THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM… Regulatory Body of BP in Humans

Hello dear all student nurses

While talking about hypertension and Antihypertensive drugs, I thought, it would be beneficial if you get an idea regarding how BP is regulated in our body.

In our body, BP is regulated by Neuroendocrine mechanisms. The sympathetic nervous system gives the neuro mechanism for BP regulation, through baroreceptors and chemoreceptors.

Endocrine Regulation

Renin-Angiotensin-Aldosterone system is the hormone system, that regulates BP and fluid balance.

How it acts

In response to water or electrolyte imbalance, the Juxtaglomerular apparatus of the kidneys release Renin into the circulation.

Renin cleaves Angiotensinogen (released by the liver) into Angiotensin I

Angiotensin I gets converted into Angiotensin II, by Angiotensin Converting Enzyme, found in lungs.

Angiotensin II  acts in two ways

  1. Angiotensin II  itself is a vasoconstrictive peptide, and it increases the peripheral vascular resistance and BP.
  2. Angiotensin II  stimulates the secretion of Aldosterone from the adrenal cortex. Aldosterone increases the reabsorption of sodium and water into the blood and eliminates potassium and maintain electrolyte balance. The increase in fluid volume, in turn, increases the BP.

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This mechanism is much important when you deal with the antihypertensive agents, which we will discuss in the next few articles… see you all soon. Have a good study day…

Feel free to enter your feedback and suggestions in the comment box.

What you need to know about HYPERTENSION

Hello to all student nurses….

Thought to share with you some interesting facts on Hypertension, The Silent Killer of all time….yes, it’s silent, as the majority of the people with hypertension doesn’t know the fact that they have it as this condition hardly have any symptoms. Come to have a good look at the details.

ALL ABOUT HYPERTENSION

By definition, hypertension is the condition in which there is an elevation in the blood pressure readings.

Blood pressure is the force exerted on the blood vessels by the blood during the pumping action of the heart. It is directly related to the resistance of the blood vessels and the cardiac output from the heart.

Normal BP ——–> 120/80 mmHg

Hypertension ———-> BP > 130/80 mmHg ( As per the guidelines of AHA, Nov 2017).

Types Of Hypertension

1. Primary or Essential Hypertension

  • could be mild, moderate, or severe
  • Not caused by any other disease condition
  • Leads to dangerous changes in kidneys, eyes and blood vessels

2. Secondary Hypertension

  • Caused by underlying disease condition ( eg: pregnancy, acute kidney disease)

QUICK FACTS ON HYPERTENSION

  • It’s a global health concern. 85million people in the US have Hypertension. Prevalence of hypertension in India was 32.5% ( WHO 2008). And it is rising alarmingly.
  • The major cause is an acute stress situation or an underlying disease condition.
  • A silent killer without any major symptoms
  • If left untreated, it leads to complications including stroke and heart attack.
  • Could be treated by modification of lifestyle and medication.

Treatment

Lifestyle modifications including,

Weight reduction

Sodium restriction

Alcoholism restriction

Stop smoking

Exercise

Behavioral modification

Medication

Single-drug should be considered from any class:

Diuretics

Calcium channel blocking agents

Beta-blocking agents

ACE inhibitors

Initial therapy is for one month. If no response, combination therapy is needed.

All about antihypertensive agents can be discussed in the following posts. Now bye – bye…stay healthy…..

PHARMACOLOGY OF INSULIN

Hello to all student nurses

In an earlier post, we find out what is the role of insulin in our body. With the increased incidents of diabetes, the need for insulin builds up. Earlier sole source of insulin was animal origins. By 1980’s production of human insulin by recombinant DNA technology gained popularity and now either human insulin or analogs of human insulin is used in the treatment of Type 1 and Type 2 Diabetes Mellitus. ( with analogs, the insulin molecular structure is modified slightly to alter the pharmacokinetic properties of insulin).

PHARMACOKINETICS

Absorption

SQ administered insulin is absorbed directly into the bloodstream. Its absorption is affected by some factors as, the exercise of the injected area, local massage, temperature, site of injection ( faster absorption from the abdomen ) lipohypertrophy, jet injectors etc.

Elimination

Kidneys and liver account for the majority of insulin gradation. But, the major role is taken by the kidneys. So its administration in patients with renal dysfunction should be done cautiously.

PHARMACODYNAMICS

Pharmacodynamics of insulin or it’s metabolic effects (onset, peak, and duration of action) vary among insulin preparations. According to this, the available insulins are categorized as Rapid-acting, Short-acting, Intermediate-acting, and Long-acting.

The following table shows the details of the pharmacodynamics of the various insulins.

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PHARMACODYNAMICS download here

STORAGE OF INSULIN – POINTS TO KEEP IN MIND

  • unopened vials or pens can be stored at 36- 46 f(2-8c)
  • insulin should never be frozen, or kept in direct sunlight, or stored in an ambient temperature> 86F(30C)
  • vials, cartridges, or pens can be kept at room temperature for 1 month
  • loaded insulin is to be used within 2 weeks or to be discarded
  • clear insulin if became cloudy to be discarded.

NURSES IMPLICATION FOR ADMINISTRATION OF INSULIN

  1. Give correct dose and the correct type of insulin. Double check the prescription before administration.
  2. Use correct syringe – that is calibrated in units.
  3. Invert the vial several times to mix before the insulin is withdrawn. ” Avoid vigorous shaking”
  4. Rotate site of administration to prevent tissue necrosis.
  5. Be sure patient took his normal diet. ( Take special care with patients with vomiting, patients in NPO status )
  6. While mixing use the mnemonic – clear before cloudy.
  7. Assist the patient in self-administration of insulin.
  8. Apply pressure at the site for 1 minute, don’t massage since it may interfere with the rate of absorption.

