Disease Management & Therapeutics: Key Health Conditions

Posted on Jul 20, 2025 in Other university degrees and diplomas

Pharmacotherapeutics

Pharmacotherapeutics is the treatment of health conditions using pharmaceutical products (drugs) as medication.

Scope and Objectives of Pharmacotherapeutics

  • Gain correct knowledge regarding drug chemical reactions in the body.
  • Decide correct drug categories for treating specific diseases.
  • Decide correct dose and formulation for treating specific diseases.
  • Identify the right patient for a particular drug.
  • Determine suitable and effective routes of administration.
  • Determine correct time of administration (e.g., gastric drugs on empty stomach, others after meals).
  • Assess drug tolerance and resistance capacity.
  • Identify drug incompatibility or adverse effects (e.g., aspirin in dengue).
  • Evaluate drug-food interactions (e.g., calcium-rich food and antibiotics should not be taken together).
  • Consider natural and environmental conditions for drug administration.

Irrational Use of Drugs

Irrational drug use refers to the improper use of medicines and formulations, including:

  • Selection of wrong medicine.
  • Selection of wrong doses.
  • Administration to the wrong person.
  • Administration at the wrong time.

Asthma

Asthma is a condition in which airways become narrow, swell, and produce extra mucus. This can make breathing difficult and trigger coughing, a whistling sound (wheezing) when breathing out, and shortness of breath.

Classification of Asthma

  • Seasonal Asthma: Triggered by minute seasonal changes (cold, hot, rain). Allergic reactions due to seasonal variations can complicate the condition if not treated early.
  • Allergic Asthma: Caused by allergens such as pollen, animal dander, or dust.
  • Occupational Asthma: Induced by exposure to chemicals in industrial settings.
  • Exercise-Induced Asthma: Triggered by excessive physical exercise.
  • Asthma-COPD Overlap: Chronic Obstructive Pulmonary Disease (COPD), including emphysema and bronchitis, can lead to hyperactivity of mucosal glandular cells, contributing to asthma.

Insulin: Purpose and Function

The major purpose of insulin is to regulate the body’s energy supply by balancing micronutrient levels during the fed state. Insulin is critical for transporting intracellular glucose to insulin-dependent cells/tissues, such as liver, muscle, and adipose tissue.

Chronic Obstructive Pulmonary Disease (COPD)

COPD (Chronic Obstructive Pulmonary Disease) is a multifactorial entity with a wide range of clinical manifestations and a leading cause of morbidity and mortality globally.

COPD Etiopathogenesis

  • Primarily caused by smoking or allergic substances. Long-term exposure to contaminants modifies respiratory receptors into secretory/glandular receptors, leading to excessive mucus production and airway obstruction. Heat from smoking damages immunological cells or receptors, creating resistance or functional deformity, which contributes to COPD.
  • Harmful particulate gases from smoking and industrial waste enter alveolar sacs, accumulating and forming ligand compounds with alveolar chemicals, thereby decreasing the alveolar surface area.

COPD Clinical Manifestations

  • Heart disease: Congestive heart disease, ischemic heart disease.
  • Liver disease.
  • Lung cancer.
  • Respiratory infections (e.g., Upper Respiratory Tract Infections (URTIs) like cough, sore throat).
  • Mental disorders.
  • Pulmonary hypertension.
  • Muscle fatigue.

COPD Pharmacological Management

For COPD management, general bronchodilators and fixed combination drugs are used.

Fixed Combination Drugs for COPD

  • Albuterol + Ipratropium.
  • Fenoterol + Ipratropium.
  • Budesonide + Formoterol.
  • Fluticasone + Salmeterol.

General Bronchodilators for COPD

  1. β-agonists
    • Short-acting β-agonists (SABAs): e.g., Albuterol/Salbutamol, Fenoterol, Terbutaline.
    • Long-acting β-agonists (LABAs): e.g., Salmeterol, Formoterol.

COPD Non-Pharmacological Management

  • Cigarette smoking is a major cause of COPD; therefore, the best management involves avoiding or stopping smoking.

Diabetes Mellitus

Diabetes Mellitus is a group of metabolic disorders sharing the common feature of hyperglycemia.

Classification of Diabetes Mellitus

  • Type 1 Diabetes: An autoimmune disease characterized by pancreatic β-cell destruction and an absolute deficiency of insulin. It accounts for approximately 5% to 10% of all cases.
  • Type 2 Diabetes: Caused by a combination of peripheral resistance to insulin action and an inadequate secretory response by the pancreatic β-cells (“relative insulin deficiency”). Approximately 90% to 95% of diabetic patients have Type 2 diabetes.

Diabetes Etiopathogenesis

Type 1 Diabetes Mellitus

Also known as Insulin-Dependent Diabetes Mellitus (IDDM). It is an autoimmune disease where islet destruction is primarily caused by immune effector cells reacting against endogenous β-cell antigens. Individuals with Type 1 diabetes require insulin for survival; without it, they can develop serious metabolic complications like ketoacidosis and coma. It typically occurs in children.

