blood sugar level by the diet as well as exercises
alone. This is often suggested to the patients to take in combination with that of the diets and exercises for
the improvement of the blood sugar levels. Researchers are of the opinion that this medication can be
used alone or can be used with several other medications like that of the metformin, rosiglitazone as well
as pioglitazone (Sakura et al., 2018). However, while providing this medication to the patient, the nursing
professionals should make the patients aware of the different side effects that the medication results in. it
might cause upper respiratory tract infection as well as headache. Many of the research studies have also
associated this medication with that of the abdominal pain, nausea and even diarrhea. The nursing

4
COMPLEX NURSING
professionals first need to monitor whether the patient is allergic to sitagliptin. If the patient is not
allergic, then only the medication should be given. The nurses need to take proper history assessment of
the patient whom she is providing the medication. This is because researchers are of the opinion that this
medication should not be provided to such individual who have kidney disorders or are on dialysis.
Moreover, it should be also not given to patients who are suffering from the pancreatitis as well as high
triglycerides and even having gallstones or alcoholism (Betari & Haidar, 2014). Many of the studies also
suggest that this medication is also not proper to be given to patients who have heart disorders. The
patient in the case study is suffering from atrial fibrillation. Therefore, it is important for the nurses to
consult with senior healthcare professionals who are experienced and to find more evidence based articles
for gaining more knowledge on the topic.
Sevikar 0/10/25 mane
This medication is used for the treatment of the patients who are suffering from high blood
pressure that is mainly called hypertension. This medication is mainly seen to be comprising of the
component called the olmesartan medoxomil. The latter mainly belongs to the group of medication called
the angiotensin-II receptor antagonists. Angiotensin-II is mainly the substances that are produced in the
body of human beings for tightening of the blood vessels. This medication mainly helps in the blocking of
the action of Angiotensin-II and thereby this medication helps in the relaxation of the blood vessels and
thereby helps in the lowering of the blood pressure (Sirenko et al., 2016). Studies have also reported that
this medication helps in containing of amlodipine besilate which is actually a channel blocker. This
helps in the reduction of the movement of the calcium into the cells of the heart as well as that of the
blood vessels. This is also found to be very helpful in the lowering of the blood pressure and mainly helps
in relaxation of the blood vessels thereby increasing the supply of the blood and oxygen to the heart. This
medication is also seen to contain hydrochlorothiazide. This mainly diuretic compound helps in the
reduction of the fluid amount in the body. This also helps in the lowering of the blood pressure. The
nursing professionals need to be very careful and they need to consider that whether the patients are
allergic to olmesartan, medicines like amlodipine besilate belonging to the group of chemicals called the
dihydropyridines that are often used in the treatment of the blood pressure and heart problems. The
allergy chance of the patients to that of the hydrochlorothiazide that is a diuretic or any of the ingredients
like sulfonamide-derived drugs should be also considered before prescribing the medication to the patient.
The nurses should know the conditions of the patients when this medication should not be given and
therefore they need to monitor and analyses the history of the patient. The medication should not be given
to the patient if the patient has liver or severe kidney disorders. The patient should not be also prescribed
this medication if the patient has high potassium as well as sodium levels in the blood or have high

