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1.
Brasília; s.n; 4 maio 2020.
Non-conventional in Portuguese | LILACS (Americas), ColecionaSUS, PIE | ID: biblio-1097406

ABSTRACT

Essa é uma produção do Departamento de Ciência e Tecnologia (Decit) da Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde (SCTIE) do Ministério da Saúde (Decit/SCTIE/MS), que tem como missão promover a ciência e tecnologia e o uso de evidências científicas para a tomada de decisão do SUS, tendo como principal atribuição o incentivo ao desenvolvimento de pesquisas em saúde no Brasil, de modo a direcionar os investimentos realizados em pesquisa pelo Governo Federal às necessidades de saúde pública. Informar sobre as principais evidências científicas descritas na literatura internacional sobre tratamento farmacológico para a COVID-19. Além de resumir cada estudo identificado, o informe apresenta também uma avaliação da qualidade metodológica e a quantidade de artigos publicados, de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, entre outros). Foram encontrados 24 artigos e 10 protocolos.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Vitamin D/therapeutic use , Calcium Channel Blockers/therapeutic use , Heparin/therapeutic use , Chloroquine/therapeutic use , Azithromycin/therapeutic use , Drug Combinations , Hydroxychloroquine/therapeutic use
2.
Int. j. cardiovasc. sci. (Impr.) ; 30(3): f:199-l:206, mai.-jun. 2017. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-836659

ABSTRACT

Fundamento: Um programa permanente de educação em serviço melhora o desempenho dos profissionais de saúde e aumenta os índices de controle da hipertensão arterial. Objetivo: Estimar a prevalência do controle da hipertensão arterial e da inércia terapêutica em adultos atendidos nas Unidades Básicas da Saúde após a implantação de um programa de apoio matricial em cardiologia. Métodos: Estudo transversal, com amostragem por conglomerados, mediante pesquisa em prontuários, em que foram avaliados 463 portadores de hipertensão arterial. Foram avaliados pressão arterial, medicamentos e incrementos terapêuticos em 2013, e comparados ao resultados obtidos em 2007. Resultados: Houve predomínio de pacientes das unidades de Estratégia Saúde da Família e do sexo feminino. A idade variou entre 24 e 92 anos (média de 61,7). Observaram-se redução das médias da pressão arterial (148,62/91,60±23,52/14,51mmHg para 137,60/84,03 ± 21,84/12,72 mmHg) entre o primeiro e o último registro, e controle em 58% dos pacientes, ou seja, superior aos 36,6% encontrados em 2007. No período analisado, houve incremento terapêutico de 39% das ocasiões e 52% dos pacientes, superior aos 12% e 29,5%, respectivamente, em 2007. A média de fármacos por paciente aumentou de 1,85 para 2,05, predominando diuréticos e inibidores da enzima de conversão da angiotensina. Conclusão: Houve redução da inércia clínica e aumento do controle da hipertensão arterial, comparados com os achados do estudo anterior. O resultado sugere que o programa de apoio matricial para os profissionais da saúde e outras medidas para melhorar o controle da doença nas Unidades Básicas da Saúde foram eficazes


Background: A continuing education program for health professionals improves their performance and increases hypertension control rates. Objective: To estimate the prevalence of hypertension control and therapeutic inertia among adults treated at Primary Health Care Units after a continuing education program focused on cardiology for health professionals. Methods: A cross-sectional study was carried out, which included cluster sampling and analysis of medical records. We evaluated 463 patients with high blood pressure and analyzed the blood pressure, medications, and therapeutic increments in 2013, which were compared to the data obtained in 2007. Results: There was prevalence of female patients and appointments at the Family Health Care Units. The age ranged between 24 and 92 years (mean of 61.7 years). There was a reduction in the mean blood pressure (148.62/91.60 ± 23.52/14.51 mmHg to 137.60/84.03 ± 21.84/12.72) between the first and last records, and BP control in 58% of the sample, that is, higher than the 36.6% found in 2007. In the analyzed period, there was a therapeutic increment of 39% in appointments, which benefited 52% patients with high blood pressure, higher than the 12% and 29.5%, respectively, found in 2007. The mean number of drugs per patient increased from 1.85 to 2.05, with a predominance of diuretics and angiotensinconverting-enzyme inhibitors. Conclusion: There was a reduction in the clinical inertia and increased control of arterial hypertension was observed, compared with the findings of the previous study. The result suggests that the matricial support program for health professionals and other measures to improve disease control in the Primary Health Care Units were effective


