First Degree Atrioventricular Block Essay

First Degree Atrioventricular Block Essay
First Degree Atrioventricular Block
First degree atrioventricular block is a type of heart block. The heartbeat is a coordinated contraction
between the upper and lower chambers of the heart. This coordinated contraction happens because
of an electrical impulse that is sent from the upper chambers of the heart to the lower chambers of
the heart. The electrical impulse causes the heart to beat and pump blood. Normally, this electrical
impulse is transmitted without delay. A first degree heart block is a slight delay of this electrical
impulse transmission from the upper chambers of the heart to the lower chambers of the heart.
CAUSES
RISK FACTORS
Older age. The heart's electrical system can slow due to the aging process.
History
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Treatment For Inappropriate Sinus Tachycardia
ABSTRACT
Inappropriate Sinus Tachycardia is a chronic medical condition with a wide variety of clinical
presentations making it, sometimes, very insidious at the time of the diagnosis. Several therapeutic
options including, pharmacotherapy, cardiac rehabilitation and modification or ablation of the sinus
node have been proposed for the management of Inappropriate Sinus Tachycardia. But due to the
complexity and not well understood pathophysiology, it can be difficult to manage despite the
numerous treatment options currently available. The purpose of this review is to analyze the
treatment for Inappropriate Sinus Tachycardia focusing on the role of newer therapy and the
potential benefits in the management of this cardiac rhythm ... Show more content on
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[4]
The clinical presentation of patients with IST can vary due to the diversity of its multiple symptoms
including: intermittent palpitations, dyspnea, dizziness, lightheadedness, pre–syncope, syncope,
chest pain, myalgia, and fatigue. [12] Associated psychological and emotional problems can also be
seen, but no relationship with IST has been identified. [8]
Using a criteria of a resting heart rate >100 bpm and an average heart rate of >90 bpm on 24–hour
Holter monitoring, Still et al., estimated the prevalence of IST in a middle–aged population of men
and women. The IST prevalence was 1.2% (7 of 604 patients) [2], including both symptomatic and
asymptomatic patients. IST has also been reported in older population. [5] Although, IST is believed
to be a chronic condition, long–term complications are few. IST has been associated with
tachycardia–induced cardiomyopathy in isolated cases [6][7] and no mortality has been yet reported.
IST is a medical entity that should be diagnosed by exclusion, medical history and physical
examination and should be assessed thoroughly, aiming to the potential causes of sinus tachycardia,
thus, thyroid disease, medications, hypovolemia, panic attacks, anxiety and substance abuse should
be ruled out. A 12–lead EKG is useful for recording tachycardia and defining sinus rhythm, which
helps differentiate IST from

Angina Essay
In Focus on Pharmacology Essentials For Health Professionals, Jahangir Moini states "angina
pectoris is a common form of ischemic heart disease and often precedes and accompanies MI"
(Moini, 2013. p.359). When having angina, a patient will feel pressure in the chest like a squeezing
sensation and the pain can travel to the jaw, down the arm, into the neck, shoulders, or back.
There are three types of angina: stable, unstable, and variant. Most common types are stable and
unstable. Stable angina is a result of plaque buildup which has caused narrowing of the coronary
artery. The body can get enough blood to the heart when it's in a resting state and not exerting itself.
When the need for exertion arises, climbing a set of stairs for example, it needs more oxygen since
the heart is working harder but the narrowed artery is preventing the increase in blood flow needed.
The angina symptoms will start to subside after taking nitroglycerin and resting. ... Show more
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This can occur while the body is in a state of rest unlike with stable angina. Nitroglycerin and rest
will not alleviate the uncomfortable feeling and pain. This typically occurs when there is a partial or
full blockage of the coronary artery due to a blood clot.
Variant angina can occur in people who do not even have hart disease. It is rare, but is the result of
coronary artery spasms. The spasms cause the walls to constrict which lessens or stops the blood
flow to the heart.
On the website CV Pharmacology, Richard Klabunde, PhD tells us that the classes of drugs to treat
angina are as

Types And Classifications Of Pulmonary Hypertension
Abstract Pulmonary hypertension is a disease that without treatment becomes progressively worse
until a patient dies. It is characteristically a disease of young adults, but may occur all across the
lifespan making this disease even more devastating.1 Pulmonary hypertension is characterized by
elevated intrapulmonary pressures which cause dynamic changes to the cardiovascular system of the
affected individual. The adequate functioning of the cardiovascular system is vital to the survival of
the patient so while treatment is rarely curative, with the exception of organ transplant which will be
discussed later, the main goal of medical therapy is to optimize cardiovascular functioning and stop
disease progression allowing people living with this disease the best possible quality of life and
level of functioning. There are several types and classifications of pulmonary hypertension with
multiple pathogenesis. Different treatment modalities have been proven effective to treat this disease
process; the mainstay of treatment relies heavily on pharmacologic therapies. Pharmacologic
treatments include drugs in the following pharmacological classes: calcium channel blockers,
prostacyclins including synthetic prostacyclins and prostacyclin analogues, endothelin receptor
antagonists, and phosphodiesterase inhibitors. While pharmacologic therapies are the mainstay of
treatment, heart and, or lung transplant maybe available for a specific subtype of PH, primary PH.
Organ transplant is

Prescribing Patterns Of Drugs Used For Treating...
Original Research Article
PRESCRIBING PATTERN STUDY IN HYPERTENSIVE OUTPATIENTS IN A TERTIARY
CARE TEACHING HOSPITAL M.S.K.M.CHAITANYA*, D.SATHEESH KUMAR and
V.J.VISHNU VARTHAN.
Department of Pharmacy Practice, SRM College of Pharmacy, SRM University, Kattankulathur zip
code 603203, Chennai, India.
ABSTRACT
Aims: The prescribing pattern of drugs used for treating hypertension changes over time in response
to changes in recommended guidelines and innovations in drug formulations, among others. In
addition, the classes of antihypertensive drugs used vary among the countries. The aim of this study
was to investigate the practice of antihypertensive medications in Tertiary care hospital in India.
Study Design: Retrospective analysis of prescription pattern for hypertensive outpatients.
Place and Duration of the Study: Tertiary care hospital, Tamil Nadu, India and duration of the study
was 12 months.
Methodology: Prescription pattern of 400 hypertensive outpatients were analyzed on basis of age,
percentage of male and female patients, anti–hypertensive drug category, most frequently prescribed
hypertensive drug and percentage of one/two drug combination.
Results: As monotherapy ACE–Inhibitors 38.25% (153 prescriptions) were the most commonly