5
COMPLEX NURSING
calcium of uric acid levels in the blood. The patient should also not take this medication if he is having a
diabetes medication called Alsikiren. Many of the reports have suggested that this medication should not
be used for the patients who are suffering from heart disorders. However, the patient in the case study is
suffering from atrial fibrillation and therefore the professionals should consult with senior experienced
health professionals and follow more evidence-based articles to understand whether it would be safe for
the patient to use it or not to. The nursing professionals also need to identify whether any side effects are
present in the patient or not because of the disorder (Bramlage et al., 2014). The allergic reactions might
occur as a result of taking of the medication which affect the whole body along with the swelling of the
face, mouth as well as the larynx. This might occur together with itching, rash and others during the time
of the treatment with this medication. It can also result in the falling of the low pressure below normal or
might be due to the result of the allergic reaction. The nurse should stoop the medication if the patient
shows such symptoms.
Atenolol 25 mgs mane
This medication is mainly used singly or in association of the other medication that helps in the
treatment of the high blood pressure. This medication mainly helps in the lowering of the high blood
pressure and in turn helps in the prevention of the other disorders. This mainly helps in the prevention of
strokes. Kidney problems as well as different types of other issues like heart attacks might also result.
This medication is also seen to treat chest pains like angina and helps in improving of the survival after
heart attacks. The nursing professionals should also try to monitor and observe whether the patient is
suffering from any types of side effects or not (Lacro et al., 2014). Dizziness, tiredness, light-headedness
as well as nausea might take place in the patients. If any of the disorders take place, the pharmacist or the
doctor should be consulted promptly. In many cases, it is also reported that the drug might result in
reducing the flow of the blood to the hands as well as feet and these make the patients to feel cold.
Smoking might worsen the condition, the patients might develop negative symptoms, and therefore, this
should be taken care. Before taking of the medication, the nurses have to make sure that the patient is not
allergic to the components of the medications or do not have any other allergies (Lacro et al., 20150. The
professionals should also consider whether the patients have issues or not like that of improper heart
rhythm , breathing problems, blood circulating problems, kidney disorders, muscle disorders and many
others. In cases, when the patient is having diabetes issues, it might result in fast heartbeat if the blood
sugar is seen to fall too low. The nurse who is treating the patient should notice that the patient is having
diabetes as well as heart problems and therefore this medication might have negative outcomes on the
patient. Therefore, consulting with seniors and pharmacists are important before giving this medication.

6
COMPLEX NURSING
Flecaainide 100 mgs BD
This medication is used for the treating of certain types of serious as well as
irregular heartbeat like that of the persistent ventricular tachycardia as well as
paroxysmal supraventricular tachycardia. This medication is mainly used for the
restoration of the normal heart rhythm and thereby helps in the maintenance of the
regular as well as steady heartbeat. This medication is also used for the prevention
of the certain types of irregular heartbeat from returning mainly as case of the trial
fibrillations. Therefore, for this reason, the nursing professionals can also give the
patient the medication. This medication is known as the anti-arrhythmia drug
(Kannakeril et al., 2016). This medication is mainly seen to be working by the
blocking of the certain electrical signals in the heart that can have irregular
heartbeat. Proper treatment of the irregular heartbeat result in the decreasing of
the risk of the blood clots and this in turn results in the reduction of the heart attack
as well as stroke (Kannankeril eta l., 2017). A number of side effects are also seen
to be associated with the medication like dizziness, vision problems, and shortness
of breath. Moreover, it also causes many side defects like that of the headache,
nausea, weakness, shaking and tiredness. If any of the signs and symptoms, which
are mentioned above when found in the patient, the nurse should immediately
report them to the seniors. The doctors usually advise this medication when the
benefits are higher than the risk of the side effects. Before taking the medication,
the nursing professionals need to read and assess the history of the patient before
giving her the medication so that this medication does not interact with that of the
other medications. The patient should be first checked whether she is allergic to the
medication (Mullins et al., 2017). The patient should also reveal that whether she
has kidney disorders, liver issues or that of the other heart problems like previous
heart attacks or pace-makers surgeries. Taking of alcohol or marijuana might make
the situation worse as the medication makes patients dizzy and alcohol would
aggravate the situation. Therefore, the professionals should consider all these
before giving the patient this medication.
Lasix 20mgs:
This medication is mainly used in the reduction of the extra fluid in the body, which is called the
edema. These issues are mainly seen to be occurring because of heart failures, liver disorders as well as