Subject(s)
Humans , Male , Female , Middle Aged , Adult , Health Education/methods , Hypertension/epidemiology , Hypertension/prevention & control , Medication Adherence , Prevalence , Primary Health Care/methods , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Calcium Channel Blockers/therapeutic use , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/physiopathology , Cross-Sectional Studies/methods , Drug Therapy/methods , Health Centers , Inertia , Statistical Analysis , Treatment Outcome
3.
Porto Alegre; Universidade Federal do Rio Grande do Sul. Telessaúde; 2017. ilus.
Non-conventional in Portuguese | LILACS (Americas) | ID: biblio-995641

ABSTRACT

As principais causas de tremor em pacientes atendidos na Atenção Primária à Saúde são: exacerbação de tremor fisiológico, tremor essencial (acomete 5% da população acima de 40 anos) e as síndromes parkinsonianas. É importante definir corretamente sua origem, pois o tratamento e o prognóstico são variados. Esta guia apresenta informação que orienta a conduta para casos de tremor e síndromes parkinsonianas no contexto da Atenção Primária à Saúde, incluindo: etiologia do tremor e síndromes parkinsonianas, avaliação clínica, tipos de tremor, sintomas cardinais de parkinsonismo, medicamentos indutores, fluxograma de avaliação do tremor, exames complementares, tratamento do tremor essencial e doença de parkinson, encaminhamento para serviço especializado.


Subject(s)
Humans , Parkinsonian Disorders/diagnosis , Parkinsonian Disorders/therapy , Essential Tremor/diagnosis , Essential Tremor/therapy , Primary Health Care , Referral and Consultation , Antipsychotic Agents/therapeutic use , Calcium Channel Blockers/therapeutic use , Hypokinesia , Antiemetics/therapeutic use
4.
Porto Alegre; Universidade Federal do Rio Grande do Sul. Telessaúde; 2017.
Non-conventional in Portuguese | LILACS (Americas) | ID: biblio-995608

ABSTRACT

Cardiopatia isquêmica é uma causa importante de morbimortalidade no Brasil. Visto sua importante prevalência, seus casos estáveis devem ser manejados na Atenção Primária à Saúde (APS). A principal etiologia é a aterosclerose, porém podem ocorrer eventos por espasmo coronariano, alteração da relação da oferta de oxigênio e demanda miocárdica ou trombose coronariana. A manifestação clínica mais comum é a angina pectoris (desconforto torácico em aperto, retroesternal, relacionado com esforços físicos ou emocionais e que alivia com repouso ou nitratos), mas podem ocorrer outras situações, como: infarto agudo do miocárdio, arritmia, insuficiência cardíaca, isquemia silenciosa e morte súbita. O papel do médico na APS é avaliar a probabilidade clínica da dor ser de origem cardíaca e iniciar investigação diagnóstica apropriada, continuar ou otimizar tratamento farmacológico em pacientes com diagnóstico confirmado, trabalhar no controle dos fatores de risco e coordenar o cuidado de pacientes que necessitam encaminhamento para o cardiologista ou serviço de emergência. Esta guia apresenta informação que orienta a conduta para casos de cardiopatia isquêmica no contexto da Atenção Primária à Saúde, incluindo: Classificação clínica da dor torácica, Probabilidade pré-teste na dor torácica, Classificação da angina, Exames complementares, Acompanhamento na APS, Tratamento farmacológico, Tabela com medicamentos, Manejo na APS da doença arterial aguda, Encaminhamento para serviço especializado.


Subject(s)
Humans , Telemedicine/methods , Myocardial Ischemia/diagnosis , Myocardial Ischemia/therapy , Education, Distance/methods , Primary Health Care , Calcium Channel Blockers/therapeutic use , Adrenergic beta-Antagonists/therapeutic use , Nitrates/therapeutic use
6.
Yonsei Medical Journal ; : 90-98, 2017.
Article in English | WPRIM (Western Pacific) | ID: wprim-65058

