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Author: P. Lichtlen Publisher: Springer Science & Business Media ISBN: 3642680852 Category : Medical Languages : en Pages : 713
Book Description
Pharmacological and clinical research on nitrates continues to be of growing interest in many centers. This is surprising in view of the fact that their favorable effects in angina pectoris were described by Brunton and by Murrell in the Lancet more than 100 years ago. As expected, a host of new information has been collected since the two previous symposia on nitrates held in Stockholm in 1975 and Berlin in 1978. New insights were gained into the pharmacology, pharmacokinetics and pharmacodynamics of nitrates, as well as into their clinical effects in acute and chronic ischemic heart diseases and in severe congestive heart failure. Relatively little progress, however, was observed in research into the basic action of nitrates. Although most investigators agree that intracellular sequestration of calcium is probably the main mechanism by which nitrates lead to the reduction of vascular smooth muscle tone, the exact site of their action still remains undefined. In contrast, dose-dependent differences in venous and arteriolar tone have long been clearly established. Treatment was again in the main stream of discussion. The question of tolerance following long-term administration was discussed in depth and the term "pseudotolerance" was introduced to describe the adaptation of the body's circulatory system to chronic vasodilation. This is especially important in long term prophylactic antiischemic treatment in stable, as well as in unstable angina pectoris (i.e. during increased vasomotor tone - spasm).
Author: P. Lichtlen Publisher: Springer Science & Business Media ISBN: 3642680852 Category : Medical Languages : en Pages : 713
Book Description
Pharmacological and clinical research on nitrates continues to be of growing interest in many centers. This is surprising in view of the fact that their favorable effects in angina pectoris were described by Brunton and by Murrell in the Lancet more than 100 years ago. As expected, a host of new information has been collected since the two previous symposia on nitrates held in Stockholm in 1975 and Berlin in 1978. New insights were gained into the pharmacology, pharmacokinetics and pharmacodynamics of nitrates, as well as into their clinical effects in acute and chronic ischemic heart diseases and in severe congestive heart failure. Relatively little progress, however, was observed in research into the basic action of nitrates. Although most investigators agree that intracellular sequestration of calcium is probably the main mechanism by which nitrates lead to the reduction of vascular smooth muscle tone, the exact site of their action still remains undefined. In contrast, dose-dependent differences in venous and arteriolar tone have long been clearly established. Treatment was again in the main stream of discussion. The question of tolerance following long-term administration was discussed in depth and the term "pseudotolerance" was introduced to describe the adaptation of the body's circulatory system to chronic vasodilation. This is especially important in long term prophylactic antiischemic treatment in stable, as well as in unstable angina pectoris (i.e. during increased vasomotor tone - spasm).
Author: P. Needleman Publisher: Springer Science & Business Media ISBN: 364266024X Category : Medical Languages : en Pages : 206
Book Description
Nitroglycerin and other organic nitrates have been used for over a century in the treatment of angina pectoris. Millions of patients, throughout the world, have placed nitroglycerin tablets under the tongue and have experienced rapid and dramatic relief from the chest pain that frequently occurs as a manifestation of disease of the coronary arteries. The empirical observation of the safe use of nitrates for tile alleviation of the symptoms of angina have led to their widespread medical acceptance. The use of organic nitrates preceded any knowledge of their mechanism of action or their ultimate metabolic fate. Thus, more simply stated, although sub lingual nitrates helped the patients, little was known concerning what these drugs do to the body or what the body does to the drugs. A substantial number of investigators have focused on these questions especially during the last two decades. We now have considerably more insight into the pathways of degradation of organic nitrates and the relationship of the metabolic processes to the biological action of these agents. Similarly, considerable effort has been expended in understanding the mechanism of action of these agents directly on vascular smooth muscle and on cardiac work and performance. Finally, there is a more substantive understanding of the physiology of the coronary circulation as well as the" pathophysiologic manifestations of myocardial disease.