7
COMPLEX NURSING
kidney disorders. This can help in the lessening the symptoms such as the shortness of the breath as well
as swelling in the arms, legs and the abdomen. This drug is mainly used in treatment of the high blood
pressure. It helps in the lowering of the high blood pressure and thereby prevents strokes, heart attacks
and even the different kidney problems (Hodson et al., 2017). Many of the researchers are of the opinion
that such medications are called water pill and this makes causing the patients to make more urine. This
medication helps the body in getting rid of extra water as well as salt. Like the previous medication, this
medication administration also requires the healthcare professionals to consider whether the patient is
having, any side effects or not. Dizziness, light-headedness, headache and blurred vision might occur in
the patients as side effects and therefore, it is necessary to observe that such symptoms are present of not
in the patients (Poraghei et al., 2015). This medication can also cause severe loss of water from the body
resulting in dehydration. Other side effects include muscle cramps, weakness, unusual tiredness, fainting,
drowning, nausea, vomiting, dizziness, and many others 9Yao et al., 2016). All these should be noted in
the patient after administering them.
Management and prevention of the atrial fibrillation is mainly seen to involve the different
modifiable risk factors with the help of the different lifestyle changes (Pathak, 2015). This would be
mainly including the smoking cessations, exercises, treatment, weight management, treatment for the
alcohol and the drug abuses. Moreover, the nursing professionals also need to prevent any form of
thrombo-embolism and control the heart rate of the patient. The nurse should use the 12 lead ECG for
diagnosing the atrial fibrillation (Verma et al., 2015). The waves here would be found chaotic and the
beat remains irregular. The atria can be seen to be quivering between the QRS and there would be no
discernible P waves. Pacemaker can be provided to the patient which is a device that can sent the cardiac
signal to the heart for making it to beat with the right rhythm. Moreover, the nurses can also control the
heart arte with the help of the beta blockers, calcium channel blockers as well as cardiac glycosides
(Lauffenburger et al., 2015). The nursing professionals can also provide the anticoagulant therapy which
is actually the thinning of the blood that helps in the disintegration as well as breaking of the clot and
increasing of the flow of the blood (Nishimura et al., 2017). Prevention of fall should be taught because if
they bleed somehow, they might have difficulty in stopping the blood, as they will be on blood thinners.
As they have the chance of blood clot formation which might move to the brain, the nursing professionals
should also teach the patient and their family members about the signs as well as symptoms of the stroke
like feeling of confusion, weakness and similar others. Present day researchers are of the opinion that
cardiac enzyme monitoring is also important like that of Troponin I Creatine Kinase MB. Troponin will
remain elevated for up to 14 days from 2 to 4 hours after ischemic cardiac event. Analysis of this
enzymes help the nurses in getting trending information and sooner the information is received, it
becomes better for saving the life of the patient from harmful reactions (Holmquisvt et al., 2015).

8
COMPLEX NURSING
From the above discussion, it becomes clear that the patient had mild heart failure and atrial
fibrillation. These are associated with irregular heartbeat that exposes the patient to not only situations of
cerebrovascular accidents but also life threatening issues. Therefore the nursing professionals need to
allocate proper medications and need to be observe the patients to find out side effects are present or not.
Moreover, they also need to care for the patient in ways by which not only his quality of life would be
developed but her family and she can herself recognize whether any fatal condition of stroke is resulting
or not. Pharmacological and non-pharmacological interventions need to provided to ensure best health of
the patient.

9
COMPLEX NURSING
References:
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Conti, J. B., ... & Sacco, R. L.
(2014). 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a
report of the American College of Cardiology/American Heart Association Task Force on
Practice Guidelines and the Heart Rhythm Society. Journal of the American College of
Cardiology, 64(21), e1-e76. DOI: 10.1016/j.jacc.2014.03.022
Pathak, R. K., Middeldorp, M. E., Meredith, M., Mehta, A. B., Mahajan, R., Wong, C. X., ... & Lau, D.
H. (2015). Long-term effect of goal-directed weight management in an atrial fibrillation cohort: a
long-term follow-up study (LEGACY). Journal of the American College of Cardiology, 65(20),
2159-2169. https://doi.org/10.1093/europace/euv309
Yao, X., Abraham, N. S., Alexander, G. C., Crown, W., Montori, V. M., Sangaralingham, L. R., ... &
Noseworthy, P. A. (2016). Effect of adherence to oral anticoagulants on risk of stroke and major
bleeding among patients with atrial fibrillation. Journal of the American Heart Association, 5(2),
e003074. https://www.ahajournals.org/doi/abs/10.1161/JAHA.115.003074
Lauffenburger, J. C., Farley, J. F., Gehi, A. K., Rhoney, D. H., Brookhart, M. A., & Fang, G. (2015).
Effectiveness and safety of dabigatran and warfarin in real‐world US patients with non‐valvular
atrial fibrillation: a retrospective cohort study. Journal of the American Heart Association, 4(4),
e001798. https://www.ahajournals.org/doi/abs/10.1161/JAHA.115.001798
Verma, A., Jiang, C. Y., Betts, T. R., Chen, J., Deisenhofer, I., Mantovan, R., ... & Albenque, J. P. (2015).
Approaches to catheter ablation for persistent atrial fibrillation. New England Journal of
Medicine, 372(19), 1812-1822. https://www.nejm.org/doi/full/10.1056/NEJMoa1408288
Nishimura, R. A., Otto, C. M., Bonow, R. O., Carabello, B. A., Erwin, J. P., Fleisher, L. A., ... & Rigolin,
V. H. (2017). 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the
management of patients with valvular heart disease: a report of the American College of
Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of
the American College of Cardiology, 70(2), 252-289. DOI: 10.1016/j.jacc.2017.03.011

