2. HEALTH EFFECTS 2.1 INTRODUCTION the Primary
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Comparison of the Antiischaemic and Antianginal Effects of Nicorandil and Amlodipine in Patients with Symptomatic Stable Angina Pectoris: the SWAN Study
Journal of Clinical and Basic Cardiology An Independent International Scientific Journal Journal of Clinical and Basic Cardiology 1999; 2 (2), 213-217 Comparison of the antiischaemic and antianginal effects of nicorandil and amlodipine in patients with symptomatic stable angina pectoris: the SWAN study The SWAN Study Group Homepage: www.kup.at/jcbc Online Data Base Search for Authors and Keywords Indexed in Chemical Abstracts EMBASE/Excerpta Medica Krause & Pachernegg GmbH · VERLAG für MEDIZIN und WIRTSCHAFT · A-3003 Gablitz/Austria ORIGINAL PAPERS, CLINICAL The SWAN study J Clin Basic Cardiol 1999; 2: 213 Comparison of the antiischaemic and antianginal effects of nicorandil and amlodipine in patients with symptomatic stable angina pectoris: the SWAN study The SWAN Study Group1 This multicentre, double-blind, randomised study compared the antiischaemic and antianginal effects of nicorandil and amlodipine in patients with symptomatic stable angina pectoris. Nicorandil is a new coronary and balanced peripheral vasodilating agent that operates through two mechanisms of action: activation of ATP-dependent K-channels and stimulation of guanylate cyclase. A total of 121 patients with symptomatic stable angina pectoris were randomised to receive nicorandil 10 mg twice daily (bd) or amlodipine 5 mg once daily (od) for 8 weeks (optional dosage increase after 2-4 weeks to 20 mg bd and 10 mg od, respec- tively). Symptom-limited exercise tolerance tests were performed at baseline, and after 2 and 8 weeks treatment, respectively. In addition, the number of anginal attacks, nitroglycerin (NTG) usage, blood pressure (BP), heart rate (HR) and adverse events were recorded, and a subjective assessment of quality of life performed. -
Response to Inhaled Nitric Oxide, but Neither Sodium Nitroprusside Nor Sildenafil, Predicts Survival in Patients With
Jachec et al., J Clin Exp Cardiolog 2015, 6:6 Clinical & Experimental Cardiology http://dx.doi.org/10.4172/2155-9880.1000376 Research Article Open Access Response to Inhaled Nitric Oxide, But neither Sodium Nitroprusside nor Sildenafil, Predicts Survival in Patients with Dilated Cardiomyopathy Complicated with Pulmonary Hypertension Wojciech Jacheć1*, Celina Wojciechowska2, Andrzej Tomasik2, Damian Kawecki2, Ewa Nowalany-Kozielska2 and Jan Wodniecki2 1II Katedra i Oddział Kliniczny Kardiologii w Zabrzu Śląskiego Uniwersytetu Medycznego w Katowicach, ul. Skłodowskiej 10, 41-800 Zabrze, Polska 2Department of Cardiology in Zabrze, Medical University of Silesia in Katowice, Poland *Corresponding author: Wojciech Jacheć, II Katedra i Oddział Kliniczny Kardiologii w Zabrzu Śląskiego Uniwersytetu Medycznego w Katowicach, ul. Skłodowskiej 10, 41-800 Zabrze, Polska, Tel: +48 32 373 23 72; Fax: +48 32 271 10 10; E-mail: [email protected] Received date: May 26, 2015, Accepted date: Jun 25, 2015, Published date: Jun 29, 2015 Copyright: ©2015 Jacheć W. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Introduction: Pulmonary hypertension in patients with dilated cardiomyopathy is associated with higher mortality. Objectives: The aim of the study was to assess the predictive value of the vasodilator response to three different drugs, sodium nitroprusside, -
Tolerance and Resistance to Organic Nitrates in Human Blood Vessels
