DOCSLIB.ORG

Endogenous Estradiol in Elderly Individuals Cognitive and Noncognitive Associations

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Endogenous Estradiol in Elderly Individuals Cognitive and Noncognitive Associations ORIGINAL CONTRIBUTION Endogenous Estradiol in Elderly Individuals Cognitive and Noncognitive Associations V. Senanarong, MD; S. Vannasaeng, MD; N. Poungvarin, MD; S. Ploybutr, MSC; S. Udompunthurak, MSC; P. Jamjumras, RN; L. Fairbanks, PhD; J. L. Cummings, MD Objective: To investigate an association between en- the Functional Assessment Questionnaire was used to as- dogenous estradiol (E2) levels and cognition and behav- sess instrumental activities of daily living. ior in elderly individuals. Results: There was no correlation between age and level of E2 in either men or women. Individuals with lower estro- Patients: We studied 135 community-based men and genlevelshadmorebehavioraldisturbances(men:r=−0.467, women aged 52 to 85 years in urban Bangkok, Thai- n=45;P=.001;women:r=−0.384,n=90;PϽ.001)andworse land; 72 had dementia and 63 did not. cognition (men: r=0.316, n=45; P=.03; women: r=0.243, n=90; P=.02) and function (men: r=−0.417, n=45; P=.004; women: r=−0.437, n=90; PϽ.001). The threshold level of Materials and Methods: Dementia was diagnosed endogenous E2 in elderly individuals for the risk of devel- using Diagnostic and Statistical Manual of Mental Disor- oping dementia was less than 15 pg/mL (Ͻ55 pmol/L) in ders, Fourth Edition, criteria after appropriate investiga- men and less than 1 pg/mL (Ͻ4 pmol/L) in women. tions. Blood samples for assay were collected in the morn- ing after 6 hours of fasting. Levels of E2 were measured Conclusion: Lower E2 levels are correlated with poor cog- by radioimmunoassay (double antibody technique). The nitive, behavioral, and functional status in older indi- Thai version of the Mini-Mental State Examination was viduals. used to assess cognition; the Neuropsychiatric Inven- tory was used to assess neuropsychiatric symptoms; and Arch Neurol. 2002;59:385-389 STROGEN replacement therapy A recent meta-analysis by Yaffe et al9 (ERT) has been reported to be concluded that results of observational and associated with a decreased clinical trials of ERT and cognitive function risk for dementia and better in AD were inconclusive. Three randomized cognitive function in post- controlledtrials10-12 ofERTpublishedin2000 menopausal women. In the Baltimore Lon- all used conjugated equine estrogen, either E 1 From the Division of gitudinal Study of Aging, a sample of 472 0.625 or 1.25 mg. The sample sizes ranged Neurology, Department of postmenopausal or perimenopausal women from 42 to 120 patients with AD and con- Medicine (Drs Senanarong was followed for 16 years. After adjust- trols, with treatment duration ranging from and Poungvarin and ment for educational level, investigators 12 weeks to 12 months. None of these stud- Ms Jamjumras), the Division of Endocrinology, Department of found a relative risk of Alzheimer disease iesfoundimprovementincognitivemeasure- Medicine (Dr Vannasaeng and (AD) in estrogen users of 0.46 compared ments or clinical global assessment findings Ms Ploybutr), and the Division with nonusers. Paganini-Hill and Hender- after estrogen therapy. Vaginal spotting and of Clinical Epidemiology, son2 found that the risk for AD decreased deep vein thrombosis were observed as ad- Department of Research with longer duration of estrogen use. Re- verse effects in some treated patients. The Development sults of observational studies demonstrate results of these studies suggest that ERT ben- (Mr Udompunthurak), Faculty that postmenopausal women perform efitswomenwithoutdementiabutnotwom- of Medicine, Siriraj Hospital, better on name recall3 and immediate en with AD. Mahidol University, Bangkok, and delayed paragraph recall4 but not on Although there have been several stud- Thailand; and the Departments clock drawing5 after ERT. Results of ran- ies assessing cognitive responses to ERT, of Psychiatry and Biobehavioral Sciences (Drs Fairbanks and domized controlled trials indicate that es- few studies have examined the relation- Cummings) and Neurology trogen therapy improved cognitive func- ship between endogenous estrogen status (Dr Cummings), University of tion in nondemented postmenopausal and behavioral or cognitive symptoms in California, Los Angeles, women6-9 but that it is not helpful in women either cognitively intact women or pa- UCLA School of Medicine. with AD.10-12 tients with dementia. We conducted a study (REPRINTED) ARCH NEUROL / VOL 59, MAR 2002 WWW.ARCHNEUROL.COM 385 ©2002 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/28/2021 Table 1. Characteristics of the Study Population PARTICIPANTS, MATERIALS, Without AND METHODS Dementia With Demenita P No. (%) (N = 63) (N = 72) Value The review board of the National Research Council Sex of Thailand and an ethical committee at the Faculty M 25 (40) 20 (28) .15 of Medicine, Siriraj Hospital, Mahidol University, F 38 (60) 52 (72) Bangkok, Thailand, approved this study. Age, mean ± SD, y 65.8 ± 5.2 70.6 ± 8.6 Ͻ.001 This study was part of a multidisciplinary project Education, No. (%) Յ4 y 45 (71) 44 (61) .28 studying health promotion in the elderly conducted Ͼ by the Faculty of Medicine, Siriraj Hospital 4 y 18 (29) 28 (39) (1997-2000). A door-to-door survey of the community- dwelling elderly population within 10 km of Siriraj Hos- pital was conducted in 1997. Their names were re- of the association of endogenous estradiol (E2) levels with corded and they were included in our ongoing study cognitive impairment and noncognitive symptoms in de- in the Integrated Health Research Program for the El- mented and nondemented elderly individuals. We had ac- derly at the Faculty of Medicine, Siriraj Hospital. A total cess to a population of women in Bangkok, Thailand, where of 3518 elderly individuals from 3 amphurs (city re- gions) agreed to participate in the study of mental and the rate of ERT use among postmenopausal women is low. nervous systems. The mean±SD age of this group was 68.8±7.2 years, and the full range of the Thai Mental RESULTS State Examination (TMSE) was represented in par- ticipants from this initial survey. The 63 cognitively healthy individuals and the 72 with de- Of the 135 men and women aged 52 to 85 years mentia were similar in sex distribution and educational solicited from this community-based cohort, 72 had level (Table 1). Alzheimer disease was diagnosed in 37 dementia and 63 did not. Internists or neurologists participants with dementia, who were significantly older obtained the medical histories and conducted physi- than those without dementia (PϽ.001), and age was used cal examinations. Dementia was diagnosed using Di- as a covariate in subsequent analyses. Most patients with agnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.13 Exclusion criteria were de- non-AD dementias had vascular dementia. Other elderly lirium and a history of psychiatric disorders before individuals with dementia had Parkinson disease with de- the onset of memory problems. Blood tests and com- mentia, dementia with Lewy bodies, normal-pressure hy- puted tomography were performed for individuals drocephalus, and neurosyphilis. Mean E2 levels in men and with suspected dementia. Alzheimer disease was di- women were markedly different in demented and nonde- agnosed according to the criteria of the joint task force mented elderly individuals, with men having higher lev- of the National Institute of the Neurological and Com- els than postmenopausal women in all diagnostic groups municative Disorders and Stroke/Alzheimer’s Dis- Table 2 14 ( ). ease and Related Disorders Association. Five of the 135 participants had been receiving ERT: Data were obtained via structured question- 2 did not have dementia, and 3 did. Four participants had naires administered by professional nurses. The TMSE,15 a translated and culturally modified ver- undergone ERT for less than 6 months and had stopped sion of the Mini-Mental State Examination16 for the more than 5 years before blood samples were drawn for Thai population, was used to assess cognitive func- E2 analysis. One individual with dementia had taken es- tion. The Neuropsychiatric Inventory (NPI)17 was ap- trogens for 2 years and had stopped a few months be- plied to caregivers, relatives, or proxies of the el- fore this investigation because of vaginal bleeding. derly individuals to assess neuropsychiatric symptoms. To investigate the relationships of estrogen status The Functional Assessment Questionnaire18 was used to cognition and behavior in each sex, we analyzed the to assess activities of daily living. These measures were association between E2 levels and TMSE and NPI scores translated from English into Thai and then back into in men and women. There was no correlation between English, and any discrepancies were resolved. age and levels of E in either men or women. There was After 6 hours of fasting, 10-mL blood samples 2 were collected from participants via venipuncture be- a negative correlation between total NPI scores and E2 tween 7 and 11 