Common Medical Conditions: Symptoms, Treatments, and Management

Posted on Sep 25, 2024 in Medicine & Health

Arteriosclerosis

Arteriosclerosis is the medical term for hardening of the arteries.

Chronic Obstructive Pulmonary Disease (COPD)

COPD is a chronic lung disease that makes it difficult to breathe.

Causes of Hypertension

  • Gender: Men under 60 are more likely to have hypertension than women.
  • Older age
  • Race
  • Genetics
  • Overweight or obesity

Non-Pharmacological Treatment for Diabetes

  • Use of non-nutritive sweeteners to replace sugar for calorie and carbohydrate control.

Diabetes Insipidus

Diabetes insipidus is an uncommon problem that causes fluid imbalance in the body.

Gestational Diabetes

Gestational diabetes is a form of high blood sugar affecting pregnant women.

Congestive Heart Failure (CHF)

CHF is a chronic condition where the heart doesn’t pump blood effectively.

Myocardial Infarction (MI)

Myocardial infarction (MI), commonly known as a “heart attack,” is caused by decreased or complete cessation of blood flow to a portion of the myocardium.

Scope of Pharmacotherapeutics

Pharmacotherapeutics refers to the use of drugs to prevent, treat, and diagnose diseases, as well as to alter normal functions.

Angina

Angina is a type of chest pain caused by reduced blood flow to the heart.

Congestive Heart Failure

Heart failure, or congestive heart failure, is a condition where the heart cannot pump enough blood to the organs due to insufficient nutrients and oxygen supply to the myocardium. Types of heart failure:

  • Left-sided heart failure: The most common form, causing fluid buildup in the lungs and shortness of breath.
  • Right-sided heart failure: Often occurs with left-sided heart failure, causing fluid backup in the abdomen, legs, and feet, leading to swelling.
  • Systolic heart failure: The left ventricle cannot contract vigorously, indicating a pumping problem.
  • Diastolic heart failure: The left ventricle cannot relax or fill fully, indicating a filling problem.

Congestive heart defects may be diagnosed before birth, right after birth, during childhood, or not until adulthood. It is possible to have a defect and no symptoms at all.

Clinical Manifestations

  • Tachycardia
  • Edema (swelling in ankles, legs, and abdomen)
  • Cachexia and muscle wasting
  • Crepitations or wheezing

Pharmacological Management

  1. Calcium channel blockers: Reduce myocardial contractility. Examples: phenylalkylamine, benzothiazepine, dihydropyridines.
  2. Vasodilators: Reduce blood pressure by vasodilation. Examples: sodium nitroprusside, hydralazine, minoxidil, fenoldopam, diazoxide.

Non-Pharmacological Management

  • Follow a proper routine for regular activities (waking, sleeping, natural urges).

Types of Hypertension

  1. Primary/Essential Hypertension
  2. Secondary/Systemic Hypertension

Etiopathogenesis

Primary hypertension, the most common type, arises from increased peripheral resistance or external factors without underlying disease. Long-term uncontrolled primary hypertension can lead to vascular damage, cerebral hemorrhage, retinal hemorrhage, and renal failure. Blood pressure can range from 100 mmHg to 250 mmHg. It can be controlled but not cured.

Secondary hypertension arises from underlying disorders, occurring when organs don’t function properly due to internal effects or infections. It’s cured by treating the underlying cause. Examples:

  • Cardiovascular hypertension: Arises from arterial blockage.
  • Renal hypertension: Due to renal artery obstruction or impaired glomerular filtration (glomerulonephritis).
  • Endocrine hypertension: Due to hyperactivity of endocrine glands.

Pharmacological Management for Angina

  • Beta blockers: Metoprolol, propranolol, atenolol, alprenolol.
  • Potassium channel openers: Nicorandil.
  • Calcium channel blockers: Amlodipine, verapamil, mibefradil, bevantolol, diltiazem, nitrendipine.
  • Nitrates:
    • Long-acting: Isosorbide dinitrate, molsidomine.
    • Short-acting: Nitroglycerin, erythrityl tetranitrate.
  • Other drugs: Oxyfedrine, ivabradine, trimetazidine, dipyridamole, acadesine.

Pharmacological Management for Hyperlipidemia

  • HMG-CoA reductase inhibitors: Lovastatin, simvastatin, atorvastatin, rosuvastatin.
  • Bile acid sequestrants: Cholestyramine, colestipol.
  • Fibric acid derivatives: Fenofibrate, benzafibrate, gemfibrozil.
  • Nicotinic acid

Non-Pharmacological Management

  • Follow a proper routine.
  • Regular exercise.
  • Yoga and meditation.
  • Proper diet.
  • Avoid polluted areas.

Myocardial Infarction

Myocardial infarction, also known as a heart attack, involves myocardial tissue death due to lack of blood supply, often caused by arterial blockage.

Features

  • Chest pain
  • Dyspnea
  • Fatigue
  • Arrhythmia
  • Increased sweating
  • Weakness
  • Nausea
  • Anxiety
  • Palpitation

Pharmacological Management for COPD

Bronchodilators and fixed combination drugs are commonly used.