10
COMPLEX NURSING
Holmqvist, F., Guan, N., Zhu, Z., Kowey, P. R., Allen, L. A., Fonarow, G. C., ... & Holmes, D. N. (2015).
Impact of obstructive sleep apnea and continuous positive airway pressure therapy on outcomes
in patients with atrial fibrillation—Results from the Outcomes Registry for Better Informed
Treatment of Atrial Fibrillation (ORBIT-AF). American heart journal, 169(5), 647-654.
https://doi.org/10.1016/j.ahj.2014.12.024
Sposato, L. A., Cipriano, L. E., Saposnik, G., Vargas, E. R., Riccio, P. M., & Hachinski, V. (2015).
Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and
meta-analysis. The Lancet Neurology, 14(4), 377-387. https://doi.org/10.1016/S1474-
4422(15)70027-X
Yao, X., Abraham, N. S., Sangaralingham, L. R., Bellolio, M. F., McBane, R. D., Shah, N. D., &
Noseworthy, P. A. (2016). Effectiveness and safety of dabigatran, rivaroxaban, and apixaban
versus warfarin in nonvalvular atrial fibrillation. Journal of the American Heart Association, 5(6),
e003725. https://www.ahajournals.org/doi/abs/10.1161/JAHA.116.003725
Kotecha, D., Holmes, J., Krum, H., Altman, D. G., Manzano, L., Cleland, J. G., ... & Von Lueder, T. G.
(2014). Efficacy of β blockers in patients with heart failure plus atrial fibrillation: an individual-
patient data meta-analysis. The Lancet, 384(9961), 2235-2243. https://doi.org/10.1016/S0140-
6736(14)61373-8
Melgaard, L., Gorst-Rasmussen, A., Lane, D. A., Rasmussen, L. H., Larsen, T. B., & Lip, G. Y. (2015).
Assessment of the CHA2DS2-VASc score in predicting ischemic stroke, thromboembolism, and
death in patients with heart failure with and without atrial fibrillation. Jama, 314(10), 1030-1038.
https://jamanetwork.com/journals/jama/fullarticle/2431702
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Conti, J. B., ... & Sacco, R. L.
(2014). 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation:
executive summary: a report of the American College of Cardiology/American Heart Association
Task Force on practice guidelines and the Heart Rhythm Society. Journal of the American
College of Cardiology, 64(21), 2246-2280. DOI: 10.1016/j.jacc.2014.03.021
Vernon, H. M., Nielsen, A. K., & O'bryan, E. C. (2016). Hypersensitivity reaction after administration of
rivaroxaban (Xarelto). The American journal of emergency medicine, 34(7), 1325-e1.
https://doi.org/10.1016/j.ajem.2015.12.021

