your chest pain… is it simply a chest pain or a heart attack???

Image result for images angina pectoris

It’s a common topic of discussion these days,  about the chest pain and heart attack. Several videos and writings regarding the topic and how to manage it is flying through the social media daily. Yes, it is a serious thing. But, do you think every chest pain of yours is a heart attack?. I thought to share with you what is my knowledge on the topic.

 

A chest pain which is felt like pressing, squeezing, choking or bursting and radiating to the left hand, shoulders, and left side of neck and jaw could be a serious symptom of a heart attack. At the same time, it could be a minor attack of angina pectoris. So,

what is the difference between Angina Pectoris and Myocardial Infarction(MI)?

ANGINA PECTORIS

  • Angina Pectoris is a symptom
  • Anginal pain is expressed as squeezing, chocking type felt at the Sternum
  • Angina can be different types
  • Caused by a decrease in oxygen supply to the heart muscles or an increased demand of oxygen
  • Maybe precipitated by activity or can occur during rest
  • ECG change noticed – ST depression
  • Investigated with the help of Stress Test
  • Relieved by rest or administration of Nitroglycerine

MYOCARDIAL INFARCTION(MI)

  • MI is a medical emergency
  • The chest pain is expressed to be crushing and typically spreads from the heart to the left arm, shoulders, jaw, neck, and back
  • Caused by the damaged myocardial cells resulting from  myocardial infarction (lack of oxygen supply to myocardium)
  • ECG shows a T wave inversion and an ST segment depression or elevation
  • Investigated mainly by labs – cardiac enzyme levels
  • Not relieved by rest or any medicines. Needed supportive therapy with Oxygen, analgesics, and positioning

 

Do you get additional points to add? .Please comment in the comment box.

Have a happy, pain-free life …

All About Antihypertensive Series 4 – Diuretics

Hello all nursing students there,

This is the fourth topic in All About Antihypertensive Series… You can read other topics in this series here… Diuretics are primarily those drugs help in the diuresis or increased production of urine. These drugs mainly affect the renal mechanism for tubular secretion and reabsorption of water and electrolytes. Diuretics are classified as follows

Classification and Examples

Thiazide and Thiazide-like diuretics

  • Chlorothiazide
  • Hydrochlorothiazide
  • Metolazone
  • Chlorthalidone
  • Indapamide

Last two are the examples for Thiazide-like diuretics.

Loop Diuretics

  • Furosemide
  • Torsemide
  • Bumetanide

Potassium-sparing Diuretics

  • Amiloride
  • Spironolactone
  • Triamterene

Osmotic Diuretics

  • Mannitol

Carbonic Anhydrase Inhibitors

  • Acetazolamide
  • Methazolamide

Mechanism of  action

The action of the diuretics varies depending on the agents. Generally, all affect on the renal mechanism for tubular secretion and reabsorption and enhance the selective excretion of various electrolytes and water.

In the management of hypertension, the diuretic of choice is the Thiazide and the Thiazide-like diuretics and the loop diuretics. Other groups have only a weak Antihypertensive property and are used in different conditions too. For instance, potassium-sparing diuretics are to conserve potassium in patients receiving  Thiazide and loop diuretics, whereas, osmotic diuretics are a major choice in treating cerebral edema.

Contraindications

  • Hypersensitivity
  • Sulfa agents allergies
  • Gout
  • Pregnancy

Adverse effects

Thiazide and loop diuretics have the following side effects

  • Orthostatic hypotension
  • Metabolic alkalosis
  • Ototoxicity
  • They decrease levels of Na+, K+, and Mg+
  • They increase the levels of serum calcium, uric acid, glucose, cholesterol, and triglycerides

potassium-sparing diuretics specially Triamterene has the following side effects

  • Nausea
  • Flatulence
  • Skin Rashes
  • Nephrolithiasis

Drug Interactions

  • Additive hypokalemia with CORTICOSTEROIDS
  • Additive Hypotension with OTHER ANTIHYPERTENSIVES
  • Hyperkalemia with potassium-sparing diuretics and  ACEIs, ARBs, or Aliskiren
  • Lithium toxicity with potassium-sparing diuretics and LITHIUM as the combo reduce lithium excretion.

Nursing considerations

  • Fluid status must be monitored by, daily weight checks, maintenance of I/O chart, and assessment for any edema, lung sounds, skin turgor, and condition of the mucous membrane.
  • Assess any electrolyte imbalances by assessing for anorexia, muscle weakness, numbness, confusion, excessive thirst
  • Monitor pulse and BP before and during the therapy
  • Monitor lab values for electrolytes, especially K+, blood glucose, BUN, serum uric acid.
  • Administer oral diuretics in the morning to prevent sleep disturbances
  • Instruct to continue the Antihypertensive dose as prescribed even if the symptoms relieved.
  • Advise to change positions slowly to manage Orthostatic hypotension
  • Instruct to monitor weight weekly and to report significant changes.
  • Teach self-monitoring of pulse and BP
  • Caution on photosensitive reactions -instruct to use protective clothing and to use protective sunscreens

Hope you find it easy to follow and useful. Give your suggestions for further improvement…

Have a concentrated study time…

All About Antihypertensive series 3 – Calcium channel blockers, CCBs

Hi to all student nurses…

This is the 3rd topic in the All about Antihypertensive series. Calcium Channel Blockers or Calcium antagonist are drugs with multiple roles, which makes it the most widely used cardiovascular medicine. This multifunction (which you can find below) property makes these drugs effective not only in hypertension but also in angina, cardiac arrhythmias, some type of a headache etc.

