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