AM. Samples were immediately cen- levels in both groups (men: r=−0.467, n=45; P=.001; trifuged, and the serum was stored at –20°C. Analy- women: r=−0.384, n=90; PϽ.001). Patients with lower sis of samples was conducted within 3 months of E2 levels had higher NPI scores and more marked neu- blood being drawn. Levels of E2 were measured by ropsychiatric symptoms. In this sample, relationships be- radioimmunoassay (double antibody technique) us- tween E2 levels and NPI subscale scores did not reach sta- ing a commercial kit (Double Antibody Estradiol; Di- tistical significance. agnostic Products Corp, Los Angeles, Calif). There was a positive correlation between global cog- Statistical analysis was performed using a soft- nitive function as measured by the TMSE and E2 levels ware program (SPSS 9.0; SPSS Inc, Chicago, Ill). The in both groups (men: r=0.316, n=45; P=.03; women: ␹2 test and analysis of variance were used to test for heterogeneity. Spearman correlation coefficients were r=0.243, n=90; P=.02).
Load more

Recommended publications
  • Drug Class Review Antianginal Agents
    Drug Class Review Antianginal Agents 24:12.08 Nitrates and Nitrites 24:04.92 Cardiac Drugs, Miscellaneous Amyl Nitrite Isosorbide Dinitrate (IsoDitrate ER®, others) Isosorbide Mononitrate (Imdur®) Nitroglycerin (Minitran®, Nitrostat®, others) Ranolazine (Ranexa®) Final Report May 2015 Review prepared by: Melissa Archer, PharmD, Clinical Pharmacist Carin Steinvoort, PharmD, Clinical Pharmacist Gary Oderda, PharmD, MPH, Professor University of Utah College of Pharmacy Copyright © 2015 by University of Utah College of Pharmacy Salt Lake City, Utah. All rights reserved. Table of Contents Executive Summary ......................................................................................................................... 3 Introduction .................................................................................................................................... 4 Table 1. Antianginal Therapies .............................................................................................. 4 Table 2. Summary of Agents .................................................................................................. 5 Disease Overview ........................................................................................................................ 8 Table 3. Summary of Current Clinical Practice Guidelines .................................................... 9 Pharmacology ............................................................................................................................... 10 Table 4. Pharmacokinetic Properties
    [Show full text]
  • Antianginal Drugs
    Antianginal Drugs Angina medications are used for angina pectoris or chest pain. The types of chest pain are chronic stable angina (which is associated with atherosclerosis), unstable angina (early stage of progressive coronary artery disease), and vasospastic angina (which results from spasms in the layer of smooth muscle that surrounds atherosclerotic coronary arteries). The three main classes of drugs used to treat angina pectoris are nitrates and nitrites, beta-blockers, and calcium channel blockers. The goal of the treatment is: 1. Minimize the frequency of attacks and decrease the duration and intensity of angina pain 2. Improve the patient’s functional capacity with as few adverse effects as possible 3. Increase blood flow to ischemic heart muscle and decrease myocardial oxygen demand 4. Prevent or delay the worst possible outcome, which is a myocardial infarction Nitrates and Nitrites Nitrates are available on many forms including sublingual, chewable tablets, oral capsules/tablets, IV solutions, transdermal patches, ointments and translingual sprays. They are broken down into rapid-acting forms and long-acting forms. The rapid-acting forms include sublingual and IV solutions. These are used to treat acute angina attacks. The long-acting forms are used to prevent angina episodes. Mechanism of Action Nitrates dilate all blood vessels; however, they predominately affect venous vascular beds and have a dose-dependent arterial vasodilator effect. This vasodilation happens because of relaxation of smooth muscle cells. 1. Vasodilation results in reduced myocardial oxygen demand and therefore more oxygen to ischemic myocardial tissue and reduction of angina symptoms. 2. By causing venous dilation, the nitrates reduce venous return and in turn reduce the leftventricular end-diastolic volume (preload) and results in a lower left ventricular pressure.