Postoperative Hypertension
Postoperative hypertension may cause serious adverse events with both cardiac and non–cardiac
patients.1–3 Postoperative hypertension generally occurs within 30 minutes after surgery has been
completed and may last up to two hours. Acute perioperative hypertension occurs in 80% of people
undergoing cardiac surgery and 25% of people undergoing non–cardiac surgeries, such as head and
neck surgery or renal transplantation. If not treated appropriately, an acute increase in blood pressure
may be related to further undesired complications, such as myocardial ischemia, stroke, bleeding,
and heart failure. Hypertensive emergencies such as postoperative hypertension are more common
in patients with uncontrolled hypertension, diabetes mellitus, or renal disease. The main risk factor
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Hypertension is presented as an increase in blood pressure. Blood pressure is the product of
increased cardiac output and systemic vascular resistance. The risk factors are what attribute to the
pathophysiology of postoperative hypertension. Hypercarbia causes an increase in catecholamine
concentrations, which increases blood pressure. To decrease the risk of end organ damage and
surgery complications associated with hypertension, therapy should be initiated in patients with
systolic blood pressure above 180 mmHg or a diastolic blood pressure above 110 mmHg once the
risk factors (pain, hypercarbia, and excitement on emergence of anesthesia) of postoperative
hypertension have been treated. There are many complications and other underlying conditions may
be associated with patients postoperatively and the medications chosen to initiate should be based on
each individual patient. The ideal medication to treat postoperative hypertension has a quick onset
and a short duration of

The Efficacy Of Neurologic Deficits From Cerebral In...
The efficacy of nimodipine in the reduction of neurologic deficits from cerebral vasospasm in
patients with aneurysmal subarachnoid haemorrhage (aSAH)
Introduction
Subarachnoid Haemorrhage (SAH) is the presence of blood in the subarachnoid space. It is
characterised by sudden onset of severe headache, often described as "thunderclap headache".[1]
Eighty–five percent of the cases are caused by an aneurysm and 50% of patients diagnosed with
SAH die.[2] The estimated incidence of SAH was at 10 to 15 per 100 000 person–years, but recent
studies showed 6 to 8 per 100 000 person–years.[3] A New Zealand study in 1985 showed higher
incidence rate of SAH in women than men.[4] Same findings were noted in one Australasian study
conducted in 2000, wherein among the four neurosurgical units tested within Australia and New
Zealand, results showed highest incidence of SAH in Auckland, attributing mainly to the high
incidence of SAH among Maori and Pacific Islanders.[9] Cigarette smoking, uncontrolled
hypertension, and excessive intake of alcohol remain to constitute the biggest threat [17]. Ten
percent of the cases were also linked to a positive family history.[2] The risk is also increased during
vigorous activities like physical exercise, Valsalva manoeuvre during defecation, micturition and
sexual intercourse[19] relatively due to increased intracranial pressure associated with these
mechanisms.
Despite recent advancements of SAH management, neurologic deficits secondary to cerebral

Bacterial Infection Paper
The first step in any bacterial infection involves the attachment of bacteria to the host surface, which
followed by colonisation, and infection. Streptococcus pneumonia is a significant human pathogenic
bacterium; organism causes invasive diseases such as sepsis, meningitis, pneumonia and some more
disease in human. In pneumonia it attaches to nasopharyngeal cells through interaction of bacterial
surface adhesins. Tao Wang et al (47) reported that Big Domain ( bacterial immunoglobulin like) of
SP0498 a surface protein is a novel Ca2+–binding module, and suggested important role of the Big
domain in many essential calcium–dependent cellular processes. Such domain are also reported in
Escherichia coli intimin, and Yersinia pseudotuberculosis ... Show more content on Helpwriting.net
...
and Tisa et al (3 and 4) Reported that the addition of a repellent resulted in E.coli cells tumbling and
a transient increase in cytoplasmic free–Ca2+ and addition of an attractant to wild–type cells caused
running and produced a transient decrease in cytoplasmic free Ca2+ levels. How an increase in
cytoplasmic Ca2+ is associated with tumbling and a decrease is associated with running remains to
be determined. Moreover In the same study (4) they showed that mutant for sensory receptor were
did not responded to chemical stimuli sensed by them, which remain unexplained?, though they
speculated/propose that increase and decrease in cytoplasmic ca level is linked with the
phosphorylation state of cheY protein which in turn controls tumbling and Running, there are no
concrete evidences to support this hypothesis as of yet. Various Ca2+ antagonists (and Ca2+channel
blockers) used in animal research, are (now) known to inhibit bacterial chemotaxis which includes
ω–Conotoxin GVIA , Gallopamil , verapamil, diltiazem, tiapamil, nifedipine, and nitrendipine to
name some .E.coli Cell treated with (these) ca channel antagonist showed running bias i.e. that ca
antagonist running was predominant and tumbling was inhibited (2,). What is the reason behind this
bias is not known yet and since animal–like Ca2+ channels do not appear to be coded for by the E.
coli genome , it is unexplained why Ca2+ antagonists

Failure Of Congestive Heart Failure
Approximately 2–3 million Americans, more than one percent of the population, are currently
affected by this medical problem with numbers increasing frequently (Drug Store News, 1997).
Congestive heart failure tends to be more common in the elderly, men, and also African Americans.
Congestive heart failure has become the most common cause for current hospital admissions.
Among causing prolonged hospital stays congestive heart failure has a very high mortality rate,
which has declined since recent medical advancements.
So what is congestive heart failure? A simple definition is the heart 's inability to pump blood to the
rest of the body but it goes way beyond that. The body's natural mechanisms try to compensate for
the changes that ... Show more content on Helpwriting.net ...
This negative feedback loop in most conditions is good, but with congestive heart failure it forces
the heart to work harder causing advancement of the disease.
Right–sided heart failure consists of the heart unable to pump blood to the lungs. This can cause
right ventricular hypertrophy, and fluid will start to back up into the body causing edema where
gravity determines. Lying down may cause edema in the buttocks and flank areas but most
commonly people see edema in their ankles and legs along with increase weight gain over short
periods of time. This type of congestive heart failure is still very important and should be seen by a
physician to prevent further problems, because patients with right sided heart failure are at high risk
for left sided heart failure.
Signs and symptoms of congestive heart failure can range from mild to severe. They also can be
associated with many other disease processes making congestive heart failure harder to diagnose.
Even most doctors have to run numerous amounts of tests to confirm the diagnosis without 100%
certainty. Patients may present with shortness of breath, rales (fluid in lungs), peripheral or
pulmonary edema, dizziness, fatigue, dyspnea on exertion, rapid and excess weight gain, jugular
venous distention, reduced ejection fraction, severe hypertension or hypotension, and failed stress
tests (Drug Store News, 1997). These symptoms are not specific enough for a clear diagnosis so
additional testing is usually

Failure Of Congestive Heart Failure
As congestive heart failure continually increases among people worldwide it is a medical condition
that is beginning to become more of a concern even for people at younger ages. It is typically a
disease addressed by late age and elderly patients but many cases of earlier age have been shown.
Because congestive heart failure has evolved when it comes to treatment, patients experience a
remarkable difference on quality of life even over the last ten years. Although signs and symptoms
remain the same, it has become easier to diagnose with technology and greater knowledge over the
last decade. Congestive heart failure has many different types of heart failure. Many risk factors play
a role in congestive heart failure that are ... Show more content on Helpwriting.net ...
Approximately 2–3 million Americans, more than one percent of the population, are currently
affected by this medical problem with numbers increasing frequently (Drug Store News, 1997).
Congestive heart failure tends to be more common in the elderly, men, and also African Americans.
Congestive heart failure has become the most common cause for current hospital admissions.
Among causing prolonged hospital stays congestive heart failure has a very high mortality rate,
which has declined since recent medical advancements.
So what is congestive heart failure? A simple definition is the heart 's inability to pump blood to the
rest of the body but it goes way beyond that. The body's natural mechanisms try to compensate for
the changes that the heart is failing to do, which in turn starts a cycle that doesn't end. When decline
in cardiac output is recognized the sympathetic system attempts to fix the problem by raising blood
pressure which causes the heart to work harder, worsening the heart muscle and starting the whole
process over again. It causes a cascading effect on the body that can be devastating. Ischemic heart
disease is the most common cause for congestive heart failure. Ischemic heart disease consists of
cardiomyopathies, dysrhythmias, valve disease, vascular problems and hypertension along with

