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13.01.08 Ward notes

ACEi in diabetes
  • Renoprotective - reduce proteinuria
  • Start when albumin:creatinine >3
  • Contraindicated in:
    • Bilateral renal artery stenosis
    • Renal failure (creatinine >150)


Saddle ST

  • Pericarditis
    • Diffuse distribution
  • Brugada syndrome
    • ST elevation only in V1, V2
    • Linked to ion channel mutations


Cancers going to bone
  • Sclerotic
    • Prostate
  • Lytic
    • Breast
    • Lung
    • Kidney
    • Thyroid

Scleroderma
  • Chronic systemic autoimmune disease
  • Characterized by fibrosis, vascular alterations, autoantibodies
  • Two major forms:
    • Limited systemic sclerosis/scleroderma
    • AKA CREST syndrome:
      • Calcinosis
      • Raynaud's phenomenon
      • Esophageal dysfunction
      • Sclerodactyly
      • Telangiectasias
  • Diffuse systemic sclerosis/scleroderma
    • Rapidly progressing
    • Affects a large area of the skin and one or more internal organs
      • Kidneys, esophagus, heart, lungs


Beta blockers in hyperthyroidism

  • Hyperthyroidism is associated with an increased number of ß-adrenergic receptors
    • Responsible for many of the symptoms associated with this disorder
    • Palpitations, tachycardia, tremulousness, anxiety, heat intolerance
  • Isomers:
    • L-propranolol causes beta-blockade
    • D-propranolol inhibits thyroxine deiodinase
      • Slowly decreases serum triiodothyronine (T3) concentrations by as much as 30 percent
        • Requires high doses
      • Via inhibition of the 5'-monodeiodinase that converts thyroxine (T4) to T3
      • Effect is slow, occurring over 7 to 10 days, and contributes little to the therapeutic effects of the drug
      • If deiodinase inhibition is considered important in a patient with severe hyperthyroidism, it is best achieved by the addition of an iodinated radiocontrast agent or the use of PTU


Exenatide

  • GLP-1 analogue
    • Liraglutide is also in development
  • Route
    • Daily injections
  • Effects on blood sugar
    • Glucose-dependent stimulation of insulin secretion 
      • => No longer stimulates insulin to cause hypoglycemia when the plasma glucose concentration is in the normal fasting range
    • Suppression of glucagon secretion
  • Effects on pancreas
    • Restores the glucose sensitivity of pancreatic β-cells
    • Inhibits pancreatic β-cell apoptosis
    • Stimulates the proliferation and differentiation of insulin-secreting β-cells
  • Effects on stomach
    • Inhibits gastric secretion and motility
    • => Delays and protracts carbohydrate absorption and contributes to a satiating effect

Notes

  • Venlafaxine
    • SNRI antidepressant
    • HTN is a side-effect
  • Telangiectasias
    • Small dilated blood vessels near the surface of the skin or mucous membranes
    • Between 0.5 and 1 millimeter in diameter
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