ABSTRACT

PURPOSE: Calcium channel blockers diltiazem and nitrate have been used as selective coronary vasodilators for patients with significant coronary artery spasm (CAS). However, no study has compared the efficacy of diltiazem alone versus diltiazem with nitrate for long-term clinical outcomes in patients with CAS. MATERIALS AND METHODS: A total of 2741 consecutive patients without significant coronary artery disease with positive CAS by acetylcholine (Ach) provocation test between November 2004 and May 2014 were enrolled. Significant CAS was defined as a narrowing of >70% by incremental intracoronary injection of 20, 50, and 100 µg of Ach into the left coronary artery. Patients were assigned to either the diltiazem group (n=842) or the dual group (diltiazem with nitrate, n=1899) at physician discretion. To adjust for potential confounders, a propensity score matching (PSM) analysis was performed using the logistic regression model. After PSM analysis, two well-balanced groups (811 pairs, n=1622, C-statistic=0.708) were generated. RESULTS: At 5 years, there were similar incidences in primary endpoints, including mortality, myocardial infarction, revascularization, and recurrent angina requiring repeat coronary angiography between the two groups. Diltiazem alone was not an independent predictor for major adverse cardiovascular events or recurrent angina requiring repeat coronary angiography. CONCLUSION: Despite the expected improvement of endothelial function and the relief of CAS, the combination of diltiazem and nitrate treatment was not superior to diltiazem alone in reducing mortality and cardiovascular events up to 5 years in patients with significant CAS.


Subject(s)
Acetylcholine , Aged , Angina Pectoris/diagnosis , Calcium Channel Blockers/therapeutic use , Cardiovascular Agents/therapeutic use , Coronary Angiography/adverse effects , Coronary Artery Disease/prevention & control , Coronary Vasospasm/diagnosis , Diltiazem/therapeutic use , Drug Therapy, Combination , Female , Humans , Incidence , Male , Middle Aged , Myocardial Infarction/prevention & control , Nitrates/therapeutic use , Propensity Score , Time Factors , Vasodilator Agents/therapeutic use
7.
Arch. argent. pediatr ; 114(1): e17-e20, feb. 2016. ilus, graf
Article in English, Spanish | LILACS (Americas), BINACIS | ID: biblio-838169

ABSTRACT

Durante la niñez, la tromboembolia pulmonar (TEP) es una afección poco frecuente, aunque potencialmente mortal. El mayor número de episodios de tromboemblia venosa (TEV) es resultado de complicaciones de factores de riesgo subyacentes, tales como tumores malignos, quimioterapia (L-asparaginasa) y colocación de un catéter venoso central. Presentamos el caso de un paciente con leucemia linfocítica aguda y TEP que tuvo un presíncope y fue tratado satisfactoriamente con heparina de bajo peso molecular y antagonistas del calcio.


In childhood, pulmonary thromboembolism (PTE) is an uncommonbut potentially life-threatening disease. The greater numbers of venous thromboembolism (VTE) are complications of underlying risk factors such as malignancies, chemotherapy (L-asparaginase), and central venous catheter. We report a patient with acute lymphoblastic leukemia and PTE, who presented with near-syncope, and was successfully treated with low molecular weight heparin and calcium channel blockers.


Subject(s)
Humans , Male , Adolescent , Pulmonary Embolism/complications , Pulmonary Embolism/drug therapy , Calcium Channel Blockers/therapeutic use , Risk Factors , Fatal Outcome , Heparin, Low-Molecular-Weight/therapeutic use , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Venous Thromboembolism/complications , Venous Thromboembolism/drug therapy
8.
Rev. Esc. Enferm. USP ; 49(1): 69-75, Jan-Feb/2015. graf
Article in English | LILACS (Americas) | ID: lil-742066

ABSTRACT

OBJECTIVE To evaluate the effect of using antihypertensive classes of drugs of the calcium channel antagonists and inhibitors of angiotensin-converting enzyme in plasma concentrations of hydrogen sulfide and nitric oxide in patients with hypertension. METHODS Cross-sectional study with quantitative approach conducted with hypertensive patients in use of antihypertensive classes of drugs: angiotensin-converting enzyme inhibitors or calcium channel antagonists. RESULTS It was found that the concentration of plasma nitric oxide was significantly higher in hypertensive patients that were in use of angiotensin-converting enzyme inhibitors (p<0.03) and the hydrogen sulphide concentration was significantly higher in hypertensive plasma in use of calcium channel antagonists (p<0.002). CONCLUSION The findings suggest that these medications have as additional action mechanism the improvement of endothelial dysfunction by elevate plasma levels of vasodilatory substances. .