Case Study : New Ob Visit
Date: 08/22/16 Formal Write–Up #2 CC: New OB HPI: YM is a 24 year old G2P1 who presents for
New OB Visit at 28 weeks 6 days. Her concerns are the following: 1. Diarrhea – The patient reports
traveling to Hawaii approximately 3 weeks ago. She returned home with loose stools. She had a
stool sample that showed positive parasites, and was subsequently started on Metronidazole. She
finished that course of antibiotics. After that, she continued to have persistent diarrhea. She was
worked up for C. diff which was found to be negative. She states that she had bloody stools initially,
but none currently. She states now she is just having watery stools, approximately 30 times per day.
2. Abdominal cramping – She attributes this to her GI symptoms as above. She denies regular and
frequent contractions but reports irregular contractions prior to her visit today. Her cramping is
cyclic in nature and persists throughout the day. 3. UTI – She is wondering if she has a UTI. She
recently had a UTI but reports taking an alternative medicine approach to its treatment. Today she
denies dysuria, hematuria, increased frequency or hesitancy of urination. 4. Weight Loss – She
reports an inability to gain and maintain weight during pregnancy. She reports that her diarrhea has
led to water loss. She also finds it hard to find foods she can tolerate. Review of Systems:
Constitutional: negative Eyes: negative Ears, Nose, Mouth, Throat: negative Cardiovascular:
negative

Calcium Channel Blockers Research Paper
Hypertension Calcium Chanel Blockers
Calcium channel blockers are antihypertensive medications that used in treating cardiovascular
conditions. There are three types of subclasses of calcium channel blockers which are
dihydropyridines, phenylalkylamines, and benzothiazipines (Edmund & Mayhew, 2014).
Medications classified as dihydropyridines are procardia, norvasc, plendil, and cardene. These
medications do not affect the cardiac conduction system. Dihydropyridines block calcium from
moving into the cell membranes of the cardiac and smooth muscle. The cell tissue affected by these
antihypertensive drugs is the cardiac muscle, SA & AV node, coronary arteries and arterioles, and
the peripheral arterioles. Calcium channel blockers contract the heart by stopping calcium ions from
going through the cell membrane during the plateau phase. This leads to failure of the calcium ions
to release large amounts of calcium into the sarcoplasmic reticulum inside the cell. The calcium is
needed to stimulate contractions by allowing the cross–bridge to form between the actin and myosin
of ... Show more content on Helpwriting.net ...
These symptoms are more likely to happen with procardia. Negative inotropic effects can also
happen with all three subclass but with verapamil first, diltiazem second and procardia last. Cardiac
conduction disturbances can happen when verapamil and diltiazem. Gastrointestinal illness such as
nausea and constipation are common with Verapamil. Procardia, verapamil, and diltiazem produce
metabolic effects such as inhibiting insulin in the body and digoxin levels has been shown to elevate
after administering of verapamil and procardia. Calcium channel blockers should not be used in
patients with second, third degree heart blocks and heart failure because the heart block can worsen
or become fatal (Russell,

Case Study Unstable Angina
1) Classical Angina (also called Stable Angina)
Can be caused by indigestion, emotional stress, when one's heart is working very hard, and not
getting as much oxygen as the heart needs. After rest, the pain goes away. Stable Angina does not
last very long.
2) Unstable Angina
Chest pain that is new, happens when working or at rest. It could be chest pain that continues to
worsen. This kind needs emergency care, possible treatment of drugs. It might be a warning of a
heart attack. Something is preventing enough blood flow or enough oxygen to get to the heart.
Unstable Angina last longer, and many times the pain is intense.
3) Variant Angina (also called Vasospastic Angina)
This kind doesn't usually happen very often, but is caused by spasms

Amiodarone Research Paper
Blood comes from the Superior and Inferior vena cava, into the right atrium. As the right atrium fills
with blood, it contracts and the tricuspid valve opens and the blood pumps into the valve. When the
right ventricle is full the tricuspid valve close to ensure blood moves in the right direction. The
blood then moves to the right ventricle and into another valve called the Pulmonary valve. Then
moves to the pulmonary artery and into the lungs. The blood moves into the lungs and picks up
fresh oxygen. Then it returns to the left heart through the pulmonary veins to the left atrium. It
passes through the mitral valve and enters the left ventricle. Oxygenated blood moves into the aortic
valve and into the Aorta to reach all parts of the body ( heart.org).
An arrhythmia is when there is a problem with the heart rate or rhythm. During an ... Show more
content on Helpwriting.net ...
This drug should be administered by a hospital or specialist. Amiodarone blocks Potassium and
Sodium ion channels and effectively reduces any type of arrhythmia( Moini, 2012).
Flecainide is a class 1c antiarrhythmic drug and used for ventricular dysrhythmias. Flecainide slows
conduction velocity throughout the myocardial conduction system and increases ventricular
refractoriness ( Moini, 2012).
Two types of Vasodilators are:
Nitroglycerin dilates blood vessels by affecting vascular smooth muscle. In stable angina, it
decreases cardiac oxygen demand, and in variant angina, it increases oxygen supply ( Moini, 2012).
Hydralazine is a strong antihypertensive and is usually only used when a patient is unresponsive to
other medications. When used, Hydralazine can produce some serious adverse effects such as
orthostatic hypotension, edema, headache, vertigo, dizziness fatigue, nausea, leukopenia and
eczema.
Beta–adrenergic blockers

ACE Inhibitor
The first line choice in patients with heart failure is Angiotensin–Converting Enzyme Inhibitors
(ACE Inhibitors). ACE inhibitors can help slow progression of heart failure and improve symptoms.
ACE inhibitors block the action of a protein (enzyme) that causes blood vessels to narrow. As a
result, blood vessels relax and widen. This lowers blood pressure and makes it easier for the heart to
pump blood. These medicines also help body release water and sodium, which also helps lower
blood pressure. ACE inhibitors relieve heart failure symptoms, such as fluid retention and edema.
They may help reduce liver disease and prevent readmission to the hospital. Examples of ACE
inhibitors are Captopril, Enalapril, Lisinopril, Quinapril, and Ramipril. ... Show more content on
Helpwriting.net ...
Amidarone extends the action potential refractory period in the heart. Each time electrical signals
are activated by reaching the action potential. They go through a refractory period where they are
decharged and it is much harder to become reactivated again. Amiderone also inhibits the sodium
channel in the heart and slow inward calcium current. Consequently, the conductivity of the
atriventricular is reduced. Amiderone should not be used in a patient with 2nd or 3rd degree heart
block or sick sinus syndrome without a pacemaker. Common side effects of amiderone include
sensitive to sunlight, fatigue, nausea and vomiting, and taste disturbances. Patients who taking
amiderone should be educated about applying sunscreen and minimize exposing to sunlight. Class
IV antiarrhythmic drugs include cardizem and verapamil. The drugs in this class are used to treat
superventricular arrhythmias which include PSVT, atrial fibrillation, and atrial flutter. The primary
action of the drug in class IV is to inhibit or slow down the movement of calcium through calcium
channels. This relaxes the vessels. The relaxed vessels let blood flow more easily through them,
thereby lowering heart rate. The common side effects of class IV drugs include constipation,
bradycardia, heart block, hypotension, dizziness, and peripheral edema.
(Textbook, p