\ö-\2- Tolerance and Resistance to Organic Nitrates in Human Blood Vessels Peter Radford Sage MBBS, FRACP Thesis submit.ted for the degree of Doctor of Philosuphy Department of Medicine University of Adelaide and Cardiology Unit The Queen Elizabeth Hospital I Table of Gontents Summary vii Declaration x Acknowledgments xi Abbreviations xil Publications xtil. l.INTRODUCTION l.L Historical Perspective I i.2 Chemical Structure and Available Preparations I 1.3 Cellular/biochemical mechanism of action 2 1.3.1 What is the pharmacologically active moiety? 3 1.3.2 How i.s the active moiety formed? i 4 1.3.3 Which enzyme system(s) is involved in nitrate bioconversi<¡n? 5 1.3.4 What is the role of sulphydryl groups in nitrate action? 9 1.3.5 Cellular mechanism of action after release of the active moiety 11 1.4 Pharmacokinetics t2 1.5 Pharmacological Effects r5 1.5.1 Vascular effects 15 l.5.2Platelet Effects t7 1.5.3 Myocardial effects 18 1.6 Clinical Efhcacy 18 1.6.1 Stable angina pectoris 18 1.6.2 Unstable angina pectoris 2t 1.6.3 Acute myocardial infarction 2l 1.6.4 Congestive Heart Failure 23 ll 1.6.5 Other 24 1.7 Relationship with the endothelium and EDRF 24 1.7.1 EDRF and the endothelium 24 1.7.2 Nitrate-endothelium interactions 2l 1.8 Factors limiting nitrate efficacy' Nitrate tolerance 28 1.8.1 Historical notes 28 1.8.2 Clinical evidence for nitrate tolerance 29 1.8.3 True/cellular nitrate tolerance 31 1.8.3.1 Previous studies 31 | .8.3.2 Postulated mechanisms of true/cellular tolerance JJ 1.8.3.2.1 The "sulphydryl depletion" hypothesis JJ 1.8.3.2.2 Desensitization of guanylate cyclase 35 1 8.i.?..3 Impaired nitrate bioconversion 36 1.8.3.2.4'Ihe "superoxide hypothesis" 38 I.8.3.2.5 Other possible mechanisms 42 1.8.4 Pseudotolerance ; 42 1.8.4. -
Current Status of Local Penile Therapy
International Journal of Impotence Research (2002) 14, Suppl 1, S70–S81 ß 2002 Nature Publishing Group All rights reserved 0955-9930/02 $25.00 www.nature.com/ijir Current status of local penile therapy F Montorsi1*, A Salonia1, M Zanoni1, P Pompa1, A Cestari1, G Guazzoni1, L Barbieri1 and P Rigatti1 1Department of Urology, University Vita e Salute – San Raffaele, Milan, Italy Guidelines for management of patients with erectile dysfunction indicate that intraurethral and intracavernosal injection therapies represent the second-line treatment available. Efficacy of intracavernosal injections seems superior to that of the intraurethral delivery of drugs, and this may explain the current larger diffusion of the former modality. Safety of these two therapeutic options is well established; however, the attrition rate with these approaches is significant and most patients eventually drop out of treatment. Newer agents with better efficacy-safety profiles and using user-friendly devices for drug administration may potentially increase the long-term satisfaction rate achieved with these therapies. Topical therapy has the potential to become a first- line treatment for erectile dysfunction because it acts locally and is easy to use. At this time, however, the crossing of the barrier caused by the penile skin and tunica albuginea has limited the efficacy of the drugs used. International Journal of Impotence Research (2002) 14, Suppl 1, S70–S81. DOI: 10.1038= sj=ijir=3900808 Keywords: erectile dysfunction; local penile therapy; topical therapy; alprostadil Introduction second patient category might be represented by those requesting a fast response, which cannot be obtained by sildenafil; however, sublingual apomor- Management of patients with erectile dysfunction phine is characterized by a fast onset of action and has been recently grouped into three different may represent an effective solution for these 1 levels. -
