Non-communicable Diseases Flashcards
Patients who are eligible for dialysis
- <55 years (normal)
- <50 years if diabetic
- candidate for transplant
Effects of hypertension
- stroke
- LVH
- RF
- retinal hypertension
Lifestyle modifications
- decrease sodium
- smoking
- alcohol
- stress
- exercise
- beware of hidden fats
Why do diabetics struggle to lose weight?
If their insulin levels are too high, they put on weight because insulin is anabolic
- cant break down fat
- must decrease carbs
Substances that increase BP
- sympathomimetics
- caffeine
- NSAIDS
- prednisone
- salt
- liquorice
Classes used in hypertension treatment
- ACE-I
- BB
- CCBs
- diuretics
Rules when giving ACE-I to a patient with renal impairment
- start low
- monitor GFR by calculating Cr-clearance
- monitor potassium levels (less aldosterone, less K secretion)
Side effects of ACE-I
- cough
- angioedema
- postural hypotension
Problems with using BB for hypertension
- doesn’t work as well at decreasing MAP
- can cause insulin resistance
- when given with thiazides, corticosteroids or neuroleptics, impaired glucose tolerance is worse
Pros for using CCBs for hypertension
- little monitoring needed
- no elecrolyte disturbances
- few adverse events
2 main types of CCBs
- dihydropyridines (nefedipine, amlodipine)
- non-dihydropyridines (verapamil)
Problem with verapamil
- vasodilates, but causes bradycardia
- patient must have a myocardium that can contract
- good for asthmatics
Effect of nefedipine
- mainly causes peripheral vasodilatation, with little effect on heart contraction
MOA of thiazide diuretics
- inhibit Na-Cl channels in the DCT
- increase sodium and water loss and vasoldilatation
Side effects of thiazide diuretics
- increased urination
- electrolyte abnormalities (hypokalaemia, hypernatraemia - give low doses)
- impaired glucose tolerance
- hyperuricaemia
Main classes used for IHD
- nitrates
- asprin
MOA of nitrates
- increases NO
- peripheral vasodilatation and venodilatation
- decreases venous return and preload
Contraindications for nitrates
- fixed output states
- RVF
- erectile dysfunction
Contraindications for asprin
- asthma (increased influx down leukotriene pathway leads to bronchospasm)
- peptic ulcer
HBA1c aim for diabetics
7.5%
Action of metformin
- switches off gluconeogenesis
- improves glucose utilization and restores insulin receptors
Side effect of metformin
Diarrhoea