    [Show full text]
  • Effects of Vasodilation and Arterial Resistance on Cardiac Output Aliya Siddiqui Department of Biotechnology, Chaitanya P.G
    & Experim l e ca n i t in a l l C Aliya, J Clinic Experiment Cardiol 2011, 2:11 C f a Journal of Clinical & Experimental o r d l DOI: 10.4172/2155-9880.1000170 i a o n l o r g u y o J Cardiology ISSN: 2155-9880 Review Article Open Access Effects of Vasodilation and Arterial Resistance on Cardiac Output Aliya Siddiqui Department of Biotechnology, Chaitanya P.G. College, Kakatiya University, Warangal, India Abstract Heart is one of the most important organs present in human body which pumps blood throughout the body using blood vessels. With each heartbeat, blood is sent throughout the body, carrying oxygen and nutrients to all the cells in body. The cardiac cycle is the sequence of events that occurs when the heart beats. Blood pressure is maximum during systole, when the heart is pushing and minimum during diastole, when the heart is relaxed. Vasodilation caused by relaxation of smooth muscle cells in arteries causes an increase in blood flow. When blood vessels dilate, the blood flow is increased due to a decrease in vascular resistance. Therefore, dilation of arteries and arterioles leads to an immediate decrease in arterial blood pressure and heart rate. Cardiac output is the amount of blood ejected by the left ventricle in one minute. Cardiac output (CO) is the volume of blood being pumped by the heart, by left ventricle in the time interval of one minute. The effects of vasodilation, how the blood quantity increases and decreases along with the blood flow and the arterial blood flow and resistance on cardiac output is discussed in this reviewArticle.
    [Show full text]
  • Angiotensin-Converting Enzyme (ACE) Inhibitors
    Angiotensin-Converting Enzyme (ACE) Inhibitors Summary Blood pressure reduction is similar for the ACE inhibitors class, with no clinically meaningful differences between agents. Side effects are infrequent with ACE inhibitors, and are usually mild in severity; the most commonly occurring include cough and hypotension. Captopril and lisinopril do not require hepatic conversion to active metabolites and may be preferred in patients with severe hepatic impairment. Captopril differs from other oral ACE inhibitors in its rapid onset and shorter duration of action, which requires it to be given 2-3 times per day; enalaprilat, an injectable ACE inhibitor also has a rapid onset and shorter duration of action. Pharmacology Angiotensin Converting Enzyme Inhibitors (ACE inhibitors) block the conversion of angiotensin I to angiotensin II through competitive inhibition of the angiotensin converting enzyme. Angiotensin is formed via the renin-angiotensin-aldosterone system (RAAS), an enzymatic cascade that leads to the proteolytic cleavage of angiotensin I by ACEs to angiotensin II. RAAS impacts cardiovascular, renal and adrenal functions via the regulation of systemic blood pressure and electrolyte and fluid balance. Reduction in plasma levels of angiotensin II, a potent vasoconstrictor and negative feedback mediator for renin activity, by ACE inhibitors leads to increased plasma renin activity and decreased blood pressure, vasopressin secretion, sympathetic activation and cell growth. Decreases in plasma angiotensin II levels also results in a reduction in aldosterone secretion, with a subsequent decrease in sodium and water retention.[51035][51036][50907][51037][24005] ACE is found in both the plasma and tissue, but the concentration appears to be greater in tissue (primarily vascular endothelial cells, but also present in other organs including the heart).
