Angiotensin Converting Enzyme (ACE) Inhibitors

General Pharmacology

 

CV Pharmacology: Angiotensin Converting Enzyme (ACE) Inhibitors: "ACE inhibitors produce vasodilation by inhibiting the formation of angiotensin II. This vasoconstrictor is formed by the proteolytic action of renin (released by the kidneys) acting on circulating angiotensinogen to form angiotensin I. Angiotensin I is then converted to angiotensin II by angiotensin converting enzyme.

ACE also breaks down bradykinin (a vasodilator substance). Therefore, ACE inhibitors, by blocking the breakdown of bradykinin, increase bradykinin levels, which can contribute to the vasodilator action of ACE inhibitors. The increase in bradykinin is also believed to be responsible for a troublesome side effect of ACE inhibitors, namely, a dry cough.

Angiotensin II constricts arteries and veins by binding to AT1 receptors located on the smooth muscle, which are coupled to a Gq-protein and the the IP3 signal transduction pathway. Angiotensin II also facilitates the release of norepinephrine from sympathetic adrenergic nerves and inhibits norepinephrine reuptake by these nerves. This effect of angiotensin II augments sympathetic activity on the heart and blood vessels.
ACE inhibitors have the following actions:

• Dilate arteries and veins by blocking angiotensin II formation and inhibiting bradykinin metabolism. This vasodilation reduces arterial pressure, preload and afterload on the heart.
• Down regulate sympathetic adrenergic activity by blocking the facilitating effects of angiotensin II on sympathetic nerve release and reuptake of norepinephrine.
• Promote renal excretion of sodium and water (natriuretic and diuretic effects) by blocking the effects of angiotensin II in the kidney and by blocking angiotensin II stimulation of aldosterone secretion. This reduces blood volume, venous pressure and arterial pressure.
• Inhibit cardiac and vascular remodeling associated with chronic hypertension, heart failure, and myocardial infarction.

Elevated plasma renin is not required for the actions of ACE inhibitors, although ACE inhibitors are more efficacious when circulating levels of renin are elevated. We know that renin-angiotensin system is found in many tissues, including heart, brain, vascular and renal tissues. Therefore, ACE inhibitors may act at these sites in addition to blocking the conversion of angiotensin in the circulating plasma.

 

Cardiorenal Effects of ACE Inhibitors

• Vasodilation (arterial & venous)
  - reduce arterial & venous pressure
  - reduce ventricular afterload & preload
• Decrease blood volume
  - natriuretic
  - diuretic
• Depress sympathetic activity
• Inihibit cardiac and vascular hypertrophy

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Aphthous Stomatitis

formation of shallow, painful, tiny ulcers on the mucosa of the mouth that heals without scarring.

Aetiology

- mostly of unknown aetiology 

- particularly common in prior to menstruation

- Mechanical injury to the oral mucosa by hard-bristled tooth brushes, sharp food          or objects that can scrape or cut mucosa 

- iron or Vitamin deficiencies, esp. folic acid and vitamin B12

- nutritional deficiencies 

- infections such as Herpes Simplex, Syphilis, Vincent's angina 

- associated with Crohn's disease, celiac disease

Clinical features

- General symptoms of Stomatitis

- on examination: numerous small round vesicles on cheeks, lips, and tongue, which soon break                   and leave little shallow ulcers with red areola. 

 Prevention

- good oral hygiene

- brushing the teeth at least once a day

- balanced die

Management 

- topical anesthetics or salicylate paste provides symptomatic relief

- topical steroids

- tetracycline mouth wash or caoting ulcers with tetracycline oral suspension.

BASIC FIRST AID

Every year many accidents occur. With some care, they can be prevented. In case an accident does happen, you can be of help if you know Basic First Aid. You will able to give vital first aid if needed. Remember always to seek help an adult immediately.
Do not move the casualty unnecessarily. Keep him warm. Make a diagnosis, decide the treatment and treat. Remember the ABC of First Aid: See if his airways are clear, that he is breathing, and his blood circulation patent.
RESPIRATION
If it is failing, give artificial respiration – Mouth to Mouth of Mouth to Nose.