11
COMPLEX NURSING
Khakhanova, O. N., Skorokhodov, А. Р., Kutashov, V. A., & Ulyanova, O. V. (2017). Cardioembolic
stroke&58; risk factors, forecast, secondary prevention. Saratovskij Naučno-medicinskij
Žurnal, 13(1), 187-192.
https://www.ingentaconnect.com/content/doaj/19950039/2017/00000013/00000001/art00037
Forslund, K., Hildebrand, F., Nielsen, T., Falony, G., Le Chatelier, E., Sunagawa, S., ... & Arumugam, M.
(2015). Disentangling type 2 diabetes and metformin treatment signatures in the human gut
microbiota. Nature, 528(7581), 262. https://www.nature.com/articles/nature15766
Petrie, J. R., Chaturvedi, N., Ford, I., Brouwers, M. C., Greenlaw, N., Tillin, T., ... & Klein, R. (2017).
Cardiovascular and metabolic effects of metformin in patients with type 1 diabetes (REMOVAL):
a double-blind, randomised, placebo-controlled trial. The Lancet Diabetes & endocrinology, 5(8),
597-609. https://doi.org/10.1016/S2213-8587(17)30194-8
Sakura, H., Hashimoto, N., Sasamoto, K., Ohashi, H., Hasumi, S., Ujihara, N., ... & Iwamoto, Y. (2018).
Analysis of the effect of seasonal administration on the efficacy of sitagliptin: Subanalysis of the
Januvia Multicenter Prospective Trial in Type 2 Diabetes Study. Journal of diabetes
investigation. https://doi.org/10.1111/jdi.12817
Betari, N., & Haidar, S. (2014). Pharmaceutical quality of generic sitagliptin tablets compared with
Januvia®. Journal of Applied Pharmacy, 6(2), 195-201.
https://www.researchgate.net/profile/Samer_Haidar/publication/320324937_PHARMACEUTIC
AL_QUALITY_OF_GENERIC_SITAGLIPTIN_TABLETS_COMPARED_WITH_JANUVIA_
R_Running_Title_Quality_of_Commercial_Sitagliptin_compared_with_Januvia_R/links/
59de1244aca272204c2c79db/PHARMACEUTICAL-QUALITY-OF-GENERIC-SITAGLIPTIN-
TABLETS-COMPARED-WITH-JANUVIA-R-Running-Title-Quality-of-Commercial-
Sitagliptin-compared-with-Januvia-R.pdf
Sirenko, Y. M., Rekovets, O. L., Kushnir, S. M., & Torbas, O. O. (2016). Comparative Efficiency of
Enalapril and Perindopril in Terms of the Effect on Central Blood Pressure and Elastic Properties
of Arteries in Patients with Mild to Moderate Hypertension. HYPERTENSION, (2.46), 101-112.
http://hypertension.zaslavsky.com.ua/article/view/74514
Bramlage, P., Ketelhut, R., Fronk, E. M., Wolf, W. P., Smolnik, R., Zemmrich, C., & Schmieder, R. E.
(2014). Clinical impact of patient adherence to a fixed-dose combination of olmesartan,
amlodipine and hydrochlorothiazide. Clinical drug investigation, 34(6), 403-411.
https://doi.org/10.1007/s40261-014-0188-z

12
COMPLEX NURSING
Lacro, R. V., Dietz, H. C., Sleeper, L. A., Yetman, A. T., Bradley, T. J., Colan, S. D., ... & Benson, D. W.
(2014). Atenolol versus losartan in children and young adults with Marfan's syndrome. New
England Journal of Medicine, 371(22), 2061-2071. DOI: 10.1056/NEJMoa1404731
Lacro, R. V., Dietz, H. C., & Mahony, L. (2015). Atenolol versus Losartan in Marfan's Syndrome. The
New England journal of medicine, 372(10), 980. doi: 10.1056/NEJMc1500128.
Kannankeril, P. J., Moore, J. P., Cerrone, M., Priori, S. G., Kertesz, N. J., Ro, P., ... & Etherdige, S. P.
(2016). A Prospective Randomized Placebo-Controlled Crossover Trial of Flecainide for
Catecholaminergic Polymorphic Ventricular Tachycardia.
Mullins, M. E., Miller, S. N., Nall, C. E., & Meggs, W. J. (2017). Intravenous lipid emulsion therapy for
flecainide toxicity. Toxicology Communications, 1(1), 34-36.
https://doi.org/10.1080/24734306.2017.1405546
Kannankeril, P. J., Moore, J. P., Cerrone, M., Priori, S. G., Kertesz, N. J., Ro, P. S., ... & Etheridge, S. P.
(2017). Efficacy of flecainide in the treatment of catecholaminergic polymorphic ventricular
tachycardia: a randomized clinical trial. JAMA cardiology, 2(7), 759-766.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2626499
Hodson, D., Jackson, K., Chunara, Z., Rao, V., Mahoney, D., Thomas, D., ... & Ahmad, T. (2017). Urine
Sodium Content is Highly Variable in Hospitalized Acute Heart Failure Patients: Lasix Urine is
Not Necessarily “Half-Normal Saline”. Journal of Cardiac Failure, 23(8), S7.
DOI: https://doi.org/10.1016/j.cardfail.2017.07.013
Pouraghaei, M., Mohammadi, B., Taghizadeh, A., Habibollahi, P., & Moharamzadeh, P. (2015).
Prognosis of emergency room stabilization of decompensated congestive heart failure with high
dose lasix. Journal of Emergency Practice and Trauma, 1(2), 44-47.
http://www.jept.ir/article_9887_1488.html