OBJETIVO Evaluar el efecto del uso de antihipertensivos pertenecientes a las clases medicamentosas antagonistas de canales de calcio e inhibidores de la enzima convertidora de angiotensina en las concentraciones plasmáticas de ácido sulfhídrico y óxido nítrico en portadores de hipertensión arterial sistémica. MÉTODO Estudio transversal con abordaje cuantitativo realizado con hipertensos que toman antihipertensivos de las clases de inhibidores de la enzima convertidora de angiotensina o antagonistas de los canales de calcio. RESULTADOS Se verificó que la concentración de óxido nítrico plasmático fue significativamente mayor en hipertensos que estaban usando inhibidores de la enzima convertidora de angiotensina (p<0.03) y que la concentración de ácido sulfhídrico plasmático fue significativamente mayor en hipertensos en uso de antagonistas de los canales de calcio (p<0.002). CONCLUSIÓN Los hallazgos sugieren que dichos fármacos tienen como mecanismo de acción adicional la mejora de la disfunción endotelial al elevar los niveles plasmáticos de sustancias vasodilatadoras. .


OBJETIVO Avaliar o efeito do uso de anti-hipertensivos pertencentes às classes medicamentosas antagonistas de canais de cálcio e inibidores da enzima conversora de angiotensina nas concentrações plasmáticas de ácido sulfídrico e óxido nítrico em portadores de hipertensão arterial sistêmica. MÉTODO Estudo transversal com abordagem quantitativa realizado com hipertensos em uso de anti-hipertensivos das classes inibidores da enzima conversora de angiotensina ou antagonistas dos canais de cálcio. RESULTADOS Verificou-se que a concentração de óxido nítrico plasmático foi significativamente maior em hipertensos que estavam em uso de inibidores da enzima conversora de angiotensina (p<0.03) e que a concentração de ácido sulfídrico plasmático foi significativamente maior em hipertensos em uso de antagonistas dos canais de cálcio (p<0.002). CONCLUSÃO Os achados sugerem que essas medicações possuem como mecanismo de ação adicional a melhora da disfunção endotelial por elevar os níveis plasmáticos de substâncias vasodilatadoras. .


Subject(s)
Female , Humans , Male , Middle Aged , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Antihypertensive Agents/therapeutic use , Calcium Channel Blockers/therapeutic use , Hydrogen Sulfide/blood , Hypertension/blood , Hypertension/drug therapy , Nitric Oxide/blood , Cross-Sectional Studies
9.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-157699

ABSTRACT

Hypertension is a prevalent condition. Improving blood pressure control would depend on understanding concerns and limitations of physicians. Objective: Understanding practice of calcium channel blockers use among physicians. Material and methods: A cross-sectional, observational paper based questionnaire survey among 218 Indian physicians. Results: According to 55.83% of physicians (n=218), prevalence of hypertension ranges between 21-40%. Sixty percent physicians get referred cases mostly from the general physicians (69.48%). More than 20% patients have concomitant illness according to 33.81% physicians, most common being diabetes (33.44%).According to 96.30% physicians, due to asymptomatic nature, hypertension remains undiagnosed, untreated and uncontrolled. Stress (32.35%), obesity (23.13%), physical inactivity (22.78%) and smoking (20.52%) are responsible for sympathetic over activity. Calcium channel blockers (CCBs) (37.19%), beta blockers (30.43%), angiotensin receptor blocker (ARB) (12.14%) and angiotensin converting enzyme (ACE) inhibitors (4.02%) are used as first choice in patients with sympathetic over activity. Ischemic event, stroke, heart failure and renal failure occur due to ignoring sympathetic over activity according to 30.91%, 25.39%, 20.97% and 22.30% physicians respectively. According to 51.63% of physicians, patient compliance to antihypertensive therapy is > 70%. Lack of awareness (40.5%) and dosage frequency (24%) are two most common reasons for noncompliance. According to 89.72% of physicians, the current CCBs primarily inhibit L-type calcium channels but cause sympathetic over activity. A total of 48.34% physicians, >10% patients complain of pedal edema with amlodipine. In physicians opinion, blockage of L and N type of calcium channels (56.47%), unique mode of action (11.76%), arteriolar and venous dilation (9.41%) and inhibition of reninangiotensin- aldosterone (RAS) system (7.06%) are responsible for less pedal edema with cilnidipine. A total of 98.7% and 99.54% physicians rated efficacy and safety of cilnidipine as “good-very good” compared to other CCB respectively. Conclusion: In hypertension, sympathetic over activity may cause many complications. As per the physicians opinion survey, cilnidipine because of its unique mechanism of action offers multiple benefits in hypertensive patients and can be preferred over amlodipine.


