NMT150 - Wk 12

Questions and Answers

What is the primary mechanism through which ACE inhibitors like Quinapril reduce blood pressure?

They enhance angiotensin II production.

They cause direct vasodilation of blood vessels.

They inhibit the conversion of angiotensin I to angiotensin II. (correct)

They increase aldosterone release.

Which of the following statements about Quinapril is accurate?

It primarily increases arterial pressure in patients.

It should be taken with high-fat meals for optimal absorption.

It has short-term effects requiring multiple doses daily.

It is classified as an ACE inhibitor with a generic name ending in -pril. (correct)

What is the most common adverse effect associated with ACE inhibitors like Quinapril?

Dry cough. (correct)

Increased heart rate.

Fluid retention.

Headache.

Which physiological factor is a major driver of hypertension according to the content?

Obesity primarily in younger adults. Signup and view all the answers

Which statement correctly describes the role of ACE in the body?

ACE plays a role in bradykinin metabolism. Signup and view all the answers

Which action is specifically aimed at expelling wind from the body?

Expels (exterior) wind Signup and view all the answers

What is the primary goal of the action that calms the mind?

To address emotional concerns and sleep difficulties Signup and view all the answers

Which point action is best when used alongside treatments for the root cause of phlegm?

Resolves phlegm Signup and view all the answers

What type of conditions does the action that removes obstructions primarily address?

Pain and stagnation of Qi or Blood Signup and view all the answers

In Traditional Chinese Medicine, what is the primary purpose of the 'Releases the Exterior' action?

To force out external pathogens and induce sweating Signup and view all the answers

What is the primary role of cellulose in plants?

To provide structure and rigidity. Signup and view all the answers

Which type of fiber is known to completely digest through microbial action?

Pectin Signup and view all the answers

Which component is primarily responsible for the antioxidant properties found in lignins?

Phenol units Signup and view all the answers

Which of the following sources is highest in soluble fiber?

Flax seed Signup and view all the answers

What distinguishes hemicellulose from cellulose?

Hemicellulose contains various sugars in short chains. Signup and view all the answers

Which herb is primarily categorized as both hypotensive and cardiotonic?

Lily of the Valley (Convallaria majalis) Signup and view all the answers

What is the recommended starting dosage for the tincture mentioned in the content?

1 teaspoon once a day Signup and view all the answers

Which herb listed is known for its nervine effects?

Motherwort (Leonurus cardiaca) Signup and view all the answers

What is primarily the role of vascular tonics among the listed herbs?

To improve blood circulation and vessel health Signup and view all the answers

In the provided formulation, which herb is included with the highest percentage?

Hawthorn (Crataegus oxyacantha) Signup and view all the answers

What is the primary component of Calcarea Carbonica?

Calcium carbonate Signup and view all the answers

Which symptom is associated with Lycopodium?

Hypertension with a mapped tongue Signup and view all the answers

What does Aurum have in common with heart conditions?

It is associated with a constricted feeling and cyanosis Signup and view all the answers

What does Cactus help alleviate in the context of heart conditions?

Palpitation at night with a feeling of constriction Signup and view all the answers

Which remedy is linked to heart-related issues, particularly mentioned symptoms like insomnia and difficulty tolerating anything around the throat?

Lachesis Signup and view all the answers

What is a common lifestyle factor related to sub-optimal body composition that can lead to cardiovascular disease?

Poor dietary choices Signup and view all the answers

Which strategy is considered a first-line approach for the primary prevention of cardiovascular events?

Lifestyle modifications Signup and view all the answers

What is the aim of the best practices identified for the primary prevention of cardiovascular disease?

To mitigate potential risk factors Signup and view all the answers

What type of external factors have been recognized as risks for cardiovascular diseases?

Environmental risk factors Signup and view all the answers

What is a potential limitation of using lifestyle changes alone in preventing cardiovascular disease?

They may not address genetic risk factors Signup and view all the answers

Study Notes

Introduction to Antihypertensive Drugs

Hypertension is a major global health issue, responsible for significant mortality and morbidity.
Approximately 23% of Canadian adults are diagnosed with hypertension, but only about 65% achieve blood pressure targets.
Hypertension leads to serious cardiovascular complications such as stroke and heart failure.

Mechanisms of Action of Antihypertensive Drugs

Angiotensin Converting Enzyme Inhibitors (ACEi): E.g., Quinapril; inhibit angiotensin II production, reduce blood pressure, and may lead to increased serum potassium levels.
Angiotensin Receptor Blockers (ARBs): E.g., Candesartan; block angiotensin II signaling, are similar in use to ACEi but do not cause cough.
Direct Renin Inhibitors: E.g., Aliskiren; prevent formation of angiotensin I, have lower incidence of cough and hyperkalemia but may cause diarrhea.
Alpha Blockers: E.g., Prazosin; decrease peripheral resistance by blocking vasoconstriction.
Beta Blockers: E.g., Atenolol; reduce heart rate and contractility, and inhibit renin secretion.
Calcium Channel Blockers (CCBs): E.g., Amlodipine; block calcium channels affecting the heart and blood vessels differently.
Centrally Acting Sympatholytics: E.g., Clonidine; reduce sympathetic outflow from the CNS, lowering blood pressure.

