Dave is a 70 year old patient with heart failure. He has been treated with ACE inhibitors and diuretics. Recently, his symptoms have worsened and become life threatening despite pharmacologic treatment. He has been hospitalized for evaluation and stabilization on a cardiac glycoside.
1. Explain how the cardiac glycoside will act to lessen the patient’s heart failure.
2. What type of cardiac glycoside do you expect the physician will most likely prescribe the patient and explain why?
3. Which medications should the patient be advised to avoid because they can potentiate glycoside toxicity?
4. Explain why the patient should also be counseled to avoid taking antacids while being treated with cardiac glycosides.
Sample solution
Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell.
In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.
God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.
Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.
To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.
References
Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.
Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.
Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.
Sample Answer
Sample Answer
The Role of Cardiac Glycosides in Treating Heart Failure
1. Mechanism of Action of Cardiac Glycosides in Heart Failure
Cardiac glycosides, such as digoxin, are medications commonly used in the treatment of heart failure. They work by improving the contractility of the heart muscle, which helps to lessen the symptoms of heart failure. Specifically, cardiac glycosides inhibit the sodium-potassium ATPase pump, leading to an increase in intracellular calcium levels. This increased calcium concentration enhances myocardial contractility and improves the heart’s pumping ability. By strengthening the force with which the heart contracts, cardiac glycosides help to alleviate symptoms associated with heart failure, such as shortness of breath and fluid retention.
2. Choice of Cardiac Glycoside for the Patient
Given the patient’s age and the fact that he has been previously treated with ACE inhibitors and diuretics, it is likely that the physician will prescribe digoxin as the cardiac glycoside. Digoxin is the most commonly used cardiac glycoside due to its long history of effectiveness and familiarity among healthcare professionals. It has a well-established safety profile when used appropriately, making it a suitable choice for elderly patients like Dave.
3. Medications to Avoid due to Potentiation of Glycoside Toxicity
When taking cardiac glycosides, it is important for Dave to avoid medications that can potentiate glycoside toxicity. These medications include:
Diuretics: Certain diuretics, such as thiazides, loop diuretics (e.g., furosemide), and potassium-sparing diuretics (e.g., spironolactone), can cause electrolyte imbalances, particularly hypokalemia or low potassium levels. Hypokalemia increases the risk of digoxin toxicity, as it enhances the binding of digoxin to its target receptors in cardiac cells.
Calcium Channel Blockers: Some calcium channel blockers, including verapamil and diltiazem, can also potentiate digoxin toxicity. These medications can slow down the heart rate and enhance the effects of digoxin on cardiac conduction. This combination can lead to an increased risk of arrhythmias.
4. The Effect of Antacids on Cardiac Glycoside Treatment
Dave should also be counseled to avoid taking antacids while being treated with cardiac glycosides. Antacids contain substances such as aluminum hydroxide, magnesium hydroxide, or calcium carbonate, which can interfere with the absorption of digoxin in the gastrointestinal tract. These substances can bind to digoxin and reduce its bioavailability, making it less effective in treating heart failure.
In addition to reducing the efficacy of digoxin, taking antacids can also lead to electrolyte imbalances. Some antacids contain high levels of aluminum or magnesium, which can cause imbalances in electrolytes such as potassium and magnesium. These imbalances can increase the risk of digoxin toxicity.
It is important for Dave to consult with his healthcare provider or pharmacist before taking any additional medications or supplements to ensure they will not interfere with the effectiveness or safety of his cardiac glycoside treatment.
Conclusion
Cardiac glycosides, such as digoxin, play a crucial role in treating heart failure by improving myocardial contractility. They achieve this by inhibiting the sodium-potassium ATPase pump and increasing intracellular calcium levels, leading to enhanced cardiac function. In Dave’s case, it is likely that digoxin will be prescribed due to its well-established efficacy and safety profile in elderly patients. However, it is important for Dave to avoid medications that can potentiate glycoside toxicity, such as certain diuretics and calcium channel blockers. Additionally, he should be advised against taking antacids, as they can interfere with the absorption and effectiveness of the cardiac glycoside treatment. By adhering to these recommendations, Dave can optimize the therapeutic benefits of his cardiac glycoside medication while minimizing the risk of adverse effects.
