Hmm..insyaAllah kali ni saya cuba Tulis tentang
1. "Nota Dr Yasser" - yg sempat saya tulis masa lecture dia
2. "Panel Discussion Question" - masa ni ramai orang rak datang, lelaki ada la beberapa ketul je yg datang .. Ni pun x dapat amik semua .. Mungkin masa ni kelaut jugak melayang...
Nota Dr Yasser
( Renin Angiotensin System )
--> Vasoconstriction
* Concept = Angiotensin II act on --> AT I receptor causing --> Allow noradrenaline release
--> Release of aldosterone (impotant point)
* Bnyak lg tapi ini yg paling penting
- Action of aldosterone is :-
- Eliminate K+ and H+
- Act at distal portion of distal convoluted tubules (For NaCl reabsorbtion)
* So kita kene la inihibit daripada process atas ni berlaku utk hypertensive patient
- APa kene buat ??? ---> Bagi ACE Inhibitor
Contoh drugs :-
1. Captopril --> By acting on -SH group (can give sublingually)
2. Enalapril --> By competition
* In comatous = Hypertensive Encephalopathy --> Give Captopril Sublingually
Case 1
Myocardiac infarction
Heart Failure --> Give Drugs to --> Dilate afferent (kidney)
Diabetic Nephropathy -- > Dilate efferent 2x *(To prevent albuminuria)
*Vascular Growth factor --> Can also dilate afferent and efferent nephron
Side Effect of ACE Inhibitor
1. Hyperkalaemia --> Reduced by Diuretic (Thiazide or Loop Diuretic)
2. Cough
3. Brochospasm --> Cough n Bronchospasm (Give ARBs)
Drugs Choice (Ni yang Mahal ni..)
1. Severe Hypertension --> Captopril (sublingual) n Labetalol
2. Mild Hypertension + Pregnancy --> a-methyldopa
3. CHD --> ARBs , ACE I , carvedalol , metoprolol and Bisoprolol
( minimize preload n afterload + prevent remodelling )
Drugs Contraindicated
1. Asthmatic Patient --> Avoid B-blocker and ACE I (But give Ca Channel Blocker)
2. Diabetic Patient ---> Avoid B-blocker and Diuretic (But give Ca channel blocker , ACE I or ARBs)
3. Heart Block --> Avoid B-blocker and Ca Channel blocker (But Give Nifedipine and Rennin Inhibitors)
Panel Discussion
1) How come "amiodarone" cause "Torsade de pointes"
- Block K Channel + also another channel
* For Torsade de Pointes to happen (prolonged QT segment)
- Ca channel is blocked --> effect electrical impulse
2) Lidocaine only effect ventricles --> Longer duration of depolarization
(Sorry lukisan buruk -pakai paint je lukis ni)
Ni la macam mana drug action on heart for angina
3) ACE I --> Prevent diabetic nephropathy = By dilates affent + dilates efferent nephron 2x
4) B-blocker in diabetic --> Patient will hypoglycemic (not aware)- as the sympathetic nerve is blocked
5) Diuretic --> minimize insulin in the body
6) B-blocker --> reset baroreceptor by
- First = Cold in extermities (Constrict B2)
- Decrease RAS
7) Cholestyramine --> increase VLDL = Increase bile salt synthesis ---> Increase VLDL (simultaneously)
8) Take BAS (Cholestyramine) + Anticoagulant --> Not Absorbed = Decrease anticoagulant
9) Digoxin --> Vagus like action --> slowing the AV conduction (use in dysrythmia)
side effect :- (Increase in dosage)
- Increase excitability to ventricular Muscles
9 ) Verapamil --> contraindicated in Ventricular Tachycardia (block Ca channel)
10) Patient with hepatotoxicity - we can give
- BAS (cholestyramine)
- Fibrates
Penambahan baikan .....
(lukisan kedua utk hari ini)
Ok..Apa yg cik "Hamba" dan ustaz "afiq fahimy"
Torsades de pointes ni boleh disebabkan oleh
- electrolyte disorders
- hypokalemia
- hypomagnesemia
- hypocalcemia
* Disebabkan QT segment ni melibatkan dua2 "Depolarization" and "Repolarization"
- So, both calcium and potassium ni amik peranan dalam 'Torsades de pointes' ni terjadi...
- Kalau fikir2 balik kenapa xleh bg Verapamil pada patient yg ada Ventricular tachycardia ???
(hehe, lu pikiq la sendiri...assalamualaikum)
Maka datanglah sesudah mereka, pengganti (yang jelek) yang menyia-nyiakan shalat dan memperturutkan hawa nafsunya, maka mereka kelak akan menemui kesesatan,
kecuali orang yang bertaubat, beriman dan beramal saleh, maka mereka itu akan masuk syurga dan tidak dianiaya (dirugikan) sedikitpun, yaitu syurga 'Adn yang telah dijanjikan oleh Tuhan Yang Maha Pemurah
kepada hamba-hamba-Nya, sekalipun (syurga itu) tidak nampak. Sesungguhnya janji Allah itu pasti akan ditepati.
(surah maryam ayat 59 -61)
* sedikit perkongsian, memandangkan bidang medic ni "berat" dan kita tidak cukup masa utk mencari semua tentang agama..apa kata kita cari "ilmu agama" yang mencukupi utk menambahkan iman kita kepada ALLAH..
wallahu a'lam
-islahmujahidin-
