Author Topic: Case (69)  (Read 4466 times)

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Offline Dr.Habiib

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Case (69)
« on: March 15, 2011, 09:43:49 PM »
A 35-year old female presents in your clinical office for regular check-up. Her only complaint is recurrent migraine headaches, which increased in frequency over the years. On examination her blood pressure is elevated at 150/70.  You decide to start her on antihypertensive therapy that is also used as prophylaxis of migraines.

1. What is this drug?
2. What are actions of this drug to the CNS?
3. What are the actions on cardiovascular system?
4. What are the adverse effects   of this drug to cardiovascular system?
5. What are the uses of this drug to the following:   A. Heart.  B. Blood vessels. C. Blood Pressure.


Ethical principles of medical professionalism:
1. Beneficence: to do good to patient.
2. Non maleficence: not to harm the patient.
3. Justice: to be fair to all patients.
4. Respect for autonomy: free decision for the patient

Offline Dr. Acromion

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Re: Case (69)
« Reply #1 on: March 17, 2011, 04:25:20 PM »
1.   What is this drug?
Propranolol  also known as Inderal as the commercial name,  a non-selective B-blocker.

2.   What are the actions of this drug to the CNS?
It blocks the action of epinephrine and norepinephrine on both B1 and B2 adrenergic receptors, hence decreasing the sympathetic outflow from the vasomotor centers in the brain.

3.   What are the actions on the cardiovascular system?
Propranolol reduces the heart rate  the reason it's useful in treating abnormally rapid heart rhythms, it also reduced the force of heart contractions, it also reduced the need for oxygen by the heat muscles ( reducing the heart pain in Agina Pectoris)  and most importantly lowers blood pressure.

4.   What are the adverse effects of this drug to the cardiovascular system?
Dangerously very low blood pressure ( Hypotension),  Abnormal decrease of heart beat (Bradycardia),  Heartblock, Congestive heart failure (CHF) can also be a sequala of beta blokers.

5.   What are the uses of this drug to the following;

A.   Heart ;   The heart rate is decreased , the force of contractions of the muscles of the heart decreased ( decrease cardiac outpu), the amount of oxygen required by the muscles of the heart is also decreased.

B.   Blood vessels;  dilatation (relaxation of the smooth muscles) of blood vessels, therefore reduced resistance to bloodflow.

C.   Bloold pressure;  B/P is lowered.



Offline Dr.Habiib

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Re: Case (69)
« Reply #2 on: March 17, 2011, 11:13:53 PM »
Thank you Dr. Acromion  you are right. Thank you very much,

This is the key of case
Answers:
1.  The drug is PROPRANOLOL :  non selective β- blocker.

2. The actions of drug to the CNS:
- It inhibits β in CNS so decrease sympathetic flow making hypotension.
-  It is antagonize the somatic manifestation of anxiety.
- It is reduce tremors due to the   sympathetic over activity and used in tremors of Parkinsonism.
- It reduces the incidence and severity of attacks of migraine head age. The mechanism may depend on the blockade of catecholamine-induced vasodilation in brain vascular.

3. Actions of the drug to cardiovascular system: the most important site of action.
a. Heart: decrease all cardiac properties.
-Decrease contractility (-ve inotropic).
- Decrease heart rate (HR) (-ve chronotropic).
              This two action leads to decrease cardiac output (CO)
-Decrease work of heart   and oxygen consumption.
- Decrease excitability.
     
B. Blood vessels:
- Peripheral resistance is increasing initially (peripheral vasoconstriction) and blood flow to tissue is reduced   (due to the unopposed α vasoconstriction tone) followed by decrease of total peripheral resistance on long use.

c. Blood pressure:
 Hypotension on prolong use (4 weeks)

4. Adverse effect of the drug to the cardiovascular system:
Heart:
- Heart failure in case of inadequate myocardial function as myocardial infarction.
- Heart block (atropine is antidote).
Blood vessels:  Cold extremities, Raynaud`s phenomenon, intermittent claudication, numbness, tingling.
Blood pressure: Hypotension.

5. Uses of the drug on:
a. Heart: use to treat.
- Angina pectoris prophylaxis (between attacks).
- Acute phase of myocardial infraction.
- Arrhythmia.
- Hypertrophic cardiomyopathy.
- FAllot`s tetralogy cyanotic spell.

B. BLOOD VASSELLS: It use for.
- Prevention and treatment of GIT bleeding (varices) in liver cirrhosis.
- Acute dissecting aortic aneurysm.

C. Blood pressure: It use for.
-Essential hypertension.
- Pheochromocytoma (combined with α-blocker).



 
Ethical principles of medical professionalism:
1. Beneficence: to do good to patient.
2. Non maleficence: not to harm the patient.
3. Justice: to be fair to all patients.
4. Respect for autonomy: free decision for the patient

Offline Dr. Acromion

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Re: Case (69)
« Reply #3 on: March 17, 2011, 11:41:25 PM »

Thank you Dr. Habib, your answers are very systematic. i can't believe number 5, i completely missed the point and made my own question which i answered, kind of misread............lol

Aaad baad u mahadsantahay Dr. habiib.

 

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