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.

10 questions to ask your doctor about headaches by MedicineNet.com

10 questions to ask your doctor about headaches by MedicineNet.com: "Headache is defined as pain in the head that is located above the eyes or the ears, behind the head (occipital), or in the back of the upper neck. Headache, like chest pain or dizziness, has many causes. There are two types of headaches: primary headaches and secondary headaches. Primary headaches are not associated with (caused by) other diseases. Examples of primary headaches are migraine headaches, tension headaches, and cluster headaches. Secondary headaches are caused by associated diseases such as brain tumors, strokes, meningitis, subarachnoid hemorrhages, caffeine withdrawal, or discontinuation of analgesics. In rare occasions, headaches may signal heart attacks.

Establishing the diagnosis of the headache, arriving at effective treatment(s) for the headache, and taking measures to prevent or reduce headache episodes will require cooperation between you and your doctor. Following are suggestions on how to work with your doctor in diagnosing and managing your headaches.

How Can I Help My Doctor?

Pay attention to your symptom(s) so you can describe your condition as accurately as possible:

What are your headache location, duration, severity (worst ever headache?), and character (dull, sharp, throbbing, etc.)?

What brings them on (for example, certain foods, stress, bright light, fasting, or sleep disturbances)?

What aggravates them (exertion, coughing, bending, or sexual activity)?

What relieves them?

How long have you had these headaches? Have you had these headaches since childhood?

How frequently do you get headaches? Do they occur on weekdays? Weekends?

Are headaches related to menstruation?

Do other family members have similar headaches?

Are headaches often preceded by warning symptoms such as fatigue, yawning, sleepiness, or euphoria?

Are your headaches associated with visual disturbances, nausea, vomiting, pallor, cold hands and feet, seizures, weakness or unusual sensations of the arm or leg, unsteady gait, slurred speech, or fever?

Has there been a recent head trauma or a fall?

Prepare a list of all your medications, medical conditions, and surgeries.

Include all prescription and nonprescription medications, supplements, vitamins, herbs, and minerals. You might bring them with you to show your doctor. This will help answer any questions your doctor may have about your medications and dosages.

List prior and current medical conditions such as diabetes, high blood pressure, heart attacks, or cancers.

List prior surgeries (appendectomy, hysterectomy, knee replacement, etc.), procedures (colonoscopy, mammography, upper GI x-rays, etc.), and hospitalizations. Bring any hospitalization records and procedure reports in your possession.

10 Important Questions to Ask Your Doctor

1. What do you think is causing my headaches?
   
2. Is there more than one condition (disease) that could be causing my headaches?
   
3. What tests will you do to diagnose my headaches?
   
4. How accurate are the tests?
   
5. How safe are the tests?
   
6. What is the likely course of my condition? What is the long-term prognosis?
   
7. What are my treatment options? How effective is each treatment option? What are the benefits versus the risks of each treatment option?
   
8. If my symptoms worsen, what should I do on my own? When should I contact you?
   
9. Are you aware of each of the medications that I am taking? Can they adversely interact with the medications you are prescribing for me?
   
10. Should we monitor for side effects of the medications that you are prescribing or for their interactions with other medications I am taking?

How About Follow-up Care?
Arriving at an accurate diagnosis and optimal treatment often takes time and may require repeated visits and tests. Be patient and communicate with your doctor. Here are some suggestions:

• Do not stop taking prescribed medications on your own. If your prescription runs out, ask your doctor whether you should obtain a refill.

• If the prescribed treatment is not helping you, or is causing side effects, inform your doctor right away. He/she may have to rethink the diagnosis and/or change the treatment.

• If the doctor cannot offer you a firm diagnosis or help you with your symptoms despite repeated visits, it is OK to ask for another opinion. Most doctors will be glad to help their patients solicit second opinions or specialty consultations.

• Always ask your doctor about your test results. Never assume that everything must be fine if you do not hear from the doctor's office.

• Inform your doctor if you are using alternative medicine or non-prescription remedies, because some of these remedies may interact with your prescribed medications.

• Educate yourself with credible and authoritative medical information. Increasing your own knowledge about the characteristics of your particular condition, your medications, and their side effects can benefit you, your family, and your doctor. Information about your condition may be provided by your doctor. You can also find valuable information on the Internet. Be certain to look for credible Web sites.

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Gastrointestinal System

Gastrointestinal system is concerned with the digestion and absorption of foods we eat. it is consist of the alimentary canal known as the digestive track or the gut, extending from the mouth to gut and the related organs.

The alimentary canal is made up of smooth muscles which contracts and move the food in waves along the track. this process is known as peristalsis. food is broken down into smaller absorbable forms by a group of protein substances known as enzymes present in the digestive juices, secreted by the exocrine glands of the alimentary canal.

Enzymes are complex proteins that are capable of bringing chemical changes in other substances without being changed themselves. they are capable of accelerating the speed of chemical reactions.

the function of alimentary tract is to breakdown food into smaller particles, absorb the nutrients and expel the rest as wast. different pats of the tract has different functions.

Food enters through the mouth or oral cavity. Jaws, teeth and tongue work to mash the food and mix the food into smaller particles. saliva secreted from the salivary glands moistens the food to make it easier to transport. saliva also contains enzymes that begin the process of digestion hence, the process of digestion begins in the mouth.

from the mouth food enters the esophagus and than to the stomach. Stomach is acidic in nature which is necessary for proper functioning of the enzymes in the stomach. this also helps to destroy any micro organisms which might enter with the food. in the stomach the food id further broken down into smaller particles and mixed with digestive juices to form a semi solid mixture. this mixture passes in to the duodenum which is the first part of the small intestine. More digestive juices are added to this mixture and the process of digestion continues.

As the food particles move further down the small intestine they are reduces into smaller and smaller constituents of, carbohydrates, proteins, fats and water. these are absorbed through the lining of the small intestine and pass into the blood stream. They are either stored in the liver to be used later or carried to places where they are metabolized to get energy or for building and repair.

two other organs are essential in the process of digestion.One is the liver which store nutrients and and also produces bile. Bile helps in the digestion and absorption of fats and fat soluble vitamins. Bile travels into the small intestine via the gall bladder and the bile ducts.

the other organ is the pancreas which makes several enzymes involved in the breaking down of food in the small intestine.

Once the food reaches the end of the small intestine, what's left is essentially wast material. The wastes enters the large intestine or colon. As it travels along the colon, water is re-absorbed and the waste hardens and becomes feces. the fecal matter is than stored in the rectum, before being expelled through the anus.