Type 2 Diabetes Mellitus

Also known as Non-Insulin-Dependent Diabetes Mellitus (NIDDM). Type 2 diabetes is a complex disease that involves an interplay of genetic and environmental factors, along with a proinflammatory state. Unlike Type 1 diabetes, there is no evidence of an autoimmune basis. It typically occurs in middle age.

Diabetes Clinical Manifestations

  • Excessive hunger and thirst.
  • Frequent urination.
  • Progressive weight loss.
  • Sudden vision changes.
  • Tingling or numbness in the hands or feet.
  • Very dry skin, sometimes accompanied by skin disorders.
  • Blood vessel obstruction (impaired blood supply).
  • Induced cardiac diseases.
  • Slow healing wounds.

Diabetes Pharmacological Management

  1. Insulin

    Insulin Types

    • Long-acting: e.g., Insulin Degludec, Insulin Glargine.
    • Intermediate-acting: e.g., Insulin Zinc Suspension.
    • Short-acting: e.g., Biphasic Insulin.
    • Rapid-acting: e.g., Insulin Aspart, Insulin Lispro.
  2. Oral drugs.

Hypothyroidism

Hypothyroidism is a condition caused by a structural and functional derangement that interferes with the production of thyroid hormone, leading to thyroid hormone deficiency. It is a fairly common disorder, more prevalent in females than males. Based on causative factors, it is divided into two types:

  1. Primary Hypothyroidism: Arises due to intrinsic abnormality in the thyroid itself, or as a result of pituitary and hypothalamic disease. It accounts for the vast majority of cases and may be accompanied by an enlargement of the thyroid gland (goiter). It can be congenital (due to iodine deficiency), autoimmune, or iatrogenic.
  2. Secondary Hypothyroidism: Arises from processes outside the thyroid gland.

Hypothyroidism Etiopathogenesis

  • Congenital Hypothyroidism: Most often results from endemic iodine deficiency in the diet. Other rare forms include inborn errors of thyroid metabolism. In rare instances, there may be a complete absence of thyroid parenchyma or a greatly reduced gland size due to germline mutations in genes responsible for thyroid development.
  • Autoimmune Hypothyroidism: The most common cause of hypothyroidism in iodine-sufficient areas. The vast majority of cases are due to Hashimoto’s thyroiditis. Circulating autoantibodies, including anti-microsomal, anti-thyroid peroxidase, and anti-thyroglobulin antibodies, are found, and the thyroid is typically enlarged.
  • Iatrogenic Hypothyroidism: Can be caused by surgical or radiation-induced abnormalities. A large resection of the gland (total thyroidectomy) for hyperthyroidism or a primary neoplasm can lead to hypothyroidism. Certain drugs, such as Methimazole and Propylthiouracil, can also decrease thyroid secretion.

Hypothyroidism Clinical Manifestations

Hypothyroidism Pharmacological Management

  1. Levothyroxine
  2. Triiodothyronine.

Hypothyroidism Non-Pharmacological Management

  • Follow a diet plan as indicated by a physician, as maintaining iodine levels is crucial in thyroid disorders.
  • Avoid consumption of goitrogenic foods such as broccoli and cauliflower.
  • Increase intake of yellow vegetables, eggs, and carrots.

Hypertension

Hypertension is defined as blood pressure higher than normal. Normal values are typically 110 to 140 mmHg for systolic pressure and 60 to 80 mmHg for diastolic pressure. When systolic and diastolic pressure remain elevated above 150 mmHg and 90 mmHg, respectively, it is considered hypertension. Commonly, an increase only in systolic pressure is called systolic hypertension.

Types of Hypertension

  1. Primary/Essential Hypertension.
  2. Secondary/Systemic Hypertension.

Hypertension Etiopathogenesis

Primary Hypertension: The most common type, arising from increased peripheral resistance or external factors without an underlying disease. Long-term, untreated primary hypertension can lead to vascular damage, small blood vessel damage, cerebral hemorrhage, retinal hemorrhage, and renal failure. Blood pressure can range from 100 mmHg to 250 mmHg. It can be controlled but not cured.

Secondary Hypertension: Arises due to underlying disorders, occurring when body organs do not function properly or are imbalanced due to internal effects or infections. It is cured by treating the responsible underlying disease. Examples include:

  • Cardiovascular Hypertension: Arises due to arterial blockage.
  • Renal Hypertension: Arises due to obstruction of the renal artery or improper glomerular filtration (e.g., glomerulonephritis).
  • Endocrine Hypertension: Arises due to the hyperactivity of endocrine glands.

Hypertension Clinical Manifestations

  • Renal failure.
  • Myocardial infarction.
  • Arrhythmia.
  • Cerebrovascular accident (strokes).
  • Retinal hemorrhage.
  • Left ventricular failure.
  • Dyspnea (shortness of breath).
  • Epistaxis (nosebleeds).