Acute Effect of Sodium Nitroprusside on Microvascular Dysfunction In
Clinical Studies Acute Effect of Sodium Nitroprusside on Microvascular Dysfunction in Patients Who Underwent Percutaneous Coronary Intervention for Acute ST-segment Elevation Myocardial Infarction Kotaro Morimoto,1, 2 MD, Shigenori Ito,2 MD, Kosuke Nakasuka,2 MD, Satoru Sekimoto,2 MD, Kazuyuki Miyata,2 MD, Masahiko Inomata,2 MD, Takayuki Yoshida,2 MD, Nozomu Tamai,2 MD, Tomoaki Saeki,2 MD, Shin Suzuki,2 MD, Yoshimasa Murakami,2 MD, Koichi Sato,2 MD, Akihiro Morino,3 CE, and Yoshiyuki Shimizu,3 CE Summary Even in the era of thrombus aspiration and distal protection for ST-segment elevation acute myocardial infarction (STEMI), microvascular dysfunction does exist and improvement of microvascular dysfunction can improve the progno- sis and/or left ventricular dysfunction. We evaluated the acute effects of nitroprusside (NTP) on coronary microvascular injury that occurred after primary percutaneous coronary intervention (PCI) for STEMI in 18 patients. The final Throm- bolysis in Myocardial Infarction trial (TIMI) flow grade after PCI was 3 in 17 patients and 2 in 1 patient. The index of microcirculatory resistance (IMR) was improved significantly from 76 ± 42 to 45 ± 37 (P = 0.0006) by intracoronary NTP administration. IMR improved to the normal range (IMR < 30) in 9 patients (50%). Higher TIMI flow grade and lower IMR at baseline were observed more frequently in patients whose IMR recovered to normal range after NTP ad- ministration. NTP improved the microcirculatory dysfunction at the acute phase in patients who underwent PCI for STEMI and -
Cardiovascular Drugs and Therapies NITRATES COMPARISON CHART
Cardiovascular Drugs and Therapies NITRATES COMPARISON CHART Isosorbide Generic Nitroglycerin Nitroglycerin Nitroglycerin Nitroglycerin Dinitrate Isosorbide Isosorbide Name Intravenous Patch Ointment Sublingual Sublingual Dinitrate 5-Mononitrate Trade Name TRIDIL, NITRODUR, NITROL NITROLINGUAL generics generics (for IMDUR, generics TRANSDERM- Pumpspray, immediate generics NITRO, RHO-NITRO release) MINITRAN, Pumpspray, SR: no longer TRINIPATCH NITROLINGUAL available Metered dose spray NITROSTAT sublingual tablet Dosage 100 mg/250 mL 0.2 mg/h 30 g/30 inches SL spray: SL tablet: 5mg Immediate SR tablet: Forms premixed bottle 0.4 mg/h ointment 0.4 mg/ dose release 60 mg SR - UHN 0.6 mg/h SL tablet: tablet: Note: 0.84 mL 0.8 mg/h 0.3 mg, 0.6 mg 10 mg *Non- alcohol per 100 mL 30 mg formulary at solution UHN 100 mcg/mL 200 mcg/mL 400 mcg/mL 10 mg/10 mL vial - UHN 50 mg/10 mL vial - UHN CARDIOVASCULAR PHARMACOTHERAPY HANDBOOK All contents copyright © University Health Network. All rights reserved Cardiovascular Drugs and Therapies NITRATES COMPARISON CHART Isosorbide Generic Nitroglycerin Nitroglycerin Nitroglycerin Nitroglycerin Dinitrate Isosorbide Isosorbide Name Intravenous Patch Ointment Sublingual Sublingual Dinitrate 5-Mononitrate Dosing Starting and 0.2 to 0.8 ½ inch to 1 inch SL spray: SL tablet: Immediate 60-240 mg SR Usual dose target doses mg/h once tid-qid; remove 0.4 mg prn; 5-10 mg q2-4h release: once daily range are determined daily. for 8-10 hours dose may be for prophylaxis 10-45 mg tid by clinical per 24-hour repeated after of acute angina on qid situation and 12-14 hour period; 5 minutes for schedule the number and patch-free response to interval e.g., ON 0600, total of 3 doses (e.g. -
Pneumocystis Pneumonia and Disseminated