Drug Classes and Specifics

ACE Inhibitors

Quinapril reduces arterial and venous pressure and is used for hypertension, kidney disease, and post-myocardial infarction.
Common adverse effects include dry cough, hyperkalemia, and potential renal failure risks.

Angiotensin II Receptor Blockers (ARBs)

Candesartan acts similarly to ACEi but avoids cough due to lack of bradykinin involvement.
Same contraindications as ACEi, including pregnancy.

Direct Renin Inhibitors

Aliskiren is relatively new with less data on long-term safety, contraindicated in pregnancy, with diarrhea being a common side effect.

Calcium Channel Blockers

CCBs include dihydropyridines (e.g., Amlodipine) for vascular action and non-dihydropyridines (e.g., Verapamil) affecting cardiac activity.
Side effects vary: Amlodipine can cause peripheral edema, Verapamil can cause constipation and heart block.

Sympatholytic Drugs

Alpha blockers (E.g., Prazosin) can cause reflex tachycardia and complications due to renal artery dilation.
Beta blockers (E.g., Atenolol) have variable selectivity and may cause fatigue and bradycardia.

Diuretics

Loop diuretics (e.g., Furosemide) are used primarily for edema and heart failure.
Thiazide diuretics (e.g., Hydrochlorothiazide) are first-line for hypertension and effective especially in black populations.
Potassium-sparing diuretics (e.g., Spironolactone) are sometimes used in combination to maintain potassium levels.

Treatment Standards

First-line antihypertensive options include thiazide diuretics, ACEi, ARBs, beta-blockers, or long-acting CCBs depending on the patient's profile.
For hypertensive patients with diabetes and additional risk factors, ACEi or ARBs are preferred.

Sample Questions

Identify which antihypertensive drug modifies the renin-angiotensin-aldosterone system.
Determine the first-line therapy for a hypertensive patient with type 2 diabetes and smoking habits.

Monitoring and Contraindications

Regular monitoring of renal function and potassium levels is essential for patients on ACEi and diuretics.
Certain drugs are contraindicated in specific populations, particularly pregnant patients and those with existing heart conditions.

Learning Objectives

Understand Traditional Chinese Medicine (TCM) action terms related to various therapeutic approaches.

Releases the Exterior

Facilitates the expulsion of pathogens from the skin-muscle layer.
Functions as a diaphoretic, promoting sweating.
Effective against external pathogens including wind, heat, cold, dampness, and dryness.
Most beneficial when applied at the onset of symptoms.

Expels (Exterior) Wind

Similar in action to "releases the exterior," focusing specifically on wind.
Believed to open body gates for the escape of wind.
Targets exterior wind trapped in the Wei Qi layer.

Calms the Mind

Offers diverse effects based on specific conditions.
Can either slow down an overactive mind or stimulate a sluggish mind.
Assists with sleep issues related to an overactive mind.
Addresses emotional distress including depression, anxiety, and stress.
Focuses on treating symptoms while ideally pairing with treatments targeting root causes.

Resolves Phlegm (Damp)

Transforms phlegm into a less viscous and more mobile form.
Does not directly address the underlying causes of phlegm or damp accumulation.
Best employed alongside other treatment methods that target root issues.

Removes Obstructions

Manifests as pain or impeded energy flow; targets various types of obstructions.
Functions self-regulatively; adjusts according to what needs to be removed.
Applicable for stagnation of Qi, blood, phlegm/damp, or cold.
Similar to others, it treats symptoms while being most effective when combined with root-cause therapies.

Learning Objectives

Provide nutritional guidance focused on diet, fiber applications, lipid management, weight control, and cardiovascular disease (CVD) prevention.

Treatment Goals

Alleviate presenting symptoms and enhance patient comfort.
Promote full recovery for return to regular activities.
Educate patients on health and nutrition.
Monitor and prevent sequelae.

Types of Fibers

Gums, Mucilage, Fructans: Soluble fibers aiding in gel formation and digestive health.
Cellulose, Hemicellulose, Lignins: Insoluble fibers contributing to bowel health and fecal bulk.

Cellulose

Polysaccharide: long, unbranched chains of carbon, hydrogen, and oxygen.
Provides structure to plants (stiffness), insoluble in water.
Increases fecal volume; sources include bran, legumes, and root vegetables.

