ABSTRACT
Cardioselective ß-blockade is generally well tolerated in practice and contraindications to this therapy are uncommon. ß-blockers are a diverse therapeutic class, and their individual tolerability profiles are influenced strongly by their pharmacodynamic effects across different adrenergic receptors. Bisoprolol, probably the ß-blocker with the highest selectivity for blockade of ß1- vs. ß2-adrenoceptors, does not block ß2-adrenoceptors to an appreciable extent at doses in therapeutic use. Side-effects often attributed to ß-blockers, such as erectile dysfunction and adverse metabolic effects are uncommon with bisoprolol and other ß-blockers used at doses which only block ß1-adrenoceptors. Cautious use of a cardioselective ß-blocker is not contraindicated in people with chronic obstructive pulmonary disease or asthma and the outcomes benefits of ß-blockers in patients with coronary heart disease or heart failure are also apparent in patients with concurrent COPD. Starting with a low dose and titrating upwards carefully is important for optimising the tolerability of a ß-blocker. Most people with hypertension will receive combination antihypertensive therapy in practice, and the low-dose combination therapy approach provides a useful strategy for optimising the efficacy and tolerability of a regimen that includes a ß-blocker, compared with up-titrating an existing monotherapy.
Subject(s)
Bisoprolol , Pulmonary Disease, Chronic Obstructive , Male , Humans , Bisoprolol/adverse effects , Adrenergic beta-Antagonists/adverse effects , Pulmonary Disease, Chronic Obstructive/drug therapy , Adrenergic beta-1 Receptor Antagonists/adverse effects , Receptors, Adrenergic/therapeutic useABSTRACT
Los bloqueadores de los receptores plaquetarios de las glicoproteínas IIb/IIIa han demostrado su utilidad en el tratamiento de los síndromes coronarios inestables. En este trabajo presentamos una revisión de los estudios multicéntricos más importantes que dan evidencia de la utilidad de estos medicamentos. Enunciamos la nueva alternativa en el tratamiento con la combinación de dosis bajas de fibrinolíticos y glicoproteínas IIb/IIIa, los cuales han logrado más posibilidades de reperfundir las coronarias epicárdicas y la microcirculación, y mayor rapidez en lograr flujo TIMI 3. Proponemos las indicaciones de estos medicamentos en las diferentes condiciones clínicas de los síndromes coronarios inestables.