    [Show full text]
  • Calcium Channel Blockers
    Calcium Channel Blockers Summary In general, calcium channel blockers (CCBs) are used most often for the management of hypertension and angina. There are 2 classes of CCBs: the dihydropyridines (DHPs), which have greater selectivity for vascular smooth muscle cells than for cardiac myocytes, and the non-DHPs, which have greater selectivity for cardiac myocytes and are used for cardiac arrhythmias. The DHPs cause peripheral edema, headaches, and postural hypotension most commonly, all of which are due to the peripheral vasodilatory effects of the drugs in this class of CCBs. The non-DHPs are negative inotropes and chronotropes; they can cause bradycardia and depress AV node conduction, increasing the risk of heart failure exacerbation, bradycardia, and AV block. Clevidipine is a DHP calcium channel blocker administered via continuous IV infusion and used for rapid blood pressure reductions. All CCBs are substrates of CYP3A4, but both diltiazem and verapamil are also inhibitors of 3A4 and have an increased risk of drug interactions. Verapamil also inhibits CYP2C9, CYP2C19, and CYP1A2. Pharmacology CCBs selectively inhibit the voltage-gated L-type calcium channels on cardiac myocytes, vascular smooth muscle cells, and cells within the sinoatrial (SA) and atrioventricular (AV) nodes, preventing influx of extracellular calcium. CCBs act by either deforming the channels, inhibiting ion-control gating mechanisms, and/or interfering with the release of calcium from the major cellular calcium store, the endoplasmic reticulum. Calcium influx via these channels serves for excitation-contraction coupling and electrical discharge in the heart and vasculature. A decrease in intracellular calcium will result in inhibition of the contractile process of the myocardial smooth muscle cells, resulting in dilation of the coronary and peripheral arterial vasculature.
    [Show full text]
  • Anti-Inflammatory Action of Corticosteroids M
    Postgrad Med J: first published as 10.1136/pgmj.52.612.631 on 1 October 1976. Downloaded from Postgraduate Medical Journal (October 1976) 52, 631-633. Anti-inflammatory action of corticosteroids M. W. GREAVES M.D., M.R.C.P. Institute of Dermatology, University of London Summary The anti-inflammatory action of corticosteroids is com- plex. At a cellular level, they cause redistribution of granulocytes, resulting in increased circulating granu- locytes and reduced tissue pools. They also cause lymphopenia. The significance of these phenomena in relation to the anti-inflammatory activity of steroids is unknown. The most obvious pharmacological effects of corticosteroids are seen on blood vessels. They cause adrenergically mediated vasoconstriction and .'Fq,,:t;^.A^~~~~~~;rE .> i due to non-competitive antagonism of vasodilation Protected by copyright. prostaglandin E and bradykinin. t~~A4 W~~ Prostaglandin formation is inhibited by cortico- steroids but whether this is due to an effect on enzymic synthesis or release is uncertain. Corticosteroids -iiL' 8 l " ;' '. .A -'' .'.. stabilize the lysosomal membrane preventing release 4 of enzymes in vitro but the of lysosomal significance FIG. 1. Simple representation of inflammatory response. this in vivo is debatable. A =mast cell, B =polymorphonuclear, C =monocyte. THE corticosteroids differ from almost all other responses to injury leads to spontaneous remission. anti-inflammatory drugs in that they are capable of It may well be that the pharmacological and cellular inhibiting virtually all the components of inflam- mechanisms involved in the natural termination of mation. It is proposed to deal with the anti-inflam- inflammation are just as important in terms of matory action of corticosteroids on three interrelated understanding the pathology and therapy of in- components of the inflammatory response: (i) flammation as the mechanisms involved in its pro- http://pmj.bmj.com/ inflammatory cells; (ii) blood vessels; (iii) release or duction.
    [Show full text]
  • Circulating Bile Acids Predict Outcome in Critically Ill Patients
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Crossref Horvatits et al. Ann. Intensive Care (2017) 7:48 DOI 10.1186/s13613-017-0272-7 RESEARCH Open Access Circulating bile acids predict outcome in critically ill patients Thomas Horvatits1,2†, Andreas Drolz1,2†, Karoline Rutter1,2, Kevin Roedl1,2, Lies Langouche3, Greet Van den Berghe3, Günter Fauler4, Brigitte Meyer5, Martin Hülsmann6, Gottfried Heinz6, Michael Trauner1 and Valentin Fuhrmann1,2* Abstract Background: Jaundice and cholestatic hepatic dysfunction are frequent fndings in critically ill patients associated with increased mortality. Cholestasis in critically ill patients is closely associated with stimulation of pro-infammatory cytokines resulting in impaired bile secretion and subsequent accumulation of bile acids. Aim of this study was to evaluate the clinical role of circulating bile acids in critically ill patients. Methods: Total and individual serum bile acids were assessed via high-performance liquid chromatography in 320 critically ill patients and 19 controls. Results: Total serum bile acids were threefold higher in septic than cardiogenic shock patients and sixfold higher than in post-surgical patients or controls (p < 0.001). Elevated bile acid levels correlated with severity of illness, renal dysfunction and infammation (p < 0.05). Total bile acids predicted 28-day mortality independently of sex, age, serum bilirubin and severity of illness (HR 1.041, 95% CI 1.013–1.071, p < 0.005). Best prediction of mortality of total bile acids was seen in patients sufering from septic shock. Conclusions: Individual and total BAs are elevated by various degrees in diferent shock conditions.
