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Summary Global health and Pharmacotherapy
- Instelling
- Rijksuniversiteit Groningen (RuG)
Summary of all the Global health and Pharmacotherapy lectures
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Elaborations on Global Health lecturesLecture 1: Introduction
Drugs are small organic molecules, they can be administered in various ways. When a medicine is
administered orally ADME, will take place. Few drugs are passed passively because they are too large
to transport passively, hence why they are almost always transported actively. Concentration time
curve, measures the concentration of the drug in the blood. Deleterious side effects are toxic side
effects and nondeleterious effects are regular side effects. Allergic reactions do not classify as a side
effect.
No evidence that taking NSAIDs increase the risk of COVID-19. Certain comorbidities such as
diabetes, hypertension, cardiovascular disease and chronic respiratory disease increase the risk of
more severe COVID-19. There is no evidence that inhaled corticosteroids for COPD increase the risk
associated with COVID-19. COVID-19 patients with underlying COPD have a 4 times higher risk of a
serious disease course than patients without COPD, and this risk appears to be somewhat higher for
smokers. There is no evidence to support the preventive effects of hydroxychloroquine.
Inflixmab is the most costly drug in the Dutch healthcare system.
Lecture 2: Hypertension
Hypertension is abnormally high blood pressure. Blood pressure is the force exerted by circulating
blood against the walls of the body’s arteries, the major blood vessels in the body. Blood pressure is
presented in two ways. The systolic (first) blood pressure represents the pressure in blood vessels
when the hart contracts or beats. The diastolic (second) blood pressure number represents the
pressure in the vessels when the heart rests between beats. Blood pressure is ‘normal’ when systolic
pressure is between 120-129 and diastolic 80-84.
Symptoms of hypertension are unspecific or there are no symptoms at all. It can be caused by
lifestyle, like high sodium intake, weight gain and obesity and excess alcohol intake. Medications can
also cause hypertension, NSAIDs and stimulants for example. Genetic predisposition can also play a
role. It can also be caused by other diseases such as renal, renovascular, endocrine and urologic
diseases.
Consequences of hypertension are changes in the heart, hypertrophy
(increased muscle size) will occur. Pathological changes in the vessels will
occur. In the brain strokes can occur. Vessels in the eye can occur because of
hypertension. If the heart is damaged to a large extend the heart will
malfunction. Kidneys can be damaged so much that a patient needs dialysis.
Elevated blood pressure was the leading global contributor to premature
death it causes almost 10 million deaths. Ischaemic heart disease: 4.9
million. Heamorrhagic, bleeding in the brain, stroke: 2.0 million. Ischaemic,
blocking of the vessels, stroke: 1.5 million.
Prevalence is the number of cases seen in a population, for men the
prevalence of high blood pressure is 24%, for women 20%. If fatal consequences are survived there
will still be a major impact on your life.
It can be treated by lifestyle modifications or by drug treatment. Lifestyle modifications can be
restricting sodium intake, weight loss if the patient is overweight, exercise, moderation of alcohol
intake and stop smoking if applicable. Drugs that are used are, ACE inhibitors (angiotensin converting
enzyme inhibitors), Angiotensin-receptor blockers (ARBs), Calcium-channel blockers (CCB), Diuretics,
, Beta blockers. Situational drugs are alpha-blockers, centrally acting agents and mineralocorticoid
receptor antagonists (MRAs).
Diuretics, only thiazide-diuretics are used as antihypertensives like hydrochlorothiazide,
chlortalidone, indapamide. Target organ is the kidney, it will block sodium uptake, will lead to drop in
blood pressure. When used in too high doses this may cause hypotension or dizziness or headache.
When sodium levels are too low electrolyte disturbances may occur. For patients with diabetes
caution is needed.
Beta blockers, they antagonise the Beta1-receptor which will result in an antihypertensive effect,
reduction of myocardial contractility and heart rate. Unwanted side-effects are the result from
blocking the Beta2-receptor, peripheral vasoconstriction, bronchoconstriction, hypoglycemia.
Selective Beta1-blockers are atenolol, bisoprolol, metoprolol. Nonselective blocker is propranolol.
Because of their short plasma half-lives more than once-daily dosing is needed.
Calcium-channel blockers, verapamil, diltiazem and dihydropyridines. They inhibit influx of calcium
which will cause relaxation of vascular smooth muscles, the heart will have negative inotropic effects.
Adverse effects are headache, flushing, dizziness and ankle oedema. They are long acting drugs so
they are dosed once daily.
ACE inhibitors inhibit the biosynthesis of Angiotensin II. Agents are benazepril, captopril, enalapril,
fosinopril, lisinopril, perindopril, quinapril, ramipril and zofenopril. It can cause hyperkalaemia,
coughing, sudden hypotension at start of treatment and angioedema, rapid swelling in the nose,
throat, mouth, glottis, larynx, lips or tongue, treatment needs to be stopped. They are
contraindicated in pregnancy and monitor renal function. They have to be administered once or
twice daily and Renoprotective effects in diabetic patients may occur, therefore preferred
antihypertensive in diabetes patients.
The angiotensin receptor blockers block AT1 receptors, relax smooth muscle leading to vasodilation.
Increases renal salt and water excretion, reduces plasma volume and decreases cellular hypertrophy.
ARBs are renoprotective in type 2 diabetes mellitus. Examples are losartan, candesartan, irbesartan,
valsartan. They can be administered once per day and have the adverse effects of hypotension and
hyperkalaemia. Cautious use in reduced renal function, do not combine them with ACE inhibitors.
They are contraindicated in pregnancy.
Guidelines are developed by experts they are based on evidence and provide recommendations to
guide diagnosis and treatment. Meta-analysis is combining data from multiple studies.
Recommendations of hypertension treatment starts with a diagnosis of the patient, blood pressure is
measured. Additional causes of hypertension need to be taken into a count, lifestyle, concomitant
medications or family history. Also already damaged organs and existing cardiovascular diseases
need to be taken into a count. The risk factor can be calculated, in Europe it is the SCORE system. It
takes into a count; age, sex,
smoking habits, total cholesterol
level and systolic blood pressure.
After the diagnosis and
determination of the risk factors,
treatment will begin. All patients
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