Gingival Overgrowth Analysis
This article examines the causes of drug–induced gingival overgrowth. Three main categories of
drugs that are particularly related to gingival overgrowth are discussed. The authors also discuss the
appearance of this condition so that dental hygienists can easily identify it. They continue with
offering ways in which dental hygienists can be prepared to help patients with this condition. The
authors discuss three categories of drugs that contribute to gingival overgrowth: anticonvulsants,
immunosuppressants, and calcium channel blockers. First of all, the anticonvulsant phenytoin (brand
name is Dilantin) is the preferred drug used to treat epilepsy. It is also used to treat neuralgia and
cardiac arrhythmias. Phenytoin is often prescribed for long term use, and approximately ... Show
more content on Helpwriting.net ...
The appearance of phenytoin–induced gingival overgrowth usually includes an enlarged "pebbly"
marginal gingiva and bulbous interdental papillae. In severe cases, the gingival overgrowth may
completely cover the teeth surfaces. Bacterial plaque is an important determining factor of the
severity of phenytoin–induced gingival overgrowth. Secondly, calcium channel blockers are another
drug with gingival overgrowth implications. These drugs are used to treat cardiovascular disorders,
such as angina, arrhythmias, hypertension, and acute myocardial infarction. With this type of
gingival overgrowth, gingival enlargement is usually more prevalent in the anterior region of the
mouth. Gingivitis is a factor that predisposes patients to gingival overgrowth when they are taking
calcium channel blockers. Finally, the immunosuppressant drug cyclosporine is the

A Patient With A Suspected Dvt
What is an appropriate focused assessment and care to provide a patient with a suspected DVT? A
focused assessment is an assessment that centers directly on the chief complaint that a patient
presents with when they arrive to seek out care. In this case, our assessment is focused on a potential
deep vein thrombosis (DVT). A DVT is a essentially a ball of blood cells that are clumped together
impeding blood flow which can cause irritation to the vein and potentially more dangerous
problems. If the thrombus moves, it can travel through the body and into the lungs and impeded
breathing which is not good. Therefore, it is essential to catch DVT's right away and treat them to
prevent them from moving. The first thing that needs to be assessed when a patient presents with a
suspected DVT is their level of consciousness and their vital signs including the heart rate, blood
pressure, respirations, temperature and oxygen saturation. Next, assess the site of the expected DVT,
and perform a neurovascular assessment which comparing to the same site on the opposite side of
the patients body. Check for adequate circulation by assessing for pink color distal to the site. While
performing this assessment, you want the area distal to the site to be pink to ensure there is adequate
blood flow. If it is whitish in color, this is a sign of a DVT and needs to be documented. While
assessing color, also assess the site directly for any color deviation from the clients natural skin
color. If the

The Role Of Calcium Channels In Prostate Cancer
Cancer, the uncontrolled division of mutated cells producing tumours. Likelihood of developing the
disease is increased by a variety of factors such as age, over exposure to sunlight, certain chemical
exposures, etc. Research has shown that there is a role of calcium channels in cancer. Calcium
channels are essential pathways needed to allow calcium ions to enter the cells of the human body as
they are unable to penetrate the phospholipid bilayer. Calcium is needed in the body for such things
as nerve impulses and the formation of bones and teeth.
Calcium channels in prostate cancer: calcium channel blockers have been shown to prevent the
cancer from becoming more aggressive it has been shown that increased permeability of Ca2+
channels causes

Hypertension With Rationale
5. Medical or Surgical Management of Hypertension with Rationale:
There are many methods of treatment for hypertension. This includes exercise, a healthy diet,
quitting smoking, and medications. Some medications that might be prescribed to a hypertension
patient are thiazide diuretics, beta blockers, angiotensin–converting enzyme (ACE) inhibitors,
calcium channel blockers, and renin inhibitors. Thiazide diuretics, also known as water pills, help
improve the kidneys. They eliminate the sodium (salt) and excess water which reduces the blood
volume. Thiazide diuretics are most commonly the first drug that is prescribed to a hypertension
patient. These types of drugs include hydrochlorothiazide (Microzide), chlorthalidone, and many
others. Beta ... Show more content on Helpwriting.net ...
The patient diagnosed with having high blood pressure could easily deny it. This means that they
don't want to believe that they do, in fact, have hypertension. However, denial could also be a result
of the patient not understanding what hypertension is and how it affects him/her. Once the patient is
diagnosed and understands what this means for him/her, this could lead to psychological distress.
This includes anxiety and depression. Anxiety and/or depression could come from simply knowing
that they have hypertension or from the medications that the patient is placed on to treat their high
blood pressure. These are considered as side effects of the medication rather than from the high
blood pressure itself, although that is possible. Depression is a feeling of sadness, hopelessness, or a
feeling of being discouraged. Anxiety is a feeling of worry or nervousness. The family of a patient
who is diagnosed with hypertension would be affected by the response of the patient. Seeing their
loved one in distress caused by the challenges that he/she faces to treat their high blood pressure or
even the depression or anxiety can lead to psychological distress among the family itself. This
means that the loved one could become depressed or have anxiety. However, this can also be due to
the expense of the treatment. High levels of depression and anxiety in either the patient or family
can lead to horrible events such as an abuse of alcohol or controlled substances, a lack of motivation
for life, or in extreme cases, suicide. Even though hypertension can be a hard thing to cope with,
there are some methods that can help. Some methods could include meditating or yoga. This relaxes
the patient and family while also providing a form of physical activity. Another way for the patient
and even the family to cope could be exercising. Although exercise alone may not completely

Market Analysis Of Amidipine
Executive Summary:
Manidipine is a long acting dihydropyridine calcium channel blocker, a subclass of antihypertensive
drugs.
Manidipine competes direct with CCBs especially with Amlodipine Molecule (CCBs Market
Leader).
The total Amlodipine market volume reached 4.4 million strips (10 Tablets) for Amlodipine 5 mg
and 1.9 million strips for 10 mg.
Amlodipine is considered a first line of treatment of hypertension, especially in elderly patient,
according to international guidelines.
Manidipine is newly oriented to the market.
Situation Analysis:
Market Overview:
Defined Market
Long acting Calcium Channel Blockers (Mono Molecule).
Sub–Market: Amlodipine Antihypertensive (Mono Molecule).
Current Market Trend (5 Years) IMS–Data: ... Show more content on Helpwriting.net ...
Financial Objectives:
Thousands EGP FY/2013 FY/2014 FY/2015
Total Brand 3,746 5,594 7,033
Amlodipine 5 mg Tablets 2,474 4,004 5,045
Amlodipine 10 mg Tablets 1,272 1,590 1,988
Target Audience:
Cardiologist
Internist
General Practionner
Positioning Statement:
Amlodipine Tablets (Amriya) offers a 24 hour cardio protection beyond hypertension control for
those patient suffering hypertension with or without other risk factors, Amlodipine offers a high
quality product at an affordable cost and convenient once daily dose.
Main Indications:

