Atelectasis

partly or completely collapse lungs
not a disease but a condition associated w/ many respiratory disorders.

Cause:
obstruction of the bronchus, may be small or the entire lobe.
compression of the lung by pneumothorax, pleural effusion, or tumor; loss of surfactant or inability to keep an alveoli open

Manifestation:
for small atelectasis - diminished breath sounds over the affected area
bigger one - absent breath sounds, tachycardia, tachypnea, hypoxemia, dyspnea, cyanosis, reduced chest expansion

do a chest x-ray or ct scan to determine cause

Tx:
prevention is important for high risk patients - chest physiotherapy
cough, deep breath, spirometry, chest therapy
bronchoscopy if there is an obstruction that needs to be remove
antibiotic therapy to treat infectious cause (focus is treating the underlying cause)

position on the unaffected side to promote gravity drainage of the affected side
frequent position change, ambulation, coughing, deep breathing
fluids will help liquify secretions

Dyslipidemia Pharmacology

Management of Dyslipidemia:

• Maintain optimal chlolesterol, LDL, triglyceride and HDL levels

• Total Cholesterol : <200
• LDL: <100
• Triglycerides: <150
• HDL: >40 for men; >50 for women

• Diet/Exercise: increase fiber and complex carbs. DASH diet, 30 minutes exercise most days of weeks. 

• Good for you: vit. B, C, E, red wine, grape juice, bioflavonoids, garluc, cucumin, gingko biloba

Drug class	Mechanism	Side effects & considerations
Statins (“-statin”)	Reduces LDL synthesis in liver	Muscle breakdown; liver dysfunction; fatigue; abdominal discomfort. Unsafe in pregnancy.
Bile acid sequestrants Cholestyramine (Questran)	Binds with bile acids in intestine; reduces cholesterol reabsorption from intestine	GI side effects; constipation; power mixes with liquid; take with adequate fluid
Cholesterol absorption inhibitors: ezetimibe (Zetia)	Blocks absorption of cholesterol from food in small intestine	Elevated liver enzymes, gallbladder/pancreatic dysfunction

HTN Pharmacology

Mechanisms of action of drugs for HTN:

• Decrease preload (fluid volume), SVR and force of cardiac contraction.
• Block cardiovascular response to catecholamines
• Block outflow of catecholamines 

Drug class	Mechanism	Side effects & considerations
Thiazide diuretics: HCTZ (hydrodiuril)	Promotes H2O & Na+ excretion; reduces SVR. First-line tx.	↓K+, ↑ glucose & triglycerides
Angiotensin-converting enzyme (ACE)inhibitors  (“-pril” drugs)	Blocks formation of angiotensin II; prevents vasoconstriction & Na+/H2O retention	Dry persistent cough; angioedema; K+ retention; unsafe in pregnancy; first-dose hypotension
Beta-blockers  (“-lol” drugs)	Blocks  β-1 receptors in heart & vascular smooth muscle	Contraindicated in COPD & asthma; hold for bradycardia. Fatigue; bradycardia; depression. Rebound HTN if DC’d

Angiotensin receptor blockers (ARBs) (“-sartan”)	Blocks angiotensin II receptors; prevents vasoconstriction & fluid retention	Expensive. For people who do not tolerate ACE-I. Unsafe in pregnancy.  ↑K+
Calcium channel blockers (“-ipine)	Blocks influx of calcium ions in cardiac & vascular cells	Reflex tachycardia; worsens heart failure; hypotension; heart block; constipation. Hold for bradycardia.
Alpha blockers  (“-zosin)	Blocks alpha adrenergic receptors on vascular smooth muscle	First-dose syncope; orthostatic hypotension & reflex tachycardia

Central sympatholytics: clonidine (Catapres)	Alpha-2 stimulant; inhibits outflow of catecholamines to heart & vessels; vasodilation,  ↓CO	Rebound HTN with abrupt DC of med. Sedation possible. Unsafe in pregnancy. Available TD patch.
Vasodilators: hydralazine (Apresoline)	Acts on peripheral arterioles, causing vasodilation	Injectable available. Monitor HR, pulse. Orthostatic hypotension. Do not DC abruptly.

Which drugs are appropriate?

PreHypertension: lifestyle modifications
Stage 1: diuretic first, maybe add beta blocker or Ace inhibitor
Stage 2: more aggresive tx. more meds
Heart Failure: no calcium channel blockers; Beta blockers used cautiously
African American: Respond better to diuretics and calcium channel blockers
African American & elderly: More sensitive to effects of sodium in diet

HTN tx

Lifestyle modifications are recommended for all patients whose blood pressure falls within the prehypertension range and everyone with intermittent or sustained hypertension. These modifications include weight loss, dietary changes, restricted alcohol use and cigarette smoking, increased physical activity, and stress reduction. Dietary approaches to managing hypertension focus on reducing sodium intake, maintaining adequate potassium and calcium intakes, and reducing total and saturated fat intake. The DASH diet has proven beneficial effects in lowering blood pressure. Regular exercise reduces blood pressure and contributes to weight loss, stress reduction, and feelings of overall well-being. Previously sedentary patients are encouraged to engage in aerobic exercise for 30 to 45 minutes per day most days of the week. Isometric exercise, such as weight training, may not be appropriate, as it can raise the systolic blood pressure.

Hypertension management focuses on reducing the blood pressure to less than 140 mmHg systolic and 90 mmHg diastolic. The ultimate goal of hypertension management is to reduce cardiovascular and renal morbidity and mortality. The risk of cardiovascular complications decreases when the average blood pressure is less than 140/90; when the patient also has diabetes or renal disease, the treatment goal is a blood pressure less than 130/80.