    [Show full text]
  • ACS/ASE Medical Student Core Curriculum Postoperative Care
    ACS/ASE Medical Student Core Curriculum Postoperative Care POSTOPERATIVE CARE Prompt assessment and treatment of postoperative complications is critical for the comprehensive care of surgical patients. The goal of the postoperative assessment is to ensure proper healing as well as rule out the presence of complications, which can affect the patient from head to toe, including the neurologic, cardiovascular, pulmonary, renal, gastrointestinal, hematologic, endocrine and infectious systems. Several of the most common complications after surgery are discussed below, including their risk factors, presentation, as well as a practical guide to evaluation and treatment. Of note, fluids and electrolyte shifts are normal after surgery, and their management is very important for healing and progression. Please see the module on Fluids and Electrolytes for further discussion. Epidemiology/Pathophysiology I. Wound Complications Proper wound healing relies on sufficient oxygen delivery to the wound, lack of bacterial and necrotic contamination, and adequate nutritional status. Factors that can impair wound healing and lead to complications include bacterial infection (>106 CFUs/cm2), necrotic tissue, foreign bodies, diabetes, smoking, malignancy, malnutrition, poor blood supply, global hypotension, hypothermia, immunosuppression (including steroids), emergency surgery, ascites, severe cardiopulmonary disease, and intraoperative contamination. Of note, when reapproximating tissue during surgery, whether one is closing skin or performing a bowel anastomosis, tension on the wound edges is an important factor that contributes to proper healing. If there is too much tension on the wound, there will be local ischemia within the microcirculation, which will compromise healing. Common wound complications include infection, dehiscence, and incisional hernia. Wound infections, or surgical site infections (SSI), can occur in the surgical field from deep organ spaces to superficial skin and are due to bacterial contamination.
    [Show full text]
  • Beta-Blockers for Cardiovascular Conditions
    CARDIOVASCULAR SYSTEM PHARMACOLOGY MEDICINE INDICATIONS Beta-blockers for cardiovascular conditions: one size does not fit all patients Metoprolol succinate accounts for almost three-quarters of the beta-blockers dispensed in New Zealand. There is, however, little evidence to support the systematic use of metoprolol succinate over other medicines in this class. Prescribers are encouraged to use the pharmacological diversity of beta-blockers and the clinical characteristics of patients to individualise treatment and optimise care. KEY PRACTICE POINTS: Metoprolol succinate is the most frequently prescribed beta-blocker in New Zealand Beta-blockers are a diverse group of medicines and prescribers should consider their different properties, along In 2016, 325 000 people received a beta-blocker from a with the presence of co-morbidities, to individualise care for community pharmacy in New Zealand:1 patients with cardiovascular conditions 72% were prescribed metoprolol succinate; the seventh When a beta-blocker is initiated, a slow upwards titration most prescribed medicine in New Zealand of dose is recommended to minimise adverse effects. 7% were prescribed bisoprolol Beta-blockers should also be withdrawn slowly, ideally over several months, to prevent rebound symptoms such as 5% were prescribed atenolol resting tachycardia. 4% were prescribed carvedilol or propranolol From 6-12 months onwards post-myocardial infarction, consider withdrawing beta-blockers for patients without This pattern of prescribing is different to other countries, such
    [Show full text]
  • Lipotropics, Other
    Lipotropics, Other Therapeutic Class Review (TCR) October 2, 2020 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, digital scanning, or via any information storage or retrieval system without the express written consent of Magellan Rx Management. All requests for permission should be mailed to: Magellan Rx Management Attention: Legal Department 6950 Columbia Gateway Drive Columbia, Maryland 21046 The materials contained herein represent the opinions of the collective authors and editors and should not be construed to be the official representation of any professional organization or group, any state Pharmacy and Therapeutics committee, any state Medicaid Agency, or any other clinical committee. This material is not intended to be relied upon as medical advice for specific medical cases and nothing contained herein should be relied upon by any patient, medical professional or layperson seeking information about a specific course of treatment for a specific medical condition. All readers of this material are responsible for independently obtaining medical advice and guidance from their own physician and/or other medical professional in regard to the best course of treatment for their specific medical condition. This publication, inclusive of all forms contained herein, is intended to be educational in nature and is intended to be used for informational purposes only. Send comments and suggestions to [email protected]. October 2020 Proprietary Information. Restricted Access – Do not disseminate or copy without approval. © 2004-2020 Magellan Rx Management. All Rights Reserved. FDA-APPROVED INDICATIONS Agents in this class are indicated as adjuncts to dietary modifications for the treatment of various dyslipidemias.