1614 BRITISH MEDICAL JOURNAL VOLUmE 286 21 MAY 1983 Br Med J (Clin Res Ed): first published as 10.1136/bmj.286.6378.1614-a on 21 May 1983. Downloaded from Pneumocystis pneumonia and discussions, and Dr B Jameson and Dr D G Fleck for their valuable assistance disseminated toxoplasmosis in a with the pneumocystis and toxoplasma serology. Ammann A, Cowan M, Wara D, et al. Possible transfusion-associated male homosexual acquired immune deficiency syndrome (AIDS)-California. Morbidity and Mortality Weekly Report 1982;31 :652-4. 2 Du Bois RM, Branthwaite MA, Mikhail JR, et al. Primary pneumocystis Within the past two years 788 cases of the apparently new and carinii and cytomegalovirus infections. Lancet 1981 ;ii: 1339. potentially lethal syndrome of acquired immune deficiency have been Oswald GA, Theodossi A, Gazzard BG, et al. Attempted immune stimula- reported in the United States.' Only three cases have been reported in tion in the "gay compromise syndrome." Br MedJ' 1982;285:1082. the United Kingdom.2-4 We report a case in a previously healthy 37 4 Maurice PDL, Smith NP, Pinching AJ. Kaposi's sarcoma with benign course in a homosexual. Lancet 1982;i:571. year old male homosexual who was initially diagnosed and treated for Task force on acquired immune deficiency syndrome, Centers for Disease pneumocystis pneumonia and subsequently died of widespread Control. Update on acquired immune deficiency syndrome (AIDS)- toxoplasmosis. United States. Morbidity and Mortality Weekly Report 1982;31:507-14. (Accepted 4 March 1983) Case report The patient presented with an eight week history of malaise, non-produc- Departments of Microbiology and Medicine, St Thomas's Hospital, tive cough, night sweats, diarrhoea, anorexia, and weight loss. -
Soluble Guanylate Cyclase B1-Subunit Expression Is Increased in Mononuclear Cells from Patients with Erectile Dysfunction
International Journal of Impotence Research (2006) 18, 432–437 & 2006 Nature Publishing Group All rights reserved 0955-9930/06 $30.00 www.nature.com/ijir ORIGINAL ARTICLE Soluble guanylate cyclase b1-subunit expression is increased in mononuclear cells from patients with erectile dysfunction PJ Mateos-Ca´ceres1, J Garcia-Cardoso2, L Lapuente1, JJ Zamorano-Leo´n1, D Sacrista´n1, TP de Prada1, J Calahorra2, C Macaya1, R Vela-Navarrete2 and AJ Lo´pez-Farre´1 1Cardiovascular Research Unit, Cardiovascular Institute, Hospital Clı´nico San Carlos, Madrid, Spain and 2Urology Department, Fundacio´n Jime´nez Diaz, Madrid, Spain The aim was to determine in circulating mononuclear cells from patients with erectile dysfunction (ED), the level of expression of endothelial nitric oxide synthase (eNOS), soluble guanylate cyclase (sGC) b1-subunit and phosphodiesterase type-V (PDE-V). Peripheral mononuclear cells from nine patients with ED of vascular origin and nine patients with ED of neurological origin were obtained. Fourteen age-matched volunteers with normal erectile function were used as control. Reduction in eNOS protein was observed in the mononuclear cells from patients with ED of vascular origin but not in those from neurological origin. Although sGC b1-subunit expression was increased in mononuclear cells from patients with ED, the sGC activity was reduced. However, only the patients with ED of vascular origin showed an increased expression of PDE-V. This work shows for the first time that, independently of the aetiology of ED, the expression of sGC b1-subunit was increased in circulating mononuclear cells; however, the expression of both eNOS and PDE-V was only modified in the circulating mononuclear cells from patients with ED of vascular origin. -
Aldrich Raman
