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part c Tutorial on blood pressure 2025 | PharmacoPhoto | YouTubeToText
YouTube Transcript: part c Tutorial on blood pressure 2025
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This content is a tutorial segment explaining the mechanism of action, indications, contraindications, and comparative advantages of candesartan, an angiotensin II receptor blocker (ARB), over ACE inhibitors for blood pressure management.
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So, on to the third portion of this
tutorial on blood pressure. In this
portion, we're going to begin by helping
you answer the second question in this
multi-part tutorial question, which is a
long one. It's a eight-point question.
It's describe the mechanism of action of
Candace Sartin. Explaining the results
of that action at each one of the organs
highlighted in this tutorial. explain
the most important indications and
contraindications of candisartin and
include a full explanation of why
candesartin is often preferred over ACE inhibitors.
inhibitors.
So that's a big question. It's worth
eight points and I'll just break it down
into subsets so that we understand it a
lot better. So the first portion of that
is just simply describe the mechanism of
action of candisartin explaining the
results of that action at each of the
organs that were highlighted in this tutorial.
tutorial.
Now, the first thing that you're going
to need to remember is that you probably
won't do very well in this question
unless you understand the regulation of
blood pressure and the other important
foundational information that we went
through in the first portions of this tutorial.
tutorial.
You're not going to be able to just grab
this question and then go off and do a
web search expecting a really good mark
for your work.
Another important point before we start
answering that question is that the
question asks for a description of each
one of the things that it asks for and
as such you'd get little credit for
instance for a really long answer and
complete list of conditions for which
candin is prescribed.
So let's just go through each portion at
a time. So the first portion is describe
the mechanism of action of candisartin
explaining the results of that action at
each of the organs that were highlighted
in the tutorial. So with the mechanism
of action the best way to start out is
to start looking at this diagram as
you're developing your answer. Remember
that angotensin 2 receptor blockers are
going to block the receptors of the
angotensin 2 which is really the
mechanism of action. But the question
asks for what it does at each one of
those organs that I've highlighted in
the tutorial.
So I've already gone through that in the
last portion of the tutorial, but I'm
just going to give you an example right
now. So when you're talking about the
fact that it blocks angotensin 2
receptors at for instance the adrenal
cortex not just the adrenal gland but
the adrenal because it's got two
portions remember uh but the adrenal
cortex and that's going to lead to a
decrease of eldoststerone the salt
saver. And when you say that it blocks
the receptors on the posterior pituitary
gland, you're going to continue on and
say that results in a decrease in ADH,
the water saver.
So you will address each one of these
organs and also remember about this next
slide that explains that blocking the
angotensin 2 receptors at the heart
leads to reduction in the inflammatory
response in the heart and leading to
less cardiac fibrosis.
So does everybody understand the kind of
thing that you'll be saying with respect
to the mechanism of action portion of
the question?
Okay, so the next portion says explain
the most important indications and
contraindications of Candace Sartin. So
remember this is an explanation. If you
just listed the top four conditions,
it's indicated in hypertension, prehypertension,
prehypertension,
uh congestive heart failure, and
diabetic kidney disease.
That's not going to give you very much
credit, but instead you will say
something like this. Candaceartin is
indicated in the treatment of hypertension
hypertension
because it directly or indirectly
decreases all three of the main factors
that contribute to blood pressure.
Cardiac output, blood, blood vessel
resistance, and the volume of blood. And
it's also indicated in prehypertension
which is a condition that is kind of
between 120 and 130 millimeters of
mercury and that's because it delays the
time that a person will take to become
fully hypertensive. So you actually uh
the client will actually get prescribed
a candisartin and then between that time
of 120 and 130 and uh like I say it just
delays that time that the person
ultimately becomes fully hypertensive.
Candace sartin is also valuable in
congestive heart failure and remember
what congestive heart failure is. It's
it's actually going to result in really
high blood pressure that's going to be
harder for the heart. So, it's valuable
in congestive heart failure not only
because of the fact that it decreases
the blood pressure, it also decreases
the progression of cardiac fibrosis
and just a little bit more about that.
Just remember that angotensin 2
stimulates fibroblasts
itself. Angotensin 2 itself stimulates
fibiberblasts and that develops scar
tissue. Well, the candisartin has been
found to decrease the progression of
scar tissue not only in the heart muscle
but also in the arteries in the kidneys
and in the pancreas as well. And it's
probably other organs but those are the
ones that are most studied at this
point. You don't need to talk about
those. You just need to say something
about the heart. I just wanted to give
you that picture that uh angotensin 2 is
some something that actually causes
fibrosis in chronic disorders. And uh in
this question we're just concerned about
congestive heart failure. And the last
indication that I'd like you to put down
for the maximum points is um that it uh
it actually is indicated for diabetic
glomeular sclerosis. Now you can call it
diabetic kidney disease but just know
that the portion of the actual full name
is sclerosis. Glomeular sclerosis. What
does sclerosis mean? Sclerosis is an
hardening. Atherosclerosis
is a hardening of the atheros the
arteries. Atherosclerosis.