    [Show full text]
  • Pulmonary Vasodilators
    Pulmonary Vasodilators Mark S Siobal RRT Introduction Systemic Versus Selective Pulmonary Vasodilation Pulmonary Vasodilators Currently Available or Under Development Oxygen Calcium Channel Blockers Nitric Oxide Gas Nitric Oxide Donors Prostacyclins Phosphodiesterase Inhibitors Endothelin Receptor Antagonists Combined Therapies Implications for Respiratory Therapists Summary Pulmonary vasodilators are an important treatment for pulmonary arterial hypertension. They reduce pulmonary artery pressure; improve hemodynamic function; alter ventilation/perfusion matching in the lungs; and improve functional quality of life, exercise tolerance, and survival in patients with severe pulmonary arterial hypertension. This paper reviews the currently available pulmonary vasodilators and those under development, many of which can be administered via inhalation. I will also give an overview of the clinical pharmacology of, the indications for, and the evidence supporting pulmonary vasodilators, their delivery via inhalation, and potential toxic and adverse effects. Key words: pulmonary vasodilators, oxygen, calcium channel blockers, nitric oxide, nitric oxide donors, prostacyclins, phosphodiesterase inhibitors, endothelin receptor antagonists. [Respir Care 2007;52(7):885–899. © 2007 Daedalus Enterprises] Introduction eration, and remodeling and narrowing or thrombosis of small pulmonary arteries.1 If left untreated, these pathological Pulmonary arterial hypertension (PAH) can be character- changes result in a progressive rise in pulmonary artery pres-
    [Show full text]
  • Antianginal Drugs
    Antianginal drugs Antianginal drugs are drugs used for the treatment of ischemic heart disease (coronary heart disease). Ischemic heart disease (IHD) is characterized by disbalance between myocardium oxygen demand and coronary blood supply. FACTORS DETERMINING MYOCARDUM OXYGEN DEMAND: 1. contractility of myocardium 2. heart rate (HR) 3. tension of myocardium wall at the end of diastole (preload), and its` maximal tension during systole (afterload). FACTORS DETERMINING MYOCARDIAL BLOOD SUPPLY 1. perfusion pressure that ensures movement of blood through coronary vessels, it is the difference between the pressures in coronary sinuses (intramyocardial pressure) and aorta. The higher is the intramyocardial pressure (for example preload increase), the lower is the perfused pressure and the worse is the myocardial blood supply. 2. resistance and diameter of coronary arteries, which depends on the external factors (which bring to passive changes of resistance and diameter of coronary vessels), internal factors (which cause active changes in them) and blood viscosity. 2.1. To the external factors belongs extravascular myocardial compression (the compression of coronary vessels due to the heart contraction during systole), especially intramural coronary vessels. In these vessels, blood supply nearly completely ceases during systole. So, 67-90% of the heart blood supply is realized during diastole, especially at its beginning, when the myocardium is fully relaxed. In this case subendocardial arteries become mainly compressed (picture 1). 2.2. To