Hemicellulose

Combination of linear and branched sugars, better digested than cellulose.
Found in bran, whole grains, nuts, and some fruits and vegetables.

Pectin

Polysaccharides acting as a "glue" in plant cell walls.
Form viscous gels in water; fully digested by microbes.
Common in apples, pears, strawberries, and citrus fruits.

Lignins

Highly branched polymers with antioxidant and phytoestrogenic properties.
Present in rigid plant structures (wood, bark) and in flax seeds and wheat.

Clinical Note: Flax Seed

Contains 35-45% fiber; beneficial for lowering CVD risk, blood pressure, and cholesterol.
Features immune-modulating properties, caution advised with immunosuppressants.

Fructans

Chains of fructose, known for prebiotic and immunomodulatory functions.
Can cause digestive discomfort; sources include chicory, garlic, and onions.

Properties & Physiological Effects of Fiber

Water Solubility plays a crucial role in digestibility and health benefits.
Soluble Fiber: Dissolves in water, delays gastric emptying, decreases nutrient absorption.
Insoluble Fiber: Adds bulk to feces, promotes bowel regularity.

Clinical Indications

Soluble Fibers: Useful for managing diabetes and high cholesterol.
Insoluble Fibers: Effective for constipation and GI health.

Fiber Intake Requirements

Recommended dietary fiber intake:
- Men: Ages 19-50 (38g), >50 (31g)
- Women: Ages 19-50 (25g), >50 (21g)

Diseases Linked to Low-Fiber Diet

Conditions such as diverticular diseases, IBS, obesity, and type 2 diabetes.

Toxicity

Common adverse effects: increased gas, bloating, potential for constipation or obstruction.

Nutrient Interactions

Fiber can interfere with the absorption of minerals (iron, calcium) and vitamins (B12, vitamin A).

Fiber and Hyperlipidemia

Dietary fibers contribute to lipid regulation through low-energy content, viscosity, and binding capacity.
They may influence lipid metabolism-related gene expression.

Fiber and Weight Management

Viscous fiber showed reduced body weight, BMI, and waist circumference in studies.
Greater effects observed in overweight individuals and those with metabolic syndrome.

Fiber and Cardiometabolic Syndromes

Higher fiber intake linked with better glycemic control and reduced cholesterol levels.
Associated with improved inflammation markers and blood pressure regulation.

Patient Scenario

For Tina, a 58-year-old obese patient with high cholesterol and CVD history, adding soluble fiber like psyllium may reduce cholesterol levels and improve health outcomes. All options presented are potentially beneficial for her condition.

Outcome Measures

Objective: Decrease blood pressure effectively.

Relevant Botanical Actions

Primary Actions: Cardiotonic to support heart function.
Secondary Actions: Vascular tonic to improve blood vessel health; circulatory tonic for enhanced blood flow.
Other Considerations: Nervine herbs for calming effects.

Featured Herbs and Their Actions

Lily of the Valley (Convallaria majalis): Strong hypotensive and cardiotonic properties.
Hawthorn (Crataegus oxyacantha): Supports cardiovascular health through hypotensive, cardiotonic, and vascular tonic actions.
Garlic (Allium sativum): Multifaceted with hypotensive and cardiotonic benefits.
Hibiscus (Hibiscus sabdariffa): Known for hypotensive and vascular tonic effects.
Linden (Tilia cordata): Offers nervine and vascular tonic properties.
Motherwort (Leonurus cardiaca): Functions as a nervine, hypotensive, and cardiotonic.
Mistletoe (Viscum album): Contributes to hypotension.
Passionflower (Passiflora incarnata): A mild nervine with hypotensive effects.
Snake Root (Rauwolfia serpentina): Known for its hypotensive and CNS depressant actions.

Herb Selection for Hypertension Formula

Composition:
- Hawthorn 40%
- Lily of the Valley 20%
- Linden 20%
- Motherwort 20%
Dosage: Start with one teaspoon (5 mL) once daily, increasing to two teaspoons (10 mL) twice daily between meals.
Duration: Recommended for six weeks, with expectations of enduring effects.

Expected Outcomes

Blood pressure reduction likely within 5-7 days, stabilizing around 10 days.

Cautions and Contraindications

Convallaria: Contains cardiac glycosides; high doses may lead to toxicity (symptoms: blurred vision, altered heart rhythm).
General Precautions: Monitor blood pressure regularly, particularly when combining with medication.

Herb-Drug Interactions

Use of hypotensive herbs can enhance the effect of existing blood pressure medications; may lead to reduced medication needs.

Effective Herbs for Hypertension

Hibiscus: Noted for its mild diuretic and vascular tonic effects; considered safe but usage caution advised during pregnancy.
Hawthorn: Nutritive and cardiotonic; berries are edible and support heart health.

