Drugs online research references
Arch Mal Coeur Vaiss. 2000 Feb;93 Spec No 2:13-6.
[Cardiac insufficiency: what treatment? what dose? For which patients? Converting enzyme inhibitors and diuretics]
[Article in French]
Komajda M.
Service de cardiologie, CHU La Pitie-Salpetriere, Paris.
Diuretics were the first family of drugs to be used in cardiac failure. They improve symptoms but no randomised control trials show their efficacy in prolonging survival. The results of the recent RALES trial, however, provides evidence in favour of antialdosterone diuretics on survival in association with a loop diuretic and an angiotensin converting enzyme inhibitor. At present, the legal requirements in France state that "the association of spironolactone and converting enzyme inhibitors is possible with low doses of angiotensin converting enzyme inhibitors and diuretic hypokalaemiant; kalaemia and creatinine have to be monitored". "The association of hypokalaemia-inducing diuretics (loop diuretics, thiazides and similar: the association with this type of diuretic, rational and useful in certain patients, does not exclude the risk of hypo- or even hyperkalaemia, especially in renal failure and diabetes; it also imposes the monitoring of serum potassium and eventually of the electrocardiogram and, if necessary, to reconsider the treatment". Many points remain unclear concerning the value and harmlessness of the prescription of diuretics in asymptomatic left ventricular failure. In cases of diuretic resistance, the use of intravenous administration, the fragmentation of doses or the association of diuretics, may induce a diuretic response. Angiotensin converting enzyme inhibitors are the first line treatment of moderate and severe cardiac failure and in post-infarction left ventricular dysfunction. On the other hand, the value of this family of drugs in left ventricular failure and normal systolic function has not been demonstrated. Analysis of clinical practice shows an underprescription of angiotensin converting enzyme inhibitors, both in number of patients and in dosage. The results of the recent ATLAS trial suggest that high doses of lisinopril improve morbidity related to cardiac failure and the combined morbi-mortality criterion. The results of this study incite the prescription of high rather than low doses of angiotensin converting enzyme inhibitor.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10830083&dopt=Abstract
Cleve Clin J Med. 2000 Jun;67(6):429-33.
Alpha-blockers and congestive heart failure: early termination of an arm of the ALLHAT trial.
Vidt DG.
Department of Nephrology and Hypertension, Cleveland Clinic, USA.
The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is a large, randomized double-blind study comparing four antihypertensive agents (chlorthalidone, doxazosin, amlodipine, and lisinopril) in hypertensive patients older than 55 years. The doxazosin arm was terminated early, when the trial's safety and monitoring board noted a twofold higher incidence of congestive heart failure in patients receiving doxazosin than in those receiving chlorthalidone (8.13% vs 4.45% at 4 years, P < .001).
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10860225&dopt=Abstract
P R Health Sci J. 1994 Mar;13(1):25-8.
Lack of interaction of angiotensin converting enzyme inhibitors with muscarinic and neuropeptide Y receptors.
Silva WI, Sanabria P, Altieri PI.
Department of Pharmacology, Universidad Central del Caribe, School of Medicine, Bayamon, Puerto Rico 00621-6032.
In studies conducted in patients undergoing cardiac catheterizations, some hemodynamic changes were observed after the acute sublingual administration of the angiotensin converting enzyme inhibitors (ACEI) captopril, enalapril, and lisinopril. These changes consisted of an increase in pulmonary artery pressure, pulmonary vascular resistance (PVR) and induction of hypoxia. The pressure changes were transitory and disappeared after 25 min. The possible mechanisms involved in these changes may relate to interactions of the ACEI with peripheral receptor systems for hormones and neurotransmitters. We have thus undertaken the task of evaluating the potential effect of ACEI on biological receptor molecules. We have begun with studies on muscarinic receptors, and the recently characterized neuropeptide Y (NPY) receptors of endothelial cells. Equilibrium binding assays with 3H-QNB have been conducted for muscarinic receptors using rat brain synaptosomes, due to its expression of multiple muscarinic receptors subtypes. In addition 125BH-NPY binding assays were conducted on intact adrenal medullary endothelial cells. Enalapril and captopril, 10(-7) to 10(-3) M, were not able to produce significant inhibition of either muscarinic or NPY receptor probes. The paradoxical changes elicited by sublingual ACEI seems not to involve interaction with muscarinic or NPY receptors.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8016291&dopt=Abstract
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