Hope you all will keep these points while administering Insulin. Have a safe duty. Please feel free to give your feedback and suggestions.

 

What does insulin do to our body

Hi, all student nurses there….

Diabetes and insulin therapy are much common these days. Global prevalence of diabetes is increasing day by day and it is the major cause of blindness, kidney failures, heart attacks, stroke, and lower limb amputation.

Insulin is the drug most of the patients with Type 1 diabetes rely on.

What is Insulin?

Insulin is a hormone, secreted by the beta cells of the pancreas. It helps to regulate blood glucose level in the body

Functions of insulin

1)Helps in the utilization of the carbohydrates by the body for glucose production.( gluconeogenesis)

2) Helps in the storage of glucose

How it acts

  • Insulin and Blood Sugar Levels

Increased levels of blood sugar stimulate the secretion of insulin from islets of Langerhans. A sugar level >3.9 mmol/L or 70 mg/dl enhance the production of insulin.

Once insulin is secreted, it binds to the cells of liver, muscles, and fats and signals them to absorb glucose.

Generally speaking, insulin is a KEY that UNLOCKS THE CELLS for the glucose to enter into. Cells use the glucose for the energy.

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  • Insulin and Glucose Storage

When the blood glucose level is more than enough, insulin converts it into glycogen and is stored in the liver. The liver can store up to around 5% of its mass as glycogen. In the fat cells, glucose is stored as triglycerides.

On the other hand, insulin also helps in the release of glucose from the stored glucagon and triglycerides when needed. In case of activities which require much energy or in between meals when the sugar level I low, insulin releases glucose into the bloodstream.

What happens if there is no insulin

If enough insulin is not produced naturally, or if the body cells become resistant to effects of insulin, one can develop symptoms of hyperglycemia or diabetes, which once left untreated, can result in many complications and require long-term treatment.

Regarding diabetes and it’s treatment I will share with you next time. Please tell me your suggestions.

RIGHTS OF MEDICINE ADMINISTRATION

Hello dear all student nurses…..

We the medical personnel are the ones dealing with medicines daily and among them we nurses are mostly dealing with tablets and injections  in every shifts. As we are also human , error is expected. But medication error is undoubtedly , unexpected from a nurse. To avoid errors while administering drugs they must follow the rights of medicine administration. The ten rights of medicine administration are as follows :

1)   RIGHT DRUG

Check if it is the right name and the drug is in the right form as prescribed. Be careful regarding the LASA drugs , that is, Look Alike – Sound Alike drug names. For example, Captopril and Carvedilol

Cisplatin and Carboplatin

Dopamine and Dobutamine etc.

Also, TRIPLE CHECK the medication label  . First check , before taking out of the shelf. Second check while preparing the medicine. And the Third check before replacing the container back to shelf.

2)  RIGHT PATIENT

Ask the patient name even if you know his / her name. Check the ID bracelet. Check and compare all the given names and not only the first name.

3)  RIGHT DOSE

check for the correct dosage in the doctor’s prescription and in the drug sheet. Be resourceful on medicine calculation formulas. Also , take into account if it’s an adult dose or a paediatric dose prescribed.

If required counter check the calculation and dose with another nurse.

4)  RIGHT ROUTE

Check the doctors prescription to confirm the route of administration of the medicine. Check if it is IV, IM, oral, SQ etc and administer and document accordingly.

5)  RIGHT TIME AND FREQUENCY

confirm from the prescription the time to administer the medication also check when was the last dose of the  medicine administered.

6)  RIGHT DOCUMENTATION

Proper documentation with date , time , medicine name, dose, route of administration, any reactions like allergies is necessary. NEVER document before the medicine is administered.

7)  RIGHT HISTORY AND ASSESSMENT

Thoroughly  check the medical history of the patient regarding any allergies to medicine or food. Any history of previous drug interactions or allergic reactions should be filed properly.

8)  RIGHT TO REFUSE

This right gives the patient full autonomy to make decision to refuse or receive the drug. Explain to the patient the uses , effects as well as the side effects of the medicine you are administering. When he / she refuses try to explain the consequences of their refusal. Inform the doctor who prescribed the drug regarding the refusal. Clearly document everything in your record.

 

9)  RIGHT EDUCATION AND RIGHT INFORMATION

Prior explanation regarding every aspect of the drug is necessary. Thoroughly explain which medicine is to be administered and why. Also explain it’s effects , time of onset of action, and any side effects of the medicine. Educate the patient to contact his/her doctor if they experience any side effects or reactions.

10) RIGHT DRUG – DRUG INTERACTIONS AND EVALUATION

Review the medicine given previously and the diet the patient took, inorder to identify any untoward drug interactions with the medicine to be administered. Thoroughly check the expiry date of the medicine also.  Also, Evaluate the outcome of the therapy after the medicine is administered.

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These 10rights if properly followed one could avoid medication errors to a larger extent. Hope you all will  keep these rights in mind while administering medicines to your patients. Have a nice duty!!!!

Please feel free to post your feedback and suggestion in the comment box .

 

 

 

To begin with pharmacology

Hi dear all student nurses ……Being a student is a bit tedious and if the case is a student nurse …..can’t express correctly what to say….In the due course of giving The TLC, being resourceful is a must.

Here I try to give some lecture notes in pharmacology which would help you all in your exams . Morethan that , trying to make you all fall in love with pharmacology which is otherwise a dry difficult subject. Feel free to give your feedback, suggestions n comments in the comment box below. 

The Journey Begins

Thanks for joining me!

Good company in a journey makes the way seem shorter. — Izaak Walton

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