Additional Herbs and Their Therapeutic Doses

Gingko biloba: Circulatory tonic; dose 3-9 mL tincture daily, with risks of gastrointestinal discomfort.
Leonurus cardiaca (Motherwort): Daily dose 3-12 mL tincture; effective for anxiety and hypertension.
Rauwolfia serpentina: Daily dose 0.5-2 mL tincture; caution advised with concurrent use of other hypotensives.

Pairing and Substitutions

Effective Combinations: Crataegus with Convallaria or Leonurus for hypertension treatment.
Closest Substitutes: Prepare for potential substitutions, such as Hibiscus for Crataegus in specific formulations.

Materia Medica - Cardiology Overview

Learning objectives include identifying keynotes of Calcarea Carbonica and reviewing remedies in cardiology.

Calcarea Carbonica (Oyster Shell)

Composed primarily of calcium carbonate (over 90%).

Keynotes and Affinities

Growth: Essential for infants, children, and adolescents.
Bone tissue: Associated with deformation or decalcification.
Lymphoid tissue: Involves hypertrophic lymph nodes and tonsils.

Morphology

Distinctive features: large, round square head, wide anterior fontanel that closes slowly.
Tendency towards perspiration in the scalp and head.
Typical complexion is fair, with possible visible blue veins.

Behavioral Characteristics

Individuals tend to be slow, shy, fearful, and have a depressive tendency.

General Symptoms

Usually plethoric with a predisposition to nutritional disorders.
May exhibit vascular symptoms such as hypertension or arteriosclerosis.

Mind Symptoms

Experiences anxiety, particularly towards evening, with fears of misfortune and contagious diseases.
Common feelings of forgetfulness, confusion, and low spirits.
Display obstinacy and experience hot-headedness with slight mental effort.
Aversion to strenuous work or exertion.

Sensation Characteristics

Experiences general coldness, particularly in feet and legs.
Notable weakness and fatigue, leading to a lack of endurance.

Modalities

Aggravation: Cold (especially damp), physical or intellectual effort, starchy food, milk, and during full moon.
Amelioration: Benefits from dry weather.

Concomitant Symptoms

Cravings for eggs, sweets, and candy.
Excretions may have a sour, acidic odor.
Localized cold sweats occur, especially on the scalp during the first sleep phase or with minimal effort.

Cardiology Symptoms

Common cardiac symptoms include palpitations at night and post-eating, especially when climbing stairs.
Palpitations accompanied by a sensation of coldness and restlessness.
Chest oppression may occur due to suppressed eruptions.

Remedy Relations

Related to other remedies such as Sulphur, Lycopodium, and various Calcarea derivatives (fluorica, sulphurica, phosphorica, arsenicosa).
Shows relations with potassium, sodium, magnesium, and baryta carbonicum.

Sample Question Insights

Recognize keynotes of Calcarea Carbonica, including perspirations during sleep, cravings for eggs, and sour odor excretions.
Understand aggravating factors such as full moon, contrasting with ameliorating factors like dry weather.

Primary Prevention of Cardiovascular Disease (CVD)

Emphasis on lifestyle changes as a primary factor in preventing cardiovascular disease.
Therapeutic goals should be articulated based on individual assessments and include consideration of uncomplicated health status.
Concept mapping may aid in visualizing lifestyle factors affecting body composition and metabolic health.

Social determinants significantly influence the risk of cardiovascular disease and metabolic syndrome.
Environmental factors, such as pollution and climate change, are critical components of cardiovascular risk assessments.
Introduction of the “15-minute city” concept promotes urban designs that encourage physical activity, reduce health inequities, and decrease environmental pollution.

Best Practices for Primary Prevention

Current best practices for preventing CVD focus on:
- Movement: Regular physical activity as a cornerstone of cardiovascular health.
- Diet: Dietary modifications play a crucial role in reducing cardiovascular risk.
- Weight Loss: Maintaining a healthy weight aids in preventing comorbidities associated with CVD.
- Healthy Psychology and Lifestyle: Psychological factors and lifestyle choices impact cardiovascular health outcomes.
- Pharmaceuticals and Natural Health Products: Consideration of medication and complementary therapies as part of a holistic prevention strategy.

Communication of health plans should be clear and tailored to patients, promoting understanding and adherence.
Educating patients on the relevance of active self-care is crucial, especially for those skeptical of lifestyle interventions.

Limitations and Biases

Potential limitations in lifestyle-focused approaches include personal biases and disparities in access to resources.
Acknowledgment of varying individual responses to lifestyle changes is vital for realistic health planning and expectations.

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Description

This quiz covers the mechanisms of action, indications, and side effects of various antihypertensive drugs. Focus areas include ACE inhibitors, ARBs, direct renin inhibitors, and more. Test your knowledge on the effective treatments for hypertension as taught in Dr. Adam Gratton's NMT150 course.