BLEEDING
Arrest the bleeding and protect the wound. Apply direct or indirect pressure. Cover with a dressing. Apply a pad and firm bandages. Elevate, keep at rest.

FRACTURES
Immobilize it with a well padded stiff support reaching the joints on either side. Apply bandages on either side of the side and at the joints on either side, support.

BURNS AND SCALDS
A burn is caused by dry heat and scald by moist heat like stream, very hot water of oil. Immediately cool the area with cold water for 15 min. till pain subsides. Do not break blisters, or apply anything on the burns. Cover with a sterile or clean cloth, pad and bandages. Give fluids.

NOSE BLEEDING
Sit him up facing the breeze with the head slightly forward. Ask him to breath through the mouth and not to blow his nose. Apply a cold compress over the nose. The soft part of the nose may be pinched close with the fingers for 10 min. cold application on the back of the neck and forehead may help.

BEE STING
Do not press the bag (of the sting) Use forceps and remove the sting. Apply cold or weak ammonia.

ANIMAL BITES
Wash with soap and plenty of water. Loose bandage may be applied. Get quick medical aid.

FAINTING
Lay him down and loosen the clothing around chest and waist. Turn head to one side. The legs may be raised a little do not attempt to give any solids or liquids. On recovery a small quantity of a drink may be given and he/she may be allowed to sit up and move after rest.

GENERAL
If you are in doubt the treatment do not do anything. You may be more harm.

Diabetes

Type 1 diabetes (previously known as insulin-dependent diabetes)

Type 1 diabetes is an auto-immune disease where the body's immune system destroys the insulin-producing beta cells in the pancreas. This type of diabetes, also known as juvenile-onset diabetes, accounts for 10-15% of all people with the disease. It can appear at any age, although commonly under 40, and is triggered by environmental factors such as viruses, diet or chemicals in people genetically predisposed. People with type 1 diabetes must inject themselves with insulin several times a day and follow a careful diet and exercise plan.

Type 2 diabetes (previously known as non-insulin dependent diabetes)

Type 2 diabetes is the most common form of diabetes, affecting 85-90% of all people with the disease. This type of diabetes, also known as late-onset diabetes, is characterized by insulin resistance and relative insulin deficiency. The disease is strongly genetic in origin but lifestyle factors such as excess weight, inactivity, high blood pressure and poor diet are major risk factors for its development. Symptoms may not show for many years and, by the time they appear, significant problems may have developed. People with type 2 diabetes are twice as likely to suffer cardiovascular disease. Type 2 diabetes may be treated by dietary changes, exercise and/or tablets. Insulin injections may later be required.

Gestational diabetes mellitus (GDM)

GDM, or carbohydrate intolerance, is first diagnosed during pregnancy through an oral glucose tolerance test. Between 5.5 and 8.8% of pregnant women develop GDM in Australia. Risk factors for GDM include a family history of diabetes, increasing maternal age, obesity and being a member of a community or ethnic group with a high risk of developing type 2 diabetes. While the carbohydrate intolerance usually returns to normal after the birth, the mother has a significant risk of developing permanent diabetes while the baby is more likely to develop obesity and impaired glucose tolerance and/or diabetes later in life. Self-care and dietary changes are essential in treatment.

Diabetic Neuropathy Symptoms

Diabetic neuropathy symptoms are a common complication of diabetes linked with nerve damage and you can feel the sensation of pain. Diabetic nerve damage causes pain and they seem to be related to high blood glucose levels are too high; there are several ways of developing this. Diabetes-related nerve damage can be painful, but in most cases, the pain is not severe.