Non-Pharmacological Management

  • Avoid or stop smoking.
  • Avoid tobacco chewing.
  • Prevent occupational exposure to chemicals or particulate matter.
  • Regular vaccination against pneumococcal pneumonia.
  • Avoid industrial areas and seek fresh air.

Etiopathogenesis of Asthma

Asthma arises from hyper-responsiveness of the immune system, causing variable and reversible airflow obstruction. Factors include:

  1. Allergens (pollen, animal dander, dust, etc.)
  2. URTIs
  3. Air pollution, cigarette smoke, chemicals
  4. Drugs (aspirin, NSAIDs, beta-blockers)
  5. Food allergens, cold air
  6. Genetic factors

These factors interact with bronchial mucosa, causing hypersensitivity reactions and stimulating helper T-cells. B-cells produce IgE, which binds to mast cells. Upon re-exposure, mast cells release histamines, leukotrienes, and other inflammatory mediators, leading to vascular permeability, glandular cell hyperplasia, and bronchial smooth muscle contraction.

Difference Between Asthma and COPD

Both asthma and COPD are lung diseases causing airway swelling and breathing difficulties. Asthma swelling is often triggered by allergens or physical activity, while COPD encompasses emphysema and chronic bronchitis with constant and worsening symptoms.

Scope and Objectives of Pharmacotherapeutics

Pharmacotherapeutics aims to:

  • Understand drug reactions in the body.
  • Determine appropriate drug categories for specific diseases.
  • Determine correct doses and formulations.
  • Select suitable patients for specific drugs.
  • Determine effective routes and times of administration.
  • Assess drug tolerance and resistance.
  • Identify drug incompatibilities and adverse effects.
  • Understand drug-food interactions.
  • Consider environmental factors influencing drug action.

Hyperthyroidism

Hyperthyroidism involves excessive release of thyroid hormones. It can be:

  1. Primary: Intrinsic thyroid abnormality (e.g., Graves’ disease).
  2. Secondary: Processes outside the thyroid (e.g., TSH-secreting pituitary tumor).

Etiopathogenesis

Thyrotoxicosis, a hypermetabolic state caused by elevated T3 and T4 levels, is commonly caused by hyperthyroidism. Common causes include:

  1. Diffuse hyperplasia (Graves’ disease)
  2. Multinodular goiter
  3. Thyroid adenoma

Other causes include genetic defects, thyroid hormone resistance, congenital defects, Hashimoto’s thyroiditis, iodine deficiency, and hypothalamic/pituitary failure.

Clinical Manifestations

  • Tachycardia
  • Tremors
  • Heat intolerance
  • Infertility
  • Polyphagia
  • Palpitations

Pharmacological Management

  • Thioamides: Methimazole, propylthiouracil.
  • Iodide salts: Lugol’s solution.
  • Iodinated contrast media: Ipodate.
  • Beta blockers: Propranolol, esmolol.
  • Anion inhibitors: Thiocyanate, perchlorate.

Non-Pharmacological Management

  • Follow a specific diet plan.
  • Consume calcium, vitamin D, magnesium, and selenium-rich foods.
  • Avoid sugar, caffeine, and alcohol.
  • Avoid allergens.
  • Manage stress.
  • Exercise regularly.

Rational Use of Medicines (RUM)

RUM ensures the right medicine for the right individual at the right time for the right disease. Factors influencing RUM include:

  1. Manufacturing procedures: Correct platform, equipment, and procedures are crucial.
  2. Individual factors: Body structure, sex, age, prior diseases, drug allergies, and tolerance.
  3. Environmental factors: Seasonal variations, pandemics, and mutations.

Improving RUM

  1. Educational promotion: Enhance pharmacy education and training.
  2. Regulatory and management promotion: Implement proper inspection and supervision.
  3. Proper compounding and dispensing: Ensure accuracy in drug preparation and packaging.

Essential Medicines List

The Essential Medicines List (EML) comprises medicines satisfying the priority healthcare needs of a population. The WHO published its first Model List in 1977, updated every two years. India’s National List of Essential Medicines (NLEM) was updated in 2021.

Standard Treatment Guidelines (STGs)

STGs are evidence-based recommendations to assist healthcare providers in making appropriate treatment decisions. Key features include simplicity, credibility, uniform standards, medicine supply based on standards, regular updates, and user-friendliness. STGs benefit patients, healthcare providers, and policymakers.

Hypothyroidism

Hypothyroidism is a condition caused by insufficient thyroid hormone production, more common in females. It can be:

  1. Primary: Intrinsic thyroid abnormality or pituitary/hypothalamic disease.
  2. Secondary: Processes outside the thyroid gland.

Etiopathogenesis

Congenital hypothyroidism often results from iodine deficiency. Other causes include inborn errors of thyroid metabolism and genetic mutations affecting thyroid development.

Clinical Manifestations

  • Fatigue and muscle pain
  • Hair loss
  • Swelling at the base of the neck

Pharmacological Management

  • Levothyroxine
  • Triiodothyronine

Non-Pharmacological Management

  • Follow a physician-recommended diet.
  • Avoid goitrogenic foods (e.g., broccoli, cauliflower).