Hypertension
Angina
Strategies:
Growth strategy:
Drive growth through market penetration:
Expanding prescribing doctor list.
Maintain current lists.
Addition of new pack (3 strips) for Amlodipine 5 mg Tablets.
Working in two dimensions:
Newly diagnosed patients.
Current un–controlled patients.
Marketing Mix:
Customer services
Revising calling lists and working on expanding prescribing and loyal doctor list in all regions.
Hammering in physicians in AM centers.
Regular PM visits/

Alcohol And Anti Hypertension Medications Essay
Ethnicity and Anti–hypertension Medications
Hypertension is a devastating disease state, increasing the risk for patients to develop strokes, heart
attacks, heart failure, and kidney dysfunction. It is prevalent in our population with an estimated 10–
15% of Americans diagnosed with hypertension (Hitner & Nagle, 2016). Hypertension is the leading
cause of cardiovascular disease (CVD), which results in nearly 1/3 of deaths annually in the United
States (Still, Ferdinand, Ogedegbe, & Wright, 2015). Hypertension is more likely after the age 60,
and is more common in African American patients. It affects 40.4% of African Americans and only
27.4% of whites, causing the African American community to carry a higher burden of
hypertension–related complications (Still et al., 2015). There is evidence that suggests some anti–
hypertensive medications are more effective in the African American population, including diuretics
and calcium channel blockers (Flack, Nasser, & Levy, 2011). It is important to understand how
ethnicity affects hypertension medications and what medications are preferential when treating
patients, especially of African American decent.
What is Hypertension?
There are two types of hypertension (hypertension), the most common is essential hypertension and
is the result of an unknown cause. Secondary hypertension occurs when the cause can be
established. Because the majority of hypertension is from an unknown there is little we can do to
manage blood pressure

Nursing Care Of The Emergency Department With The Primary...
It is important for graduate nurses to be familiar with chest pain management and therapeutic
interventions as chest pain can evolve rapidly and require quick responses from nurses and
collaborative teams. This essay will critically analyse the nursing care of a patient presenting to the
emergency department with the primary compliant of chest pain. In this particular case, the patient's
chest pain is being caused an acute coronary syndrome (ACS) possibly an acute myocardial
infarction (AMI) (Kervinen, 2013).
Following initial investigations, the priority was to manage pain and lower blood pressure. Severe
pain can impact vital signs, therefore vital signs can begin to stabilise with the reduction of pain
(ref). Hypertension also needs to be addressed as a priority. Unmanaged hypertension leads to
further damage to the myocardium and narrowing of arteries, which increases the risk of adverse
complications (refe). The pharmacological interventions carried out in emergency for pain including
Glyceryl trinitrate (GTN) and Morphine and stabilising blood pressure with Ramipril are supported
by systematic reviews and clinical guidelines including the National Institute for Health and Care
Excellence guidelines (NICE). In addition, non–pharmacological interventions to address
hypertension included bed rest, provision of comfort and dimming of lights are also supported.
Nursing Interventions (critically analyse + may identify others)
Chest pain (clinical guidelines + systematic

Total Knee Replacement
Nifedipine (Adalat,Procardia,others) Prototype Drug / .Therapeutic Class: Drug for hypertension
and angina Pharmacologic Class: Calcium channel blocker. ACTIONS AND USESNifedipine is
CCB generally prescribed for HTN and variant or vasospastic angina. It is occasionally used to treat
Raynaud's phenomenon and hypertrophic cardiomyopathy. Nifedipine acts by selectively bloking
calcium channels in myocardial and vascular smooth muscle, including those in the coronary
arteries. This results in less oxygen utilization by the heart, an increase in cardiac output, and a fall
in blood pressure. It is available as extended–release tablets (XL). ADMINISTRATION ALERTS
Do not administer immediate–release formulations of nifedipine if an ... Show more content on
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Ensure proper use and functioning of any home equipment obtained. | Ensuring therapeutic
effects:Continue frequent assessments as described earlier for therapeutic effects.(Blood pressure
and pulse should be within normal limits or within parameters set by health care provider. If drug is
given for angina and /or dysrhythmias, significant improvement in reports of pain, palpitations, or
ECG demonstrates improvement) | Encourage the patient to adopt a healthy lifestyle of low–fat food
choices, increased exercise, decreased alcohol consumption, and smoking cessation. | Encourage
appropriate lifestyle changes. Provide for dietitian consultation as needed. (Healthy

Insulin: A Case Study
Insulin (medication) is the use of insulin and similar proteins as a medication to treat disease. Insulin
comes in a number of different types including short acting (such as regular insulin) and long acting
such as NPH insulin. It is also may include: low blood sugar levels, skin reactions at the site of
injection and low potassium levels among others(ASH,2014). Insulin was first used by Canada
Charles Bestfrederick Banting. Insulin helps regulate sugar in the blood stream and also stores
excess glucose of type 2 diabetes mellitus, the patients compensate for increased insulin resistance
at the tissue level by increasing pancreatic beta–cell insulin resistance (Weyer et.,al). When this
compensation is no longer adequate to overcome the insulin ... Show more content on
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In hypertensive black patients, initiate therapy with a thiazide type diuretic or calcium channel
blockers.
Regardless of race or diabetes status, in patients 18 years or older with chronic kidney disease,
initial or add–on therapy should consist of an ACE inhibitor or ARB.
Do not use an ACE inhibitor in conjunction with an ARB in the same patient.
If a patient's BP goal is not achieved within one month of treatment, increase the dose of the dose
initial agent from another of the recommended drug classes: if 2–drug therapy is unsuccessful for
reaching th target BP, add a third agent from the recommended drug classes.
In patients whose goal BP cannot be reached with 3 agents from the recommended drug classes and
/ or refer the patients to a hypertension

The Treatment Of Pulmonary Hypertension
Treatments in Pulmonary Hypertension
Brooke Throckmorton
Kettering College
Abstract This paper discusses some of the different medications used in the treatment of pulmonary
hypertension. There are six different articles being used for each the medications, and other basic
information pertaining to pulmonary hypertension. The articles discuss studies performed on the
drugs to demonstrate their effectiveness on pulmonary hypertension. The articles exhibit important
information about how the therapeutic effects of the drugs have different levels of success in varying
patients. A few of the most common medications used in the treatment of pulmonary hypertension
being discussed in this review are: Vasodilators, High–Dose ... Show more content on
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Therefore, the pressure of the blood in the vessels is higher, causing pulmonary hypertension. If
blood cannot filter through the lungs properly, it does not get completely oxygenated. Poorly
oxygenated blood can cause many other issues to the body, so it is important to properly treat
pulmonary hypertension. Many different medications are used in treatment of pulmonary
hypertension including: Vasodilators, Endothelin Receptor Antagonists, Sildenafil, Tadalafil,
Prostacyclins, Calcium Channel Blockers, Anticoagulants, Diuretics, and Oxygen. Due to the fact
that the underlying cause of pulmonary hypertension is unknown, there are many studies on the
disease and the drugs used to treat it (Voelkel, Bogaard, Gomez–Arroyo, 2015). This review will
discuss the different types of medications used to treat pulmonary hypertension. Some of the
medications are found to be more effective than others based on the results of many studies that
have been performed on animals and humans. The goal of this review is to successfully compare and
contrast these different drugs based off of the studies performed on them.
Method
For this review, the Kettering College library online database was used to find peer reviewed articles
as references. Beginning on February 22, 2015, the search "treatment of pulmonary hypertension"
was used to narrow the results for the study. To shorten the results further, the year limit was set
from 2005