Glomeular sclerosis is a hardening of
the glomeili. What is the thing that
actually is responsible for that
hardening? Well, a lot of the
responsibility falls on the angotensin 2
stimulation of those fibroblasts.
So, candisartin is indicated in the
treatment and prevention of diabetic
glomeular sclerosis or diabetic kidney disease.
disease.
So there's a few more conditions that
Candace Sartin is indicated for like
it's it's it's actually um been found to
be pretty good for migraines. Many
people find a lot of benefit for that.
But you don't need to mention those
those other things. I want you to uh
concentrate on those four most important
things which are of course the
congestive heart failure, hypertension,
prehypertension and diabetic kidney disease.
disease.
With respect to the contraindications,
first of all, remember that this is an
explanation. It's not just a list. Uh
both the Sartin drugs and the prill
drugs, in other words, both the
angotensin 2 receptor blockers and the
ACE inhibitors, they're both going to be
contraindicated in both pregnancy and lactation.
lactation.
they're a pregnancy category with a with
respect to the explanation, you just
pretty much say, well, they're pregnancy
category D drug, which means that they
are going to cause harm if if taken
during pregnancy.
So, mention the pregnancy and lactation,
but also what I think of as the most
important uh contraindication is pretty
much potassium supplements. And there's
a really good reason for that because
when a person is first diagnosed with
hypertension, a lot of times what
they're given is a potassium wasting
diuretic and a lot of times that is hydrochloricioide.
hydrochloricioide.
That's a firstline therapy for
hypertension in Australia. It is
potassium wasting. We get rid of the
potassium. So when they are given
hydrochloroioide or another diuretic
that's a potassium wasting diuretic,
what happens is that they're also given
a script for potassium
and then they have this potassium
medicine in their drawer in in in their
medicine drawer and uh they're they know
to take it every day. Well, the client
is then put on for instance candin or an
ACE inhibitor and taken off those
diuretics maybe. Uh well, in that case
you have a potassium sparing
uh it's not a diuretic but potassium
sparing um drug. You know ACE inhibitors
and candisartin have diuretic actions u
but they are but they're not considered
a diuretic. They're cons they're a lot
more than just a diuretic and uh they
they have that increase of potassium.
They spare potassium. They increase
potassium le levels. So what happens if
you've got a potassium sparing drug and
potassium? If you're taking both of
those at the same time, of course,
you'll wind up with hyper
calmia, which is of course um increased
levels of potassium. It's really uh a
dangerous situation if that happens. So
that's why and it's very frequently seen
as well. And that's why I think of it as
one of the most important
So with the contraindications, you're
not going to go into a long list of
medications and things like that that
are contraindicated
uh with Candace Sartin. What you're
going to do is just uh home in on uh
pregnancy and potassium supplements and
just briefly describe those as we've
So everybody understands how to answer
that portion of the question.
And then the final portion of that uh
question, that sub question is and
include a full explanation of why
Candaceartin is often preferred over ACE inhibitors.
inhibitors.
In order to understand and explain that,
you're going to need to first of all
refresh your memory about ACE
inhibitors. And those are the ones that
work at this level of the enzyme uh
angotensin converting enzyme. So look at
this diagram right here. And at that
point right here in the lungs mostly in
the lungs we've got the enzyme ACE other
in other spots but mostly it happens in
the lungs.
The angotensin converting enzyme is the
one that actually converts angotensin
one to angotensin 2. And you would think
by its name that that is its only
physiological function. But of course
it's not. It's much more complicated
than that. angotensin converting enzyme
actually also degrades a a a what's
called a inflammatory mediator called
brady kynanin. So what happens if you um
degrade an inflammatory mediator called bradkinine
bradkinine
uh with a certain enzyme and then you
kind of decrease that enzyme. Well,
you're going to have a lot more bradyinine.
bradyinine.
Well, that's what happens. A person
who's taking ACE inhibitors is going to
stop their conversion of angotensin one
to endotensin 2, but they also have a
lot more of that inflammatory mediator
called bradkinanine in their system. And
that's going to lead to these two
problems in susceptible people.
Uh these that are listed over here. ACE
inhibitors are going to lead to a
chronic dry cough in about 20%
of individuals taking the medication. So
about 20% of individuals actually have
to go off the medication
and onto the angotensin 2 receptor blockers.
blockers.
A and one of the problems with that
chronic dry cough is it's a very
persistent cough and it lasts even
several weeks after the sessation of the medication.
medication.
So it's something that we oftentimes try
to avoid by prescribing the angotensin 2
receptor blocker in the first instance
and also ACE inhibitors can also lead to
a thing called angioadeema. What's
angiodma? Angioadeema is a type of fluid
buildup, but it's in the it's like
edema, but it's in the really deep
layers below the actually below the skin
and it's predominantly going to occur in
the facial area around the eyes, the
lips, the tongue and also the genital areas.
areas.
So that is the reason that angotensin 2
receptors are often times preferred over
ACE inhibitors. The chronic cough
happens in about 20% of the people and
also the angiodma that only occurs in
about 1 half of 1% of individuals but it
can be lifethreatening.
So yeah, so the
angotensin 2 uh receptor blockers are
often times preferred over the ACE
inhibitor for those two reasons.
Does anyone have any questions on that
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