Aldrich Raman Library Listing – 14,033 spectra This library represents the most comprehensive collection of FT-Raman spectral references available. It contains many common chemicals found in the Aldrich Handbook of Fine Chemicals. To create the Aldrich Raman Condensed Phase Library, 14,033 compounds found in the Aldrich Collection of FT-IR Spectra Edition II Library were excited with an Nd:YVO4 laser (1064 nm) using laser powers between 400 - 600 mW, measured at the sample. A Thermo FT-Raman spectrometer (with a Ge detector) was used to collect the Raman spectra. The spectra were saved in Raman Shift format. Aldrich Raman Index Compound Name Index Compound Name 4803 ((1R)-(ENDO,ANTI))-(+)-3- 4246 (+)-3-ISOPROPYL-7A- BROMOCAMPHOR-8- SULFONIC METHYLTETRAHYDRO- ACID, AMMONIUM SALT PYRROLO(2,1-B)OXAZOL-5(6H)- 2207 ((1R)-ENDO)-(+)-3- ONE, BROMOCAMPHOR, 98% 12568 (+)-4-CHOLESTEN-3-ONE, 98% 4804 ((1S)-(ENDO,ANTI))-(-)-3- 3774 (+)-5,6-O-CYCLOHEXYLIDENE-L- BROMOCAMPHOR-8- SULFONIC ASCORBIC ACID, 98% ACID, AMMONIUM SALT 11632 (+)-5-BROMO-2'-DEOXYURIDINE, 2208 ((1S)-ENDO)-(-)-3- 97% BROMOCAMPHOR, 98% 11634 (+)-5-FLUORODEOXYURIDINE, 769 ((1S)-ENDO)-(-)-BORNEOL, 99% 98+% 13454 ((2S,3S)-(+)- 11633 (+)-5-IODO-2'-DEOXYURIDINE, 98% BIS(DIPHENYLPHOSPHINO)- 4228 (+)-6-AMINOPENICILLANIC ACID, BUTANE)(N3-ALLYL)PD(II) CL04, 96% 97 8167 (+)-6-METHOXY-ALPHA-METHYL- 10297 ((3- 2- NAPHTHALENEACETIC ACID, DIMETHYLAMINO)PROPYL)TRIPH 98% ENYL- PHOSPHONIUM BROMIDE, 12586 (+)-ANDROSTA-1,4-DIENE-3,17- 99% DIONE, 98% 13458 ((R)-(+)-2,2'- 963 (+)-ARABINOGALACTAN BIS(DIPHENYLPHOSPHINO)-1,1'- -
ATSDR Case Studies in Environmental Medicine Nitrate/Nitrite Toxicity
ATSDR Case Studies in Environmental Medicine Nitrate/Nitrite Toxicity Agency for Toxic Substances and Disease Registry Case Studies in Environmental Medicine (CSEM) Nitrate/Nitrite Toxicity Course: WB2342 CE Original Date: December 5, 2013 CE Expiration Date: December 5, 2015 Key • Nitrate toxicity is a preventable cause of Concepts methemoglobinemia. • Infants younger than 4 months of age are at particular risk of nitrate toxicity from contaminated well water. • The widespread use of nitrate fertilizers increases the risk of well-water contamination in rural areas. About This This educational case study document is one in a series of and Other self-instructional modules designed to increase the primary Case Studies care provider’s knowledge of hazardous substances in the in environment and to promote the adoption of medical Environmen- practices that aid in the evaluation and care of potentially tal Medicine exposed patients. The complete series of Case Studies in Environmental Medicine is located on the ATSDR Web site at URL: http://www.atsdr.cdc.gov/csem/csem.html In addition, the downloadable PDF version of this educational series and other environmental medicine materials provides content in an electronic, printable format. Acknowledgements We gratefully acknowledge the work of the medical writers, editors, and reviewers in producing this educational resource. Contributors to this version of the Case Study in Environmental Medicine are listed below. Please Note: Each content expert for this case study has indicated that there is no conflict of interest that would bias the case study content. CDC/ATSDR Author(s): Kim Gehle MD, MPH CDC/ATSDR Planners: Charlton Coles, Ph.D.; Kimberly Gehle, MD; Sharon L. -
Nitric Oxide Activates Guanylate Cyclase and Increases Guanosine 3':5'