Essay On Verapamil
Prior to the early 1990s, verapamil was the only intravenous calcium channel blocker available for
the treatment of atrial tachydysrhythmias. Verapamil was notorious for its negative inotropic effects,
particularly the resultant hypotension that was seen most frequently in those patients who were also
volume–depleted. The intravenous form of diltiazem became available in the U.S. in the early
1990s; however, its use in the prehospital environment was limited until the late 1990s because the
drug was initially marketed as a refrigerated medication only. Lyophilized diltiazem has been
available for the last eight years or so, and its cost is reasonable compared with other cardiac
medications.
Diltiazem hydrochloride is a calcium ion influx inhibitor (slow channel blocker or calcium
antagonist). The therapeutic benefits of Diltiazem hydrochloride are believed to be related to its
ability to inhibit the influx of calcium ions during membrane depolarization of cardiac and vascular
smooth muscles. Diltiazem has also been shown to produce increases in exercise tolerance, probably
due to its ability to reduce myocardial oxygen demand. This is accomplished via reductions in heart
rate and systemic blood pressure at submaximal and maximal work loads. ... Show more content on
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It causes excitation–contraction uncoupling in various myocardial tissues without changes in the
configuration of the action potential. Diltiazem produces relaxation of coronary vascular smooth
muscle and dilation of both large and small coronary arteries at drug levels which cause little or no
negative inotropic effect. The result is increases in coronary blood flow (epicardial and
subendocardial) occur in ischemic and nonischemic models and are accompanied by dose–
dependent decreases in systemic blood pressure and decreases in peripheral

Use Of Calcium Channel Blockers And Parkinson 's Disease19
Use of Calcium Channel Blockers and Parkinson's Disease19 The Pasternak et al publication was a
Danish study that investigated the correlation between PD and CCB use via a retrospective cohort
study using the Danish Civil Registration System, with an Oxford 2b level of evidence. The primary
goal of this study was to determine if the incidence rate of PD in new users of DHPs differed
significantly from those non–users, when studying the Danish population ≥45 years of age between
January 1, 1998 and December 31, 2006. Researchers also hoped to evaluate PD rates among
specific DHPs, non–DHP CCBs, as well as rates of dementia and death among patients on CCBs.
Patients were excluded from the study if they had used a CCB within 2 years prior to the study, or
had pre–existing PD or PD–related dementia at the study onset. Patients use of CCBs was stratified
as: use (filling at least two consecutive prescriptions), past use, or 1 time use. PD diagnosis during
the study was defined as those individuals who had at least one hospital diagnostic code for PD in
addition to receiving at least one prescription for antiparkinson dopaminergic therapy. Raw data was
adjusted to account for sex, age, calendar year, and concomitant medication use. Propensity scores
were calculated because researchers felt that baseline differences (comorbidities, concurrent
medications, hospitalizations, socioeconomics, and geographic location). Logistic regression was
used to determine these scores, which

Jnc's Six Subsections
The following section is broken into six subsections that will assess how each topic relates to JNC 6,
7, and 8. The subsections are organized into the following: algorithms, classification of
hypertension, lifestyle modifications, pharmacological treatment, and management of care. It is
important to note that JNC 6 and 7 have a greater correlation in format and the types of
recommendations presented to clinicians. Contrastingly JNC 8 varies in format, as well as the type
of recommendations presented to clinicians, therefore each of the subsections may not contain
information on JNC 8.
Algorithms:
Algorithms are useful for clinicians because they provide a schematic visual that is presented in a
multistep model to help in the diagnosis and ... Show more content on Helpwriting.net ...
The algorithm begins with an indication that is used for adults over the age of 18 and noted that
lifestyle interventions should be continued throughout management. Goal blood pressures are
separated by age and presence of chronic disease. The goal for patients over 60 is SBP < 150 mmHg
and DBP < 90 mmHg. The goal for patients under 60 is < 140 mmHg and DBP < 90 mmHg.
Different goal values are presented for patients with chronic conditions. Treatment with medication
is categorized by: general population nonblack, general population black, chronic conditions black,
and chronic condition all races. Based on the algorithm black patients should only be prescribed
thiazide type diuretics and/or calcium channel blockers. While non–black patients can take all of the
medications listed in JNC 8 (thiazide type diuretics, ACEI, ARB, and/or CCB). If patient does not
reach goal blood pressure then three strategies are listed, along with lifestyle adherence. The
algorithm also explains not to use ACEI and ARB together. The final option for patients not at goal
blood pressure includes additional medications and/or referral to physician with an expertise in
hypertension

A Brief Note On The Role Of Intervention
VASOSPASM IN SUBARACHNOID HAEMMORHAGE The Role of Intervention
INTRODUCTION Subarachnoid haemorrhage (SAH), is a significant healthcare problem. It is
associated with significant mortality and morbidity even after adequate treatment has been
delivered. One of the major causes for this poor outcome is the development of vasospasm from the
pathophysiological process itself. For those patients who have survived the initial bleed, it remains a
challenge to ward off the effects of vasospasm. Various interventional and medical strategies have
been advanced to alleviate or minimise the effect of vasospasm, but are they really effective? An
attempt at answering this question will be made in this review of this terrible and life threatening
illness. CASE A 40 yo female presented to the emergency department of our institution with a two
hour history of a sudden onset of severe global headaches. This was associated with two episodes of
vomiting and photophobia. She had no complaints of loss of consciousness or lateralising weakness.
On examination she had a Glasgow Coma Score (GCS) of 15 with no neurological deficits. A non
contrast Computed Tomography (CT) Brain (Fig1) showed extensive subarachnoid blood in the
Sylvian fissure and basal cisterns. A CT angiogram showed a left posterior communicating (PCOM)
artery aneurysm. The patient was commenced on Nimodipine , intravenous crystalloids, blood
pressure control by titration with hydrallazine. A digital subtraction