Subject(s)
Adult , Blood Pressure/physiology , Calcium Channel Blockers/administration & dosage , Calcium Channel Blockers/therapeutic use , Dihydropyridines/administration & dosage , Dihydropyridines/analogs & derivatives , Dihydropyridines/therapeutic use , Humans , Hypertension/drug therapy , India , Middle Aged , Physicians , Surveys and Questionnaires , Sympathetic Nervous System/physiology
11.
Article in English | WPRIM (Western Pacific) | ID: wprim-164155

ABSTRACT

We aimed to assess one-year persistence with antihypertensive therapy (AHT) among newly treated uncomplicated hypertensive patients in Korea and to evaluate the effect of initial therapeutic classes on persistence. We retrospectively analyzed a random sample of 20% of newly treated uncomplicated hypertensive patients (n = 45,787) in 2012 from the National Health Insurance claims database. This group was classified into six cohorts based on initial AHT class. We then measured treatment persistence, allowing a prescription gap of 60 days. Adherence to AHT was assessed with the medication possession ratio. Calcium channel blockers (CCB, 43.7%) and angiotensin receptor blockers (ARB, 40.3%) were most commonly prescribed as initial monotherapy. Overall, 62.1% and 42.0% were persistent with any AHT and initial class at one year, respectively, and 64.2% were adherent to antihypertensive treatment. Compared with ARBs, the risk of AHT discontinuation was significantly increased with initial use of thiazide diuretics (hazard ratio [HR], 3.16; 95% confidence interval [CI] 2.96-3.74) and beta blockers (HR, 1.86; CI, 1.77-1.95) and was minimally increased with CCBs (HR, 1.12; CI, 1.08-1.15). In conclusion, persistence and adherence to AHT are suboptimal, but the differences are meaningful in persistence and adherence between initial AHT classes.


Subject(s)
Adolescent , Adrenergic beta-Antagonists/therapeutic use , Adult , Aged , Aged, 80 and over , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Antihypertensive Agents/classification , Calcium Channel Blockers/therapeutic use , Cohort Studies , Female , Humans , Hypertension/drug therapy , Male , Medication Adherence , Middle Aged , Republic of Korea , Retrospective Studies , Sodium Chloride Symporter Inhibitors/therapeutic use , Young Adult
12.
J. bras. med ; 102(6)dez. 2014. graf
Article in Portuguese | LILACS (Americas) | ID: lil-737127

ABSTRACT

O fenômeno de Raynaud (FRy) caracteriza- se por episódios reversíveis de vasoespasmos de extremidades, que ocorrem usualmente após estresse ou exposição ao frio. O FRy pode ser primário ou secundário a uma série de condições, principalmente a doenças do espectro da esclerose sistêmica (ES). Na ES o FRy costuma ser mais grave, e lesões isquêmicas de extremidades são frequentes. Nos últimos anos, avanços no estudo da fisiopatologia do FRy e da doença vascular na ES propiciaram o surgimento de novas opções terapêuticas para esta manifestação. Os bloqueadores de canal de cálcio devem ser utilizados como tratamento de primeira escolha para o FRy. Novas drogas, como os inibidores da fosfodiesterase V e os prostanoides, podem ser utilizadas em pacientes com FRy grave, e a bosentana (antagonista do receptor da endotelina-1) é indicada para a prevenção de úlceras digitais recorrentes.


Raynaud?s phenomenon (RP) is characterized by episodic vasospasm of the extremities, usually in response to stress or cold exposure. It can be primary or secondary to several conditions, especially systemic sclerosis-related diseases. In systemic sclerosis (SSc), RP is usually more severe and digital ischemic lesions are a frequent problem. In recent years, advances in the understanding of the pathophysiology of RP and of SSc vasculopathy led to the development of new therapeutic options for this condition. Calcium-channel blockers are the first choice for the treatment of RP. New drugs, including phosphodiesterase type V inhibitors and prostanoids, can be used for severe RP, and bosentan (endothelin-1 receptor antagonist) for prevention of recurrent digital ulcers.


Subject(s)
Humans , Raynaud Disease/etiology , Raynaud Disease/drug therapy , Scleroderma, Systemic , Calcium Channel Blockers/therapeutic use , Phosphodiesterase 5 Inhibitors/therapeutic use , Endothelin Receptor Antagonists/therapeutic use
13.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 24(1): 23-32, jan.-mar. 2014.
Article in Portuguese | LILACS (Americas), SES-SP, SESSP-IDPCPROD, SES-SP | ID: lil-729290

ABSTRACT

A elevada prevalência populacional de doença arterial coronária crônica propiciou a melhora dos métodos preventivos, diagnósticos e terapêuticos. A confirmação de isquemia, com ou sem sintomas, trouxe tratamento inovadores visando à redução de eventos agudos, melhora na qualidade de vida e aumento de sobrevida Estudos recentes comparam os resultados do tratamento clínico com outras intervenções e concluíram que o sucesso da intervenção clínica está embasado na otimização terapêutica. Definida a influência dos fatores de risco e os mecanismos fisiopatológicos da doença, o tratamento medicamentoso constitui a base e a sequência de todas as intervenções na doença arterial coronária crônica.