Diabetic peripheral neuropathy

The feet and legs of the body area affected by diabetic peripheral neuropathy the most common. Foot nerve damage increases the risk of foot problems

Gestational Diabetes Symptoms
Gestational diabetes symptoms are the only way to note the first type of diabetes known as insulin-dependent diabetes mellitus. It is therefore something that often starts at the time of early conception. Hyperglycemia and insulin, is a pancreatic hormone that is released when there is need for Glucose in the body
.
Glucose is a molecule that requires massive help for the use of their cell type. It is insulin that helps them, insulin acts on the cell membrane if it is wide open enough for glucose to enter and saturate it. Insulin deficiency causes the accumulation of Glucose in the blood and this can occur with a thick cell membranes.

Diabetes Insipid us Symptoms

Diabetes insipidus symptoms (DI) are the amount of urine that builds up frequently in this disease and there is an abnormal increase in thirst and fluid intake as well. It is also a state that causes frequent urination, nocturia (awakening at night to urinate frequently) and enuresis (urinary incontinence and sleep “bedwetting”).It is not usually been over look and intake is increased to compensate for the increasing level of urine output. As a result, instead of being yellow, the urine is colorless and has a pale appearance or water like look the symptom is measured for concentrations.

Stomatitis

Stomatitis is inflamation of the mouth. it may be due to micro-organisms or nutritional deficiencies. 

Aetiology (general)

- Pathogenic organisms including bacteria and viruses

- Mechanical trauma

- Irritants such as alcohol, tobacco, hot foods, spices

- Sensitization to chemical substances in toothpaste or mouthwashes

- Nutritional deficiencies, especially avitaminosis 

- Blood disorders

- Poison by drugs, especially heavy metals

- Certain skin disorders

- Systemic infections such as measles, scarlet fever, syphilis 

Clinical features (general)

- Heat

- Pain

-Increased flow of saliva
- Foul smelling of breath
- Restlessness
- Sometimes fever

Prevention (general)

- Good oral hygiene
- Brushing the teeth at least once a day (preferably twice-before sleeping and on waking up)
- Adequate use of antiseptic mouth wash
- Balanced diet

Management (general)

      -  Topical anesthetic or salicylic paste

·     - Topical steroids

- Tetracycline mouth wash

Nurses Turn To Nebulizer Devices To Deliver Respiratory Medications To Individuals

Nurses Turn To Nebulizer Devices To Deliver Respiratory Medications To Individuals: "Nebulizer devices are the most exciting new breakthroughs in today's medical devices. As a background, their use is basically for delivering medication in vapor form so that it can be breathed in through the lungs. The reason why you would want it in vapor form is because it works far more quickly and as a result works faster to reduce the symptoms associated with the various respiratory conditions. The other benefit of using the product is because it has been found to lessen the actual side effects that are quite common with these various respiratory conditions. In the past few decades nurses have turned to using this device in order to aid patients in getting their respiratory medication.

Nebulizer devices been around for more than a century but they have been dramatically changed since their inception. Today's devices are completely portable and that is something that nurses in particular have been seeking. The ability to move from one patient room to another has given them the freedom to be able to serve their patients quickly and effectively without the issue of having to deal with cables or wires. A nurse uses the product in a very simple manner. Essentially they place the medication inside the product and then within a few minutes it is transformed into vapor form which can be breathed in. The reason why it is essential to take it in vapor form is to allow for it to work much faster in order to get the symptoms under control. In addition to that the other benefit is that it actually helps to reduce the side effects associated with many of the respiratory conditions that people have to take. The future of the products continues to become more and more user friendly in order to allow the nurse the ability and power to treat patients quickly and effectively.

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Dissease of the mouth (Oral cavity)

the oral cavity harbors a verity of micro organism which is commensals and usually does not cause any disease. A good oral hygiene ensures that these organisms do not increase in number and cause disease. The oral cavity may be involved in variety of infections, which may be due to virus like Herpes Simplex and Coxsackie's virus type A, certain bacteria or yeast infection known as Oral Candidiasis or Thrush.