Potential Inappropriate Medication (HT)
INTRODUCTION Hypertension (HT), defined as a chronic elevation of systolic and/or diastolic
blood pressure (BP), is in all probability the most common chronic disease today. Clinically
hypertension is not a disease at usual sense it is a risk factor for many future vascular diseases1,2. In
human body blood pressure is maintained by several factors such as kidney, sympathetic nervous
system, hormonal mechanisms along with the diet taken. These include lipids, magnesium, sodium,
potassium and the total energy intake3. When two or more drugs are co–administrated together there
is a possibility of developing drug interactions. These alteration may be caused due to changes in the
concentration of drug (pharmacokinetic interaction) or may be due ... Show more content on
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Doctors should cautious about Potential Inappropriate Medication (PIM) and other potential drug
disease interactions (PDDI). In this patients homeostatic mechanisms and functional capacities of
most drugs are reduced on being aged. Decline in renal function and GFR also affect the drug
clearance. It is evident from many other studies about the age related reduction in metabolic
capacity of liver of man5. This significantly influence the pharmacokinetics of a drug. Apart from
kinetics pharmacodynamic changes in the elderly patients are ascribed to changes in the sensitivity
to drugs. Polypharmacy is common in elderly patients is that more than 40% persons aged 65 or
above use more than 5 drugs and 12% use ten or more different medications7. This makes elderly
populations more susceptable to drug interactions. The probability of potential drug interactions for
a person taking 7 or more drugs is 82% whereas it is only 13% for a person taking two

Calcium Channel Blockers
About seventy million American Adults have hypertension or high blood pressure. Hypertension
increases the risks for a cerebral vascular accident, heart failure/disease/attack, and kidney disease,
which are leading causes of death (Mann, 2012). The treatment for hypertension includes lifestyle
changes and Drug therapy. There are four drug categories involved in the treatment of hypertension
two of which are Calcium channel blockers and Sympatholytics (Mann, 2012). This paper will
assess the various aspects of the different calcium channel blockers and the specific contraindication
with beta–blockers, which pertain to the sympatholytic class. As mentioned above, calcium channel
blockers or CCB's ... Show more content on Helpwriting.net ...
Nifedipine is almost always to be given with a fast acting beta–blocker because it may increase HR,
decrease BP, and slightly improve cardiac functions (Rosso & Kalman, 2007).
This ADR requires close monitoring of heart rate and rhythm, even if a patient does not receive a
beta–blocker. A nurse should teach the patient to measure blood pressure and pulse rate and if these
are below normal limits to report them. Another major complication that may occur is peripheral
edema. Under these circumstances, the patient is to take a diuretic. Inform the patient to look at their
legs and feet to check for swelling and to report this. Some other adverse drug reactions include
lightheadedness, syncope, facial flushing, paresthesia, and toxicity (Jones & Bartlett,

Essay On Raynaud's Disease
Raynaud's disease is when the body restricts the amount of blood flow to various parts of the body,
such as the hands and feet. There are some factors that contribute to making this disease worse, but
there are also some factors that can help in making this disease more controllable. With the very few
known facts about Raynaud's disease, it is not a disease that should be overlooked for the fact it
affects "approximately five to ten percent of Americans." (WebMD, 2005–2016).
When Raynaud's occurs, the body limits only so much blood flow throughout the body. The most
common restriction is in the hands and feet. Since the blood flow is restricted, this then causes hands
and feet to feel cold. There is a numbing feeling that could occur, that ... Show more content on
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The most common reason why Raynaud's phenomenon occurs is because of exposure to the cold.
"In the cold, it is normal for the body to narrow the small blood vessels to the skin and to open the
blood vessels to the inside part of the body to keep the body warm. But with Raynaud's, the body
restricts blood flow to the skin more than it needs to." (WebMD, 2005–2016). Other reasons consist
of taking certain medications, using vibrating power tools for a number of years, excessive smoking,
having emotional stress, caffeine, trauma, circulatory problems, drug use, exposure to some
chemicals or toxic substances, or having frostbite could be factors that could contribute to getting
Raynaud's disease. There are many triggers, but the basic cause of Raynaud's disease is still not
known. "There has been a link established between Raynaud's and some autoimmune diseases."
"Raynaud's may also signal damage to the blood vessels caused by occupational injuries."
(Raynaud's Association, 2016). An example of an occupational injury that has been previously
discussed is using vibrating power tools over the course of several years. "Women are affected nine
times more than men with this disease." "Researchers estimate that Raynaud's affects as many as
twenty percent of all women in their child bearing years. That is one in five women from their early
teens into their early fifties." (Raynaud's Association,

Essay On Thiazide Diuretics
According to the Mayo Clinic there are many medication treatment options that are available to
anyone who has high blood pressure. Thiazide diuretics is one of the medication treatment option.
The side effects include dizziness and lightheadedness, blurred vision, loss of appetite, itching,
stomach upset, headache, and weakness. Thiazide diuretics works by changing the reabsorption of
sodium in the kidneys, leading to more fluid being produced from the body into the urine. They also
have an effect on the surrounding muscles in the blood vessels, causing the muscles to relax and
allow blood to pass through more easily. If taken as directed ones HBP will balance out. Another
treatment option is Angiotensin–converting enzyme (ACE) inhibitors ... Show more content on
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As a conclusion, blood vessels may relax and open up which makes it easier for blood to flow
through the vessels so in this event it can reduce the blood pressure. Renin inhibitors contributes to
another medication to balance hypertension. The side effects to Renin inhibitors is dizziness,
headache, diarrhea, and stuffy nose. As a result of direct renin inhibitors which help the regulation of
blood pressure, blood vessels relax and widen, making it easier for blood to flow through the
vessels, which also lowers blood pressure. Direct renin inhibitors, angiotensin–converting enzyme
(ACE) inhibitors, and angiotensin II receptor blockers (ARBs) all help the same process that
narrows blood vessels, but each type of medicine blocks a different part of the process. Calcium
channel blockers is another medication treatment option. The side effects of this medication is
lightheadedness, low blood pressure, slower heart rate, drowsiness, constipation, swelling of feet,
ankles and legs, increased appetite, and gastroesophageal reflux disease (GERD). Calcium channel
blockers dilate the blood vessels and this makes it easier for blood to flow through the vessels and
balances blood

The Silent Killer : Hypertension
The Silent Killer: Hypertension
Bernice, is an 80 year old, African American, female, who presents to the inpatient unit for further
therapy after undergoing a colostomy reversal. Her history is significant for type 2 diabetes mellitus,
stage 3 chronic kidney disease, and hypertension, for which she is taking a calcium channel blocker
and a beta blocker. Her family history indicates that both her sisters and brother, had diabetes, as
well as hypertension. Another key element is that Bernice is a former smoker. Physical examination
reveals a healthy weight women, with a blood pressure of 153/71 mmHg and a heart rate of 64 bpm.
Lungs are clear, and cardiac examination reveals a regular rate and rhythm. Abdomen is without
bruits and peripheral pulses are equal. Laboratory results are significant for a non fasting glucose of
182 mg/dL. The patient's blood urea nitrogen and serum creatinine are 26 mg/dL and 1.82 mg/dL.
Pathophysiology of Hypertension
After the analysis of this case study, I have chosen to perform research on the patient's diagnoses of
hypertension. Hypertension, also known as, high blood pressure, is a global problem. The desired
blood pressure, according to the Joint National Committee are, below 150/90 mmHg for individuals
60 years and older, and below 140/90 mmHg for individuals under 60 years of age (Beeman, 2013,
p. 334). Thus, individuals not meeting this criteria have to be treated with drug therapy.
Understanding the mechanisms in which normal blood pressure is maintained, will aid in the
understanding of hypertension. Systemic arterial pressure is a product of cardiac output and total
peripheral vascular resistance. To maintain a balance between these factors, there are four control
systems that play a role: the arterial baroreceptor system, regulation of body fluid volume, the renin
angiotensin aldosterone system, and vascular autoregulation (Beeman, 2013, p. 337).
Arterial baroreceptors are responsible for monitoring the levels of arterial pressure. When these
baroreceptors sense a rise in arterial pressure, they counteract by slowing down the cardiac system
and vasodilating (Beeman, 2013, p. 338). Changes in body fluid volume also affect arterial pressure;
a rise in pressure occurs

