Ultimate Pharmacologist

Hypertension  is defined as persistently elevated arterial blood pressure (BP).  • Isolated systolic hypertension is diastolic blood pressure (DBP) values less than 90 mm Hg and systolic blood pressure (SBP) values of 140 mm Hg or more. • Hypertensive crisis (BP >180/120 mm Hg) may be categorized as hypertensive emergency or hypertensive urgency (high BP elevation without acute or progressing target-organ injury). PATHOPHYSIOLOGY • Hypertension may result from a specific cause (secondary hypertension) or from an unknown etiology (primary or essential hypertension). Secondary hypertension(<10% of cases) is usually caused by chronic kidney disease (CKD) or renovascular disease. Other conditions are Cushing syndrome, coarctation of the aorta, obstructive sleep apnea, hyperparathyroidism, pheochromocytoma, primary aldosteronism, and hyperthyroidism. Some drugs that may increase BP include corticosteroids, estrogens, nonsteroidal anti-inflammatory drugs (NSAIDs), ...

• Anemias are a group of diseases characterized by a decrease in hemoglobin (Hb) or red blood cells (RBCs), resulting in decreased oxygen-carrying capacity of blood. The World Health Organization defines anemia as Hb less than 13 g/dL (<130 g/L, <8.07 mmol/L) in men or less than 12 g/dL (<120 g/L; <7.45 mmol/L) in women. PATHOPHYSIOLOGY • The functional classification of anemias is found. The most common anemias are included in this chapter.  • Morphologic classifications are based on cell size. Macrocytic cells are larger than normal and are associated with deficiencies of vitamin B12 or folic acid. Microcytic cells are smaller than normal and are associated with iron deficiency, whereas normocytic anemia may be associated with recent blood loss or chronic disease. • Iron-deficiency anemia (IDA) can be caused by inadequate dietary intake, inadequate gastrointestinal (GI) absorption, increased iron demand (eg, pregnancy), blood loss, and chronic diseases. ...

Ischemic Heart Disease • Ischemic heart disease (IHD) is defined as lack of oxygen and decreased or no blood flow to the myocardium resulting from coronary artery narrowing or obstruction. It may present as acute coronary syndrome (ACS), which includes unstable angina and non–ST-segment elevation (NSTE) or ST-segment elevation (STE) myocardial infarction (MI), chronic stable exertional angina, ischemia without symptoms, or ischemia due to coronary artery vasospasm (variant or Prinzmetal angina). PA THOPHYSIOLOGY • Major determinants of myocardial oxygen demand (MVo2) are heart rate (HR), contractility, and intramyocardial wall tension during systole. Because the consequences of IHD usually result from increased demand with a fixed oxygen supply, alterations in MVo2 are important in producing ischemia and for interventions intended to alleviate it. • The double product (DP) is the heart rate multiplied by the systolic blood pressure (DP = HR × SBP) and serves as an indirect ...

Rheumatoid arthritis • Rheumatoid arthritis (RA) is a chronic, progressive inflammatory disorder of unknown etiology characterized by polyarticular symmetric joint involvement and systemic manifestations. PATHOPHYSIOLOGY • RA results from dysregulation of humoral and cell-mediated immunity. Most patients produce antibodies called rheumatoid factors; these seropositive patients tend to have a more aggressive course than seronegative patients. • Immunoglobulins (Ig) activate the complement system, which amplifies the immune response by enhancing chemotaxis, phagocytosis, and release of lymphokines by mononuclear cells that are then presented to T lymphocytes. Processed antigen is recognized by the major histocompatibility complex proteins on the lymphocyte surface, resulting in activation of T and B cells. • Tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), and IL-6 are proinflammatory cytokines important in initiation and continuance of inflammation. • Activated T cells pr...

Dyslipidemia  is elevated total cholesterol, low-density lipoprotein (LDL) cholesterol, or triglycerides; low high-density lipoprotein (HDL) cholesterol; or a combination of these abnormalities. PATHOPHYSIOLOGY • Cholesterol, triglycerides, and phospholipids are transported in blood as complexes of lipids and proteins (lipoproteins). Elevated total and LDL cholesterol and reduced HDL cholesterol are associated with development of coronary heart disease (CHD). • Risk factors such as oxidized LDL, mechanical injury to endothelium, and excessive homocysteine can lead to endothelial dysfunction and cellular interactions culminating in atherosclerosis. Eventual clinical outcomes may include angina, myocardial infarction (MI), arrhythmias, stroke, peripheral arterial disease, abdominal aortic aneurysm, and sudden death. • Atherosclerotic lesions arise from transport and retention of plasma LDL through the endothelial cell layer into the extracellular matrix of the subendothel...