The high prevalence of patients with chronic coronary artery disease has led to the improvement of preventive, diagnostic and therapeutic methods. Confirmation of ischemia with or without symptoms, brought innovative treatment aimed at reducing acute events, improvement in quality of life and increased survival. Recent studies have compared the results of clinical treatment with other interventions and concluded that the success of clinical intervention is based on therapeutic optimization. Once established the inluence of risk factors and physiopathological mechanisms of the disease, drug treatment constitutes the basis and the sequence of all interventionns in chronic artery disease.


Subject(s)
Humans , Male , Female , Aspirin/administration & dosage , Coronary Artery Disease/physiopathology , Coronary Artery Disease/therapy , Myocardial Infarction/therapy , Heart Failure/physiopathology , Heart Failure/therapy , Drug Utilization/trends , Adrenergic beta-Antagonists/administration & dosage , Adrenergic beta-Antagonists/adverse effects , Calcium Channel Blockers/therapeutic use , Platelet Aggregation Inhibitors/administration & dosage , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Nitrates/therapeutic use , Trimetazidine/therapeutic use , Vasodilator Agents/therapeutic use
14.
Clinics ; 69(1): 61-67, 1/2014. graf
Article in English | LILACS (Americas) | ID: lil-697715

ABSTRACT

OBJECTIVE: Numerous recent studies suggest that abnormal intracellular calcium concentration ([Ca2+]i) is a common defect in diabetic animal models and patients. Abnormal calcium handling is an important mechanism in the defective pancreatic β-cell function in type 2 diabetes. T-type Ca2+ channel antagonists lower blood glucose in type 2 diabetes, but the mechanism remains unknown. METHODS: We examined the effect of the Ca2+ channel antagonist mibefradil on blood glucose in male db/db mice and phenotypically normal heterozygous mice by intraperitoneal injection. RESULTS: Mibefradil (15 mg/kg, i.p., b.i.d.) caused a profound reduction of fasting blood glucose from 430.92±20.46 mg/dl to 285.20±5.74 mg/dl in three days. The hypoglycemic effect of mibefradil was reproduced by NNC 55-0396, a compound structurally similar to mibefradil but more selective for T-type Ca2+ channels, but not by the specific L-type Ca2+ channel blocker nicardipine. Mibefradil did not show such hypoglycemic effects in heterozygous animals. In addition, triglycerides, basal insulin and food intake were significantly decreased by mibefradil treatment in the db/db mice but not in the controls. Western blot analysis, immunohistochemistry and immunofluorescence staining showed a significantly increased expression of T-type Ca2+ channel α-subunits Cav3.1 and Cav3.2 in liver and brain tissues from db/db mice compared to those from heterozygous animals. CONCLUSIONS: Collectively, these results suggest that T-type Ca2+ channels are potential therapeutic targets for antidiabetic drugs. .


Subject(s)
Animals , Male , Mice , Blood Glucose/drug effects , Calcium Channel Blockers/therapeutic use , Diabetes Mellitus, Experimental/drug therapy , Mibefradil/therapeutic use , Blotting, Western , Brain/drug effects , Calcium Channel Blockers/administration & dosage , Disease Models, Animal , Eating , Hypoglycemic Agents/administration & dosage , Hypoglycemic Agents/therapeutic use , Immunohistochemistry , Injections, Intraperitoneal , Liver/drug effects , Medical Illustration , Mibefradil/administration & dosage , Reproducibility of Results , Time Factors , Treatment Outcome
15.
Yonsei Medical Journal ; : 683-688, 2014.
Article in English | WPRIM (Western Pacific) | ID: wprim-58589

