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


    • 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


    • 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


    • 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