Usingthe video from
Episode 6
on Mr. Fallbrook, answertwoof the following prompts: Please identify each prompt you answer by number and restate the question in bold letters. WITH IN-TEXT CITATION AND REFERENCES
Prompt 1: Explain in detail the pathogenesis on how Mr. Fallbrook’s gastroenteritis leads to sepsis and then ARF.
Prompt 2: Research the medication Enalapril. Explain its uses, dosage, and side effects.
PROMPT 2:
Enalapril is an orally active ACE (Angiotensin-Converting Enzyme) inhibitor that works by blocking the active site of ACE. It is an oral prodrug that is converted by hydrolysis to a converting enzyme inhibitor, enalaprilat primarily in the liver. ACE drugs induce natriuresis and lower systemic vascular resistance without increasing heart rate (Elimination of sodium). They are useful in the treatment of hypertension, lowering morbidity and mortality in heart failure and left ventricular dysfunction following a myocardial infarction, and delaying diabetic nephropathy progression.It is particularly useful in treating patients with chronic kidney disease as they diminish proteinuria and stabilize renal function (even in the absence of lowering of blood pressure levels). This effect is beneficial in diabetes, and these drugs are now recommended in diabetes even in the absence of hypertension. These benefits result from improved intrarenal hemodynamics, with decreased glomerular efferent arteriolar resistance and a resulting reduction of intraglomerular capillary pressure. ACE inhibitors are also useful in the treatment of heart failure and as treatment after myocardial infarction, reduce incidence of diabetes in patients with high cardiovascular risk.
ACE inhibitors impede the breakdown of other compounds such as bradykinin, substance P, and enkephalins as well as the conversion of ANG (Angiotensin) I to ANG II. The action of ACE inhibitors to inhibit bradykinin metabolism contributes significantly to their hypotensive action. Increased bradykinin levels are thought to be more essential than decreasing ANG II levels in this scenario.
Elevated bradykinin is thought to be the cause of several negative side effects, such as cough and angioedema. These medicines are not recommended during pregnancy as fetal hypotension, anuria, renal failure, fetal malformations or death, increased teratogenic risk have been reported. Toxicity can lead to severe hypotension. Other adverse effects such as acute kidney injury, dry cough, hyperkalemia, wheezing are also reported.
Dosage:- 10-20 mg oral once or twice daily.
Reference:- Basic and Clinical Pharmacology 14th edition G. Katzung
PROMPT 1:
1. Type 1 diabetes is a chronic autoimmune disease where beta cell destruction may occur over a number of years before clinical diabetes is diagnosed. Type 2 diabetes is the result of an interplay of relative insulin deficiency or a defect in insulin release together with insulin resistance.
DKA is a complex disease process with multiple hormonal abnormalities that cause various deleterious fluid and electrolyte changes. It includes a relative exess ratio of glucogon to insulin. An increase in ketone production and a decrease in peripheral cell use lead to metabolic acidosis.PLEASE EXAMPLE BASED ON YOUR OWN WORD AND RESEARCHES.
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