Hypertension Pharmacological Management

  1. Calcium Channel Blockers: Block calcium channels in the myocardium, reducing myocardial contractility. e.g., Phenylalkylamines, Benzothiazepines, Dihydropyridines.
  2. Vasodilators: Reduce blood pressure through vasodilation. e.g., Sodium Nitroprusside, Hydralazine, Minoxidil, Fenoldopam, Diazoxide.
  3. Diuretics: Cause diuresis, reducing extracellular fluid (ECF) volume and blood volume.
  4. Angiotensin-Converting Enzyme (ACE) Inhibitors: Reduce blood pressure by blocking angiotensin formation.
  5. Angiotensin (AT1) Receptor Blockers (ARBs): e.g., Losartan, Telmisartan, Melavinus, Valsartan, Eprosartan.

Myocardial Infarction (Heart Attack)

Myocardial Infarction, also known as a Heart Attack or myocardial necrosis, is a critical condition arising from myocardial tissue death due to lack of blood supply. It begins when any blockage or obstruction occurs in the arteries.

Types of Myocardial Infarction

Type 1 MI:
Spontaneous MI due to rupture or damage of a coronary artery.
Type 2 MI:
Appears due to either increased oxygen demand or decreased blood flow.
Type 3 MI:
Due to initial myocardial necrosis.
Type 4 MI:
Due to thrombotic occlusion of a coronary stent.
Type 5 MI:
Associated with cardiac surgery.

Myocardial Infarction Clinical Manifestations

  • Chest pain.
  • Dyspnea.
  • Fatigue.
  • Arrhythmia.
  • Increased sweating.
  • Weakness.
  • Nausea.
  • Anxiety.
  • Palpitation.

Myocardial Infarction Pharmacological Management

  1. Beta Blockers: e.g., Metoprolol, Propranolol, Atenolol, Alprenolol.
  2. Potassium Channel Openers: e.g., Nicorandil.
  3. Calcium Channel Blockers: e.g., Amlodipine, Verapamil, Mibefradil, Bevantolol, Diltiazem, Nitrendipine.
  4. Nitrates

    Nitrates for Myocardial Infarction

    • Long-acting Nitrates: e.g., Isosorbide Dinitrate, Molsidomine.
    • Short-acting Nitrates: e.g., Nitroglycerin, Erythrityl Tetranitrate.
  5. Other Drugs: e.g., Oxyfedrine, Ivabradine, Trimetazidine, Dipyridamole, Acadesine.

Myocardial Infarction Non-Pharmacological Management

  • Follow a proper routine for daily activities (wake up, sleep, natural urges).
  • Engage in regular exercise and workouts (prevents fat deposition and removes excessive fats).
  • Practice yoga and meditation (helps maintain oxygen and carbon dioxide levels).
  • Create and follow a proper diet chart after consulting a specialist (include green vegetables, natural fruit juice, less fatty substances, and avoid street food items).

Congestive Heart Failure (CHF)

Heart Failure or Congestive Heart Failure is an abnormal condition involving impaired cardiac pumping. In this condition, the heart fails to pump sufficient blood to organs due to less nutrient and oxygen supply to the myocardial tissue, leading to reduced cardiac muscle ability.

Congestive Heart Failure Clinical Manifestations

  • Tachycardia.
  • Edema (swelling in ankles, legs, and abdomen).
  • Cachexia and muscle wasting.
  • Crepitations or wheezing.
  • Third heart sound.
  • Hepatomegaly.
  • Pulse alterations.
  • In infants and children, common symptoms include cyanosis, poor weight gain, recurrent lung infections, inability to exercise, fast breathing, and poor feeding.

Congestive Heart Failure Pharmacological Management

  1. Calcium Channel Blockers: Block calcium channels in the myocardium, reducing myocardial contractility. e.g., Phenylalkylamines, Benzothiazepines, Dihydropyridines.
  2. Vasodilators: Reduce blood pressure through vasodilation. e.g., Sodium Nitroprusside, Hydralazine, Minoxidil, Fenoldopam, Diazoxide.
  3. Diuretics: Cause diuresis, reducing extracellular fluid (ECF) volume and blood volume.
  4. Angiotensin-Converting Enzyme (ACE) Inhibitors: Reduce blood pressure by blocking angiotensin formation.
  5. Angiotensin (AT1) Receptor Blockers (ARBs): e.g., Losartan, Telmisartan, Melavinus, Valsartan, Eprosartan.
  6. Sympathetic Inhibitors

    Sympathetic Inhibitors for CHF

    • Alpha-Beta Adrenergic Blockers: e.g., Arotinolol, Labetalol, Carvedilol, Bucindolol.
    • Alpha Adrenergic Blockers: e.g., Prazosin, Doxazosin, Naftopidil, Phenoxybenzamine.
    • Beta Adrenergic Blockers: e.g., Atenolol, Metoprolol, Timolol, Oxprenolol, Nipradilol.
    • Central Sympatholytics: e.g., Methyldopa, Reserpine, Clonidine.

Congestive Heart Failure Non-Pharmacological Management

  • Follow a proper routine for daily activities (wake up, sleep, natural urges).
  • Engage in regular exercise and workouts (prevents fat deposition and removes excessive fats).
  • Practice yoga and meditation (helps maintain oxygen and carbon dioxide levels).
  • Create and follow a proper diet chart after consulting a specialist (include green vegetables, natural fruit juice, less fatty substances, and avoid street food items).
  • Avoid polluted areas and spend time where fresh air circulates.