Proc. Natl. Acad. Sci. USA Vol. 74, No. 8, pp. 3203-3207, August 1977 Biochemistry Nitric oxide activates guanylate cyclase and increases guanosine 3':5'-cyclic monophosphate levels in various tissue preparations (nitro compounds/adenosine 3':5'-cyclic monophosphate/sodium nitroprusside/sodium azide/nitrogen oxides) WILLIAM P. ARNOLD, CHANDRA K. MITTAL, SHOJI KATSUKI, AND FERID MURAD Division of Clinical Pharmacology, Departments of Medicine, Pharmacology, and Anesthesiology, University of Virginia, Charlottesville, Virginia 22903 Communicated by Alfred Gilman, May 16, 1977 ABSTRACT Nitric oxide gas (NO) increased guanylate cy- tigation of this activation. NO activated all crude and partially clase [GTP pyrophosphate-yase (cyclizing), EC 4.6.1.21 activity purified guanylate cyclase preparations examined. It also in- in soluble and particulate preparations from various tissues. The effect was dose-dependent and was observed with all tissue creased cyclic GMP but not adenosine 3':5'-cyclic monophos- preparations examined. The extent of activation was variable phate (cyclic AMP) levels in incubations of minces from various among different tissue preparations and was greatest (19- to rat tissues. 33-fold) with supernatant fractions of homogenates from liver, lung, tracheal smooth muscle, heart, kidney, cerebral cortex, and MATERIALS AND METHODS cerebellum. Smaller effects (5- to 14-fold) were observed with supernatant fractions from skeletal muscle, spleen, intestinal Male Sprague-Dawley rats weighing 150-250 g were decapi- muscle, adrenal, and epididymal fat. Activation was also ob- tated. Tissues were rapidly removed, placed in cold 0.-25 M served with partially purified preparations of guanylate cyclase. sucrose/10 mM Tris-HCl buffer (pH 7.6), and homogenized Activation of rat liver supernatant preparations was augmented in nine volumes of this solution by using a glass homogenizer slightly with reducing agents, decreased with some oxidizing and Teflon pestle at 2-4°. -
The Availability of Organic Nitrates from Intravenous Administration Systems
THE AVAILABILITY OF ORGANIC NITRATES FROM INTRAVENOUS ADMINISTRATION SYSTEMS by Paul Adrian Cossum B.Sc., M.P.S. submitted in partial fulfilment of the requirements for the degree of Master of Pharmacy UNIVERSITY OF TASMANIA - HOBART JUNE 1981 SUMMARY Nitroglycerin aind isosorbide dinitrate are two drugs which are infused intravenously during the treatment of ischaemic heart disease. The availability of these two drugs in solutions infused from plastic infusion bags or glass infusion bottles through plastic giving sets has been investigated. During simulated infusions the concentration of nitroglycerin and isosorbide dinitrate appearing in the effluent of the • giving set tubing was found to be much less than the concentration of the drug solution initially contained in the plastic infusion bag or glass infusion bottle. It was found that each component of the plastic infusion equipment sorbed the drugs to a significant extent and that the rate of disappearance of drugs from solutions stored in each component was in the rank order: giving set tubing > giving set burette > plastic infusion bag. There was no significant loss of either drug from solutions stored in glass bottles. The influence of formulation factors and storage conditions on the sorption of nitroglycerin, isosorbide dinitrate and another organic nitrate compound., ethylene glycol dinitrate, by plastic infusion equipment was studied. The extent of loss during simulated infusions was also found to be dependent on flow rate of drug solution through the giving set. The sorption of nitroglycerin and isosorbide dinitrate has clinical and pharmacokinetic significance. Losses of nitroglycerin and isosorbide dinitrate associated with their infusion through plastic Lnfusion equipment were minimised by infusing drug solutions from a glass syringe through high density polyethylene tubing.