Acute Chest Pain Case Study
An obese 50–year–old male is brought to the emergency department by ambulance with the
complaint of acute chest pain. The pain had an initial onset an hour ago while he was walking
outside around his neighborhood. It came on suddenly and was so severe that it made the patient
collapse to the floor . The pain has a "pressure–like feeling" and the patient holds a fist over his
sternum when showing the physicians where the pain is found and how it feels. The severity is
described as an 8/10. The pain is not getting better and there is nothing he has found that either
makes it either worse or relieves it. The pain does radiate to his right arm. The pain makes the
patient feel short of breath. He denies any other associated symptoms. He ... Show more content on
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Calcium channel blockers cause coronary vasodilation and afterload reduction, in addition to
reducing contractility of the myocardium. They are now considered a secondary treatment when
beta–blockers and/or nitrates are not fully effective. None of the calcium channel blockers have been
shown to lower the mortality in coronary artery disease, and may increase mortality because they
raise heart

I Should Go Back For Med School
"You should go back to med school" is a statement I 've been hearing for years. Deciding to apply is
not a decision i have taken lightly. This isn't a choice that came about from a burning desire to be a
Doctor since a young age, or some tragic life changing event. This has been a decision based on
professional interactions, research and personal experiences that keep pointing me in the same
direction. RN school, my job as hospital tech, and my current job in the ED have given me great
incite to the world of medicine. Before stepping into this world, i was a waiter and it was at that job
i realized how important short interactions with people can be. It 's the smaller gestures and the way
you present your self that can make the experience that much better for the customer. As i
transferred my career to the bedside, i began to see how important taking your time, speaking
calmly, allowing time for the patient to take in what you just said, and sometimes just listening is. I
've witnessed some of the most brilliant minds in medicine have awkward, rude, empty and short
interactions with people. I don 't think this was done out of malice or discontent but more a lack of
social knowledge and what it means to truly encompass the multifaceted skill it is to "treat the
patient." No patient is going to remember what antibiotic you gave, but they are going to remember
you sitting at the bedside and explaining to them why it is important to subject their sick
grandmother to more

The Effect Of Calcium On The Contribution Of Calcium...
This research utilized calcium channel blockers to measure the contribution of calcium uptake in
relation to the vesicular glutamate released into the extracellular space. After the calcium channels
were blocked glutamate was applied directly to the extracellular space and the animals ability to
remove the glutamate was measured. The results showed that animals with traumatic brain injuries
had significantly higher levels of extracellular glutamate evidenced by a nearly 80% increase when
compared to the healthy mice (Hinzman et. Al., 2012). This showed that calcium mediated neuronal
glutamate release may contribute to the cytotoxicity experienced by patients affected by traumatic
brain injury. The second part of the study examined the importance of excitatory amino acid
transporters in patients suffering from traumatic brain injury. To accomplish this, researchers applied
an EAAT blocker to both injured and normal rats to measure their ability to remove extracellular
glutamate. The data suggested that mice subjected to a traumatic brain injury had a more significant
increase in extracellular glutamate after the EAAT blocker was applied. Additionally, mice in the
traumatic brain injury required a significantly longer time for the extracellular glutamate to return to
pre–study levels (Hinzman et. Al., 2012). As such, it seems that the major mechanism responsible
for the cytotoxic levels of extracellular glutamate in traumatic brain injury is directly related to a

Atrial Fibrillation: A Case Study
It's known that atrial fibrillation (AF) is the most common sustained cardiac arrhythmia representing
abnormal rapid and irregular ventricular rates with deterioration of atrial mechanical function
resulted by disorganized atrial electrical activity classified as acute, chronic, paroxysmal,
intermittent, constant, persistent, or permanent and when a patient has 2 or more episodes, AF is
considered recurrent(1). During the last decade, it accounted for approximately one third of hospital
admissions for cardiac arrhythmias with progressive increases in the worldwide prevalence and
incidence(1,2). It is more common in patients with cardiovascular problems such as hypertension,
valvular heart disease, congestive heart failure (CHF) or coronary ... Show more content on
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Rate control is the older therapeutic strategy but it is still a primary therapy for AF. Beta–blockers
and calcium channel blockers are both effective and well resistant therapies which can be used in a
wide range of acute and long–term clinical conditions, as well as both contribute in controlling
hypertension. It's investigated that oral beta–blockers are more favorable than calcium channel
blockers for patients with ischemic heart disease, CHF and depressed left ventricular function.
Digoxin is effective for controlling heart rate especially in sedentary elderly and concomitant CHF
patients due to its effectiveness in improving ventricular function. Other potential advantages of rate
control include less adverse drug effects and less hospitalization. However, it has some
disadvantages including risk of toxicity, chronotropic incompetence and difficulties in achieving
dose adjustments in patients with compromised renal function adding that it is not preferred in
younger patients and those with a history of

Do Calcium Channel Blockers Play A Role For Preventing...
Title: Do Calcium Channel Blockers play a role in preventing Hypertensive Encephalopathy?
A– Study aim To identify the risk factors for hypertensive encephalopathy amongst patients seen in
the Emergency Department (ED) and assess whether calcium channel blockers play a role in
preventing hypertensive encephalopathy.
B– Background and significance
Hypertension is a very common problem, affecting 1 billion people worldwide, with 50 million
cases in the United States, and one third of cases going undiagnosed. 1% of the cases will
experience a hypertensive emergency in their life. (1,2)
Although 1% is not a high number, the complications for that percentage are very costly and disable
things like End Stage renal disease, Stroke, and ... Show more content on Helpwriting.net ...
The symptoms are usually reversible with adequate and prompt control of the blood pressure. (6)
The aim of the study is to identify if patients on CCB have less of a chance of developing
hypertensive encephalopathy than those treated with different antihypertensive medications.
Calcium channel blockers are a group of medications used to treat Hypertension, and also used as
prophylactic treatments for migraines. They interfere with calcium influx to the arterial wall, which
cause arterial dilatation and relaxation of the arteries and hence lowers blood pressure. Nicardipine
is one of the CCB's used commonly in treating stroke patients with very high and uncontrolled
hypertension. (6)
"Nicardipine crosses the blood brain barrier which binds to the calcium–channels of the L–type,
acting primarily at the level of the hippocampus (7). Intravenous Nicardipine has been shown to
reduce both cardiac and cerebral ischemia(8)."
We want to observe if the patient treated with calcium channel blockers medication as outpatient
home medication has less hypertensive encephalopathy complications. Moreover, we went to test if
calcium channel blockers play any protective role against patients developing hypertensive
encephalopathy.
C– Innovation of this study
There is multiple studies about the use of CCB's in treating Hypertensive emergencies, one study in
1985 shows that CCB's and specifically the Nicardipine could be used as first line drug in
management

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