Examples

CCBs includes drugs in three classes

  1. Phenylalkylamines ( verapamil)
  2. Benzothiazepines ( Diltiazem)
  3. Dihydropyridines ( Nifedipine and other alike drugs with the suffix  -dipine)

sometimes, phenylalkylamines and Benzothiazepines together is known under the class Nondihydropyridines

How CCBs act ( mechanism of action) 

These drugs inhibit or block the flow of extracellular  Ca2+ ions through the “L- type” Ca2+ channel, that is located on the vascular smooth muscles. This blocking results in the relaxation of smooth muscle cells, resulting in vasodilation and lowering of BP.

  • L-type Ca2+ channels, located on vascular smooth muscles, cardiac myocytes, and nodal tissue (SA and AV node). It regulates Ca2+ influx into the muscle cells and stimulates smooth muscle and cardiac myocytes contraction .once these channels are blocked,
  • Vascular smooth muscle relaxation – Vasodilation
  • Decrease myocardial force generation –  -ve inotropy
  • Decrease heart rate –  -ve chronotrophy
  • Decrease conduction velocity within the heart –  -ve dromotrophy

(If we consider the calcium channel as a mountain passage and the membrane as the mountain itself, CCBs act as a closed check post preventing the entry of ca2+ ions into the cells.)

CCBs

Indications

Mainly used in the following  cases

  1. Hypertension
  2. Arrhythmia
  3. Angina
  4. Raynaud’s disease
  5. Cluster headache.

Contraindications

  • Hypersensitivity
  • Pregnancy and lactation

Side Effects

Serious side effects are rare for CCBs. Major side effects may include-

  • Flushing
  • Headaches
  • Hypotension
  • Peripheral oedemas
  • Bradycardia

Grapefruit intake is not recommended along with CCBs, as it alters the effects of the drug.

Beta blockers are not given with CCBs, as both groups depress cardiac electrical and mechanical activities 

Nursing Considerations

  • Monitor BP and pulse before therapy, and in between the therapy
  • Monitor ECG periodically for prolonged period  therapy
  • Administer along with meals or milk to reduce the gastric irritation
  • Teach the patient self-monitoring of  Pulse and BP, and ask to inform any alteration
  • Advise to change position slowly to minimize the effects of Orthostatic hypotension.
  • Advise to inform any signs of side effects

These are the important points in CCBs. Have a happy and enthusiastic study time.

 

All About Antihypertensive Drugs Series-1-ACE INHIBITORS

Hello dear all nursing students…

Thought to share with you the different categories of antihypertensive drugs in the simplest way (the way which I think would help in your exams). This topic is divided into various series under the headline – All about Antihypertensive Drugs Series… In this very first series, I will give you some notes on ACE inhibitors.

ACE INHIBITORS (prils suffix group)

These are the most widely prescribed Antihypertensive agents. This group includes the drugs with – pril suffix.

Examples of ACE inhibitors

  1. Captopril ( Capoten)
  2. Enalapril ( Vasotec)
  3. Lisinopril ( Zestril)
  4. Ramipril ( Tritace)

HOW ACE INHIBITORS ACT

* As the name indicates, the fundamental action of these drugs is the inhibition or blocking of Angiotensin Converting Enzyme, which is responsible for the convention of Angiotensin I to Angiotensin II in the Renin-Angiotensin-Aldosterone mechanism, thus prevent Aldosterone release and its effects.

ACE inhibitors ———-> prevent AT II production —-> results in

  1. No Aldosterone release
  2. Eliminate sodium ions
  3. Retain potassium ions
  4. Decrease peripheral arterial resistance
  5. overall, Decrease in BP and Blood Volume

INDICATIONS (When it is used)

* Hypertension – Primary use is to decrease BP

* Congestive Heart Failure (CHF) – In combination with diuretics and digitalis for the overall improvement of the patient

* Ischemic Heart Disease – To reduce the risk of attack and stroke

* Diabetic Nephropathy – prevents progression of Nephropathy

CONTRAINDICATIONS

*Hypersensitivity

* Pregnancy

* Renovascular diseases

* Aortic stenosis

SIDE EFFECTS

* Hypotension

* Persistent dry cough

* Nausea

* Hyperkalemia

NURSING CONSIDERATIONS

* Closely monitor BP before and in between the administration. Systolic BP should be maintained > 80 mm of Hg.

* obtain baseline vital signs and lab reports of CBC, LFT, RFT, electrolytes, prior to treatment.

* First dose Hypotension management- an Initial dose of ACE inhibitors has the risk of 1st dose Hypotension. So, advise the patient to sit or lie down for 2 – 4 hours after the first dose.

* Orthostatic Hypotension management- Advise the patient to rise and change the position very slowly

* Teach the importance of withholding of potassium-sparing diuretics and other potassium supplements

* Advise reporting any of the signs and symptoms of side effects

* Explain to the patient that taste loss is expected for 2-3 months, and if it persists to notify the physician

BONUS NOTES

CAPTOPRIL

  • First ACE inhibitor
  • Only ACE inhibitor capable of passing Blood-Brain Barrier
  • Cause false positive result for urine acetone

ACE INHIBITORS – FLASH CARDS 

ACE Inhibitors Effects

DRUGS OF APRIL

INDICATIONS

CONTRAINDICATION

ACE Inhibitors NURSING considerations

 

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.

WhatsApp Image 2018-05-05 at 7.26.39 AM

 

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.

1

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.