I work in a busy 18 bed emergency department where we are often the first people to see an exacerbation of CHF. Most often after holidays like Christmas where the main meal is ham, and 4th of July where alcohol is quite often at summer celebrations. Education of patients with CHF is important from diet to medications. One medication utilized to treat CHF is Digoxin.

• Digoxin belongs to the class of medicines called digitalis glycosides. It is used to improve the strength and efficiency of the heart, or to control the rate and rhythm of the heartbeat. This leads to better blood circulation and reduced swelling of the hands and ankles in patients with heart problems. This medication is available through prescription from your physician in solution or tablet form. No age specific problems have been identified for geriatric patients, but caution should be used because elderly patients are more likely to have age-related kidney or heart problems which may require caution and an adjustment in the dose for patients receiving digoxin. Use of this medication should not be in conjunction with Amifampridine. Caution should be used with 179 other medications from naproxen to verapamil. Use of Digoxin with 40 + other medications cause an increase risk of interactions but are often used together. Digoxin should not be taken with food, tobacco or alcohol. It is important to take this medication in its full prescribed dose daily. Signs of confusion, nausea, vomiting, diarrhea or vision changes can be related to an overdose. Other possible signs of overdose are changes in the heart rate or rhythm, palpitations and fainting. Patients should not take this medication with any over the counter, herbal, vitamin or prescription medications without first consulting with their physician. Common side effects are dizziness, fainting, fast pounding or irregular heartbeat or pulse, or slow heartbeat (Mayo, 2018).
• Lisinopril an angiotension converting enzyme inhibitor is often used in conjunction with Digoxin. Lisinopril is used treat high blood pressure and heart failure. Lisinopril, a synthetic peptide derivative, competitively binds to and inhibits ACE, thereby blocking the conversion of angiotensin I to angiotensin II. This prevents the potent vasoconstrictive actions of angiotensin II and results in vasodilation. Lisinopril also decreases angiotensin II-induced aldosterone secretion by the adrenal cortex, which leads to an increase in sodium excretion and subsequently increases water outflow.(Thiessen, K, et al, 2016). Lisinopril should not be taken with Aliskiren or Sacubitril. Caution should be used for risk of increase in side effects with 91 other medications. Most common side effects are blurred vision, cloudy urine, confusion, decreased urine output or decreased urine concentrating ability, dizziness, fainting or lightheadness when getting up from lying or sitting positions, sweating and unusual tiredness. One should call their doctor immediately if they have severe stomach pain as it could be a sign of intestinal angioedema. If a patient becomes ill with vomiting or diarrhea they must let their physician know as they may lose too much sodium causing a risk of hypotension (Mayo, 2018).
  Mayo, (2018) Digoxin descriptions and brand names retrieved from: https://www.mayoclinic.org/drugs-supplements/digox…
• Mayo, (2018). Lisinnopril oral route retrieved from:https://www.mayoclinic.org/drugs-supplements/lisin…

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