Author: M. Kaltenbach Publisher: Springer Science & Business Media ISBN: 3642853234 Category : Medical Languages : en Pages : 167
Book Description
Although nitroglycerin is one of the oldest drugs in cardiology the problem of tolerance is a scientific challenge of today. The proceedings of this symposium highlight the most re cent questions related to this topic. Apparently, partial tolerance, or rather partial decrease in sensitivity, can arise during nitrate therapy. Probably this is the consequence of a partial readjustment of the vascular system. This readjustment refers particularly to the arterial system, i.e., to the hypoten sive effect of nitrates in the standing position. A similar effect on the venous side is not present. On the other hand, the results assembled in this volume confirm the experience of many decades that long-term antianginal therapy with nitrates remains effective even when high doses are applied. Thus partial tolerance which also occurs after other vasodilators such as prazosin, does not imply tolerance against antianginal effectiveness. From the information available to day it is reasonable to treat patients with angina pectoris acutely as well as chronically with nitrates in individually adjusted doses. Frankfurt, November 1982 M. Kaltenbach v Contents Foreword ... V Session 1-Pharmacology Tolerance from the Pharmacokinetic and Pharmacodynamic Viewpoints N. Rietbrock, A. Lassmann, B.G. Woodcock ... 3 Does Tolerance Develop During Long-Acting Nitrate Therapy? A Critical Review J. Abrams ... 13 Pharmacokinetics of Isosorbide Dinitrate During Tolerance Development Ho-Leung Fung ... 25 Discussion ... . 29 ... Session II - Hemodynamics Lack of Tolerance Development to the Hemodynamic Effects of Nitrates in Patients with Chronic Congestive Heart Failure Joseph A. Franciosa ... 35 Discussion ... 41 ...
Author: Udho Thadani Publisher: Springer Science & Business Media ISBN: 1461311357 Category : Medical Languages : en Pages : 292
Book Description
Nitrates remain among the most commonly used therapeutic agents in cardiology. That they can re lieve pain in angina pectoris has been known at least since 1867, when Lauder Brunton described their clinical use. Now, almost 130 years later, we are constantly learning more about their optimal use in anginal syndromes. For example, there is no doubt that nitrate tolerance occurs, but equally no doubt that certain drug dosages help to attenuate such toler ance. Thus, our understanding of nitrate tolerance has been taken further by the advent of new nitrate preparations and by studies at a basic science level. The current intense interest in nitrates has been rekindled by the growing emphasis on the role of the endothelium in the production of nitric oxide, a basic cardiovascular regulator. If nitric oxide is vasodilator and protects the vascular endothelium, then nitrates should also have similar properties. Hence this book starts off with the role of the endothelium and ni trates in vasodilation. Next, the mechanisms of ac tion of nitrates are considered with emphasis on the role of cyclic GMP. The chief limitation to the use of nitrates lies in nitrate tolerance. After carefully looking at all the evidence, the authors of the third chapter conclude that the mechanism is likely to be multifactorial. The mechanism responsible for the tolerance still remains unknown. In vitro tolerance may be due to enhanced production of vascular superoxide [1].
Author: R. Calvet Publisher: Editions Quae ISBN: 9782738002846 Category : Technology & Engineering Languages : en Pages : 584
Book Description
The contributions of this symposium on the relation agriculture-nitrogen-water deal with the economical aspects (cost evaluation and cost repartition), the quantitative approach of the nitrogen biochemical cycle, farming systems and nitrogen manegement, and land utilization, nitrogen management and water quality
Author: P. Lichtlen
Author: P. Lichtlen
Author: P. Needleman
Author: Henry Watts
Author: Henry Watts (F.C.S.)
Author: Henry Watts
Author: M. Kaltenbach
Author: Udho Thadani
Author: Roy Frederick Herrman
Author: Frederick Forchheimer
Author: R. Calvet