Hi All
In preparation for the BOH 2 OSCA lets get some discussion going on the following topics:
What are cardiomyopathies? What do you need to consider when treating patients with these conditions?
Explain the pharmacological nature of the following:
ACE inhibitors & Angiotensin- II-receptor antagonists.
Beta 1-adrenoceptors and Beta 1-blockers as well!
Why is diabetes considered an autoimmune disorder?
Lets get the discussion flowing!
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Cardiomyopathy is a disease of the heart muscle where the heart muscle is enlarged, thickened or stiffened therefore reducing its ability to pump. Usually there are no symptoms until complications develop and it becomes life-threatening.
ReplyDeleteDental considerations: adrenaline should be used in limited amounts, restriction of mitral valve movement may lead to regurgitation and need for antibiotic prophylaxis because of patient’s susceptibility to infective endocarditis
Cardiomyopathies is disease of the heart muscle causing stiffened, enlarged or thickened tissue resulting in a reduction of the ability to pump. Dental considerations include susceptibility to infective endocarditis therefore consideration of antibiotic prophylaxis (cover). Additionally when prescribing LA, adrenaline should be used with caution and in very limited amounts.
ReplyDeleteDiabetes is considered an autoimmune disease due to the auto-immune destruction of beta cells of the pancreas therefore encouraging hyperglycaemia. This is a delayed secretion of insulin in response to glucose within the blood; regulating the body's blood glucose levels. Hence BGL's are elevated! Prolonged exposure to high blood sugar levels results in:
- Cytokine (inflammatory mediator) dysfunction altering response to bacterial challenges
- Collagen (structural fibres of periodontium connective tissue) turnover defects
- Suppressed bone repair following damage and resorption
and as a result:
- Structure of blood vessels altered, affecting blood supply and
- Impaired immune defence mechanisms compromising and delaying wound healing.
Off to review ACE, AngioII Beta-1 adreno and blocker ;o)
Does that mean that only type 1 diabetes is considered an autoimmune disorder? Because type 2 is where there is insulin resistance and insulin deficiency and the beta cells are dysfunctional, not destroyed?
ReplyDeleteGood point Karen. I guess you could say destroyed or dysfunction of beta cells. Ultimately the manifestations would be similar as a result.
ReplyDeleteOkie dokie, let me tackle the pharmacology of the drugs listed.
ReplyDeleteACE Inhibitors (used to treat high BP) -
First lets explain a pathway that rises BP called the renin-angiotension-aldosterone cycle. First renin (a protein) is synthesised by the kidneys and enters plasma --> renin is then involved in producing angiotensin 1 in the blood --> following this step angiotensin 2 is made by the angiotensin-converting enzyme (ACE). So why don't we like angiotensin 2? it causes vasoconstriction which = high BP. Angiotensin 2 also stimulates the aldosterone hormone to be released. Aldosterone increases the resorbption of sodium and water back into the blood stream, resulting in greater fluid volume in the body = high BP.
This is where ACE Inhibitors come to the rescue. They basically stop angiotensin 1 being converted to angiotension 2; by inhibitng the ACE. Therefore, reducing BP.
Still on the topic...angiotension 2 antagonist --> I think these guys block receptors located in blood vessels and cardiac muscle, preventing angiotensin 2 from binding to these receptors and activating which would = vasoconstriction.
Next!
Beta1 -adrenoceptors and beta blockers.
So firstly, we know that beta-1 receptors are located in the heart, blood vessels and kidneys (i think). We also know that adrenaline comes along and binds to beta-1 receptors = a symmpathetic response e.g. accelerated heart beat and force of contraction. Beta blockers are handy this way because they compete for the beta1 receptors and in doing so stop adrenaline from binding to them..this is why B-Blockers are used to treat angina, High BP, arrhythmias.'
Phew! :)