ABSTRACT

PURPOSE: Clopidogrel is metabolized by the hepatic cytochrome P450 (CYP) system into its active thiol metabolite. CYP3A4 is involved in the metabolism of both clopidogrel and dihydropyridine calcium channel blockers (CCBs). A few reports have suggested an inhibitory interaction between CCBs and clopidogrel. Accordingly, the aim of this study was to determine the effect of CCBs on the antiplatelet activity of clopidogrel by serial P2Y12 reaction unit (PRU) measurements. MATERIALS AND METHODS: We assessed changes in antiplatelet activity in patients receiving both clopidogrel and CCBs for at least 2 months prior to enrollment in the study. The antiplatelet activity of clopidogrel was measured by VerifyNow P2Y12 assay in the same patient while medicated with CCBs and at 8 weeks after discontinuation of CCBs. After discontinuation of the CCBs, angiotensin receptor blockers were newly administered to the patients or dosed up for control of blood pressure. RESULTS: Thirty patients finished this study. PRU significantly decreased after discontinuation of CCBs (238.1+/-74.1 vs. 215.0+/-69.3; p=0.001). Of the 11 patients with high post-treatment platelet reactivity to clopidogrel (PRU> or =275), PRU decreased in nine patients, decreasing below the cut-off value in seven of these nine patients after 8 weeks. Decrease in PRU was not related to CYP2C19 genotype. CONCLUSION: CCBs inhibit the antiplatelet activity of clopidogrel.


Subject(s)
Aged , Aged, 80 and over , Blood Platelets/drug effects , Calcium Channel Blockers/therapeutic use , Dihydropyridines/therapeutic use , Drug Interactions , Female , Humans , Male , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Ticlopidine/analogs & derivatives
17.
Article in English | WPRIM (Western Pacific) | ID: wprim-62918

ABSTRACT

BACKGROUND/AIMS: This meta-analysis compared the effects of amlodipine besylate, a charged dihydropyridine-type calcium channel blocker (CCB), with other non-CCB antihypertensive therapies regarding the cardiovascular outcome. METHODS: Data from seven long-term outcome trials comparing the cardiovascular outcomes of an amlodipine-based regimen with other active regimens were pooled and analyzed. RESULTS: The risk of myocardial infarction was significantly decreased with an amlodipine-based regimen compared with a non-CCB-based regimen (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.84 to 0.99; p = 0.03). The risk of stroke was also significantly decreased (OR, 0.84; 95% CI, 0.79 to 0.90; p < 0.00001). The risk of heart failure increased slightly with marginal significance for an amlodipine-based regimen compared with a non-CCB-based regimen (OR, 1.14; 95% CI, 0.98 to 1.31; p = 0.08). However, when compared overall with beta-blockers and diuretics, amlodipine showed a comparable risk. Amlodipine-based regimens demonstrated a 10% risk reduction in overall cardiovascular events (OR, 0.90; 95% CI, 0.82 to 0.99; p = 0.02) and total mortality (OR, 0.95; 95% CI, 0.91 to 0.99; p = 0.01). CONCLUSIONS: Amlodipine reduced the risk of total cardiovascular events as well as all-cause mortality compared with non-CCB-based regimens, indicating its benefit for high-risk cardiac patients.


Subject(s)
Amlodipine/therapeutic use , Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Calcium Channel Blockers/therapeutic use , Chi-Square Distribution , Clinical Trials as Topic , Heart Failure/etiology , Humans , Hypertension/complications , Myocardial Infarction/etiology , Odds Ratio , Risk Factors , Stroke/etiology , Treatment Outcome
18.
J. bras. med ; 101(4): 13-18, jul.-ago. 2013. ilus
Article in Portuguese | LILACS (Americas) | ID: lil-699659

ABSTRACT

O fenômeno de Raynaud (FRy) caracteriza-se por episódios reversíveis de vasoespasmos de extremidades, que ocorrem usualmente após estresse ou exposição ao frio. O FRy pode ser primário ou secundário a uma série de condições, principalmente a doenças do espectro da esclerose sistêmica (ES). Na ES, o FRy costuma ser mais grave, e lesões isquêmicas de extremidades são frequentes. Nos últimos anos, avanços no estudo da fisiopatologia do FRy e da doença vascular na ES propiciaram o surgimento de novas opções terapêuticas para esta manifestação. Os bloqueadores de canal de cálcio devem ser utilizados como tratamento de primeira escolha para o FRy. Novas drogas, como os inibidores da fosfodiesterase V e os prostanoides, podem ser utilizados em pacientes com FRy grave, e a bosentana (antagonista do receptor da endotelina-1) é indicada para a prevenção de úlceras digitais recorrentes.


Raynaud's phenomenon (RP) is characterized by episodic vasospasm of the extremities, usually in response to stress or cold exposure. It can be primary or secondary to several conditions, especially systemic sclerosis-related diseases. In systemic sclerosis (SSc), RP is usually more severe and digital ischemic lesions are a frequent problem. In recent years, advances in the understanding of the pathophysiology of RP and of SSc vasculopathy led to the development of new therapeutic options for this condition. Calcium-channel blockers are the first choice for the treatment of RP. New drugs including phosphodiesterase type V inhibitors and prostanoids can be used for severe RP, and bosentan (endothelin-1 receptor antagonist) for prevention of recurrent digital ulcers.


Subject(s)
Humans , Male , Female , Raynaud Disease/physiopathology , Raynaud Disease/drug therapy , Scleroderma, Systemic/physiopathology , Scleroderma, Systemic/drug therapy , Microscopic Angioscopy/methods , Autoantibodies , Calcium Channel Blockers/therapeutic use , Vascular Diseases/physiopathology , /therapeutic use , Receptors, Endothelin/antagonists & inhibitors , Skin Ulcer/prevention & control , Skin Ulcer/drug therapy , Vasodilator Agents/therapeutic use
19.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 23(1): 44-55, jan.-mar. 2013. ilus
Article in Portuguese | LILACS (Americas) | ID: lil-686352

ABSTRACT

O tratamento das arritmias cardíacas é prerrogativa do clínico. Quando são diagnosticadas, é o médico assistente quem opta pela forma de tratar o que, na grande maioria dos casos , se baseia na prescrição de fármacos. Os medicamentos são úteis para a reversão de uma crise aguda e também para a prevenção de recorrências, mas não curam o paciente. A necessidade de tratar ou não uma arritmia depende de vários fatores, como a forma de apresentação clínica baseada na qualidade dos sintomas e a presença ou não de uma cardiopatia. Arritmias que causam colapso hemodinâmico estão associadas a elevado risco de complicações, como traumas físico e até parada cardiorespiratória, como acontece com a taquicardia ventricular. O tratamento, muitas vezes não somente com fármacos, deve ser agressivo visando à proteção do paciente. A presença de uma cardiopatia com disfunção ventricular pode tornar uma arritmia potencialmente maligna e o seu tratamento com fármacos envolve-se de alto risco, não somente pela eficácia apenas moderada dos medicamentos disponíveis, como também pelo risco de agravamento da arritmia, efeito conhecido como pró-arritmia. Não se deve transformar o tratamento mais grave do que a próxima arritmia. Com o avanço no conhecimento dos mecanismos de origem e manutenção das arritmias, houve certa redução da importância e da dependência do antiarrítmico no esquema terapêutico, já que outras classes de fármacos mostraram perfil favorável no tratamento, tal como acontece com os betabloqueadores, inibidores da enzima de conversão da angiotensina, espironolactona, estatinas, etc. Neste artigo, serão discutidos aspectos atuais do tratamento farmacológico das arritmias cardíacas.


The treatment of cardiac arrhythmias is a prerogative of the clinician. When they are diagnosed is the physician who chooses the way of dealing with that, in most cases, is based on prescription of antiarrhythmic drugs. The drugs are useful for the reversal of an acute attack and also for the prevention of recurrences, but not to cure the patient. The need to treat an arrhythmia or not depends on several factors, such as clinical presentation based on the quality of symptoms and the presence or absence of heart disease. Hemodynamic collapse caused by arrhythmias are associated with increased risk of complications, including physical trauma and even cardiac arrest as what happens during verntricular tachycardia. Treatment often, not only with drugs, should be aggressive in order to protect the patient. Some types of arrhythmias in the presence of heart disease with left ventricular dysfunctioin can be become a potentially malignant arrhythmia and its treatment with drugs engages high risk, not only for the modest effectiveness of the medications available but also due to the risk of aggravation of arrhythmia, an effect know as proarrhythmia. One should not make the treatment worse than the arrhythmia itself. With the advances in knowledge of the mechanisms of origin and maintenance of arrhythmia, there was some reduction of the importance and reliance on antiarrhytmic agent in the therapeutic regimen, as other classes of drugs showed favorable profile during treatment, as what happens with beta-blockers, angiotensin converting enzyme inhibitors, spironolactone, statins, etc. This paper will discuss current aspects of pharmacological treatment of cardiac arrhythmias.


Subject(s)
Humans , Adrenergic beta-Antagonists/administration & dosage , Adrenergic beta-Antagonists/therapeutic use , Anti-Arrhythmia Agents/administration & dosage , Anti-Arrhythmia Agents/therapeutic use , Arrhythmias, Cardiac/therapy , Calcium Channel Blockers/administration & dosage , Calcium Channel Blockers/therapeutic use , Stroke Volume
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