Term
Meet Angelo. 45 year old male c/o chest pain during exercise and sexual intercourse. ECG and exercise tolerance text were abnormal. He has a history of smoking and lives a sedentary lifestyle.
WHAT IS CLINICALLY RELEVANT? |
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Definition
| Exertional chest pain, Abnormal test, smoker, sedentary |
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Term
| What is the rationale for Angelo? |
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Definition
Stable angina is characterized by pain on exertion.
Abnormal test are due to ischemia r/t poor perfusion of the coronary arteries.
Causes- obstruction: atherosclerosis, CAD |
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Term
| What medications should be expected for Angelo? |
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Definition
Nitrates- vasodilation, decrease preload and contraction via smooth muscle relaxation, increase O2 supply, decrease O2 demand
sublingual (SL), topical, oral, inhalation, and IV
Beta-adrenergic blockers
Nonselective and selective beta-blockers
decreases need for oxygen by decreasing heart rate, decrease contractility and afterload.
Calcium channel blockers
Calcium activates myocardial contraction> increases cardiac workload and increases need for oxygen
calcium blockers decreases workload, relax arteriole spasm and relax smooth muscle in the arteries, vasodilation
Side effects/adverse reactions- h/a, hypotension, dizziness, flushing, can lead to cardiac depression and edema |
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Term
| What side effects should be expected for Angelo? |
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Definition
| headache, hypotension, dizziness, reflex tachycardia (if nitrate is given too rapidly) |
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Term
Meet Carlton. 48-year-old AA self-employed plumber.
has no significant past medical history
is taking no medicines
has no known allergies
is a regular smoker and has been since his teens
drinks a couple of stubbies a night and a bit more on the weekend
BP 148/94, repeat BP 144/92, HR 78
WHAT IS CLINICALLY RELEVANT? |
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Definition
Smoker
ATOH (ethanol=alcohol)
Stage 1 HTN |
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Term
| What medications should be expected for Carlton? |
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Definition
Thiazides: hydrochlorothiazide (HydroDiuril)
Calcium channel blockers
Calcium activates myocardial contraction> increases cardiac workload and increases need for oxygen
calcium blockers decreases workload, relax arteriole spasm and relax smooth muscle in the arteries, vasodilation
CCBs decrease calcium levels and promote vasodilation |
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Term
| What side effects should be expected for Carlton? |
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Definition
| h/a, hypotension, dizziness, flushing, can lead to cardiac depression and edema |
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Term
Meet Asa. 57-year-old man with type 2 diabetes first diagnosed 2 years ago. He has a history of heavy alcohol use but quit drinking alcohol 2 years ago. BP 168/100 mmHg, HR 84. He is asymptomatic.
Physical exam reveals a height of 5 feet, 8 inches, weight of 243 lb. There is no clinical evidence of congestive heart failure or peripheral vascular disease
WHAT IS CLINICALLY RELEVANT? |
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Definition
DM 2
Hx. of ETOH
Stage 2 HTN
Obesity |
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Term
| What medications should be expected for Asa? |
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Definition
angiotensin-converting enzyme (ACE) inhibitors
Ace inhibitors block angiotensin (a vasoconstrictor)
Captopril (Capoten),
Fosinopril (Monopril) |
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Term
| What are the side effects expected for Asa? |
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Definition
Irritating cough
Hyperkalemia
Inhibits ACE=inhibits angiotensin II (vasoconstrictor), blocks release of aldosterone, (aldosterone promotes Na retention and K excretion).
When aldosterone is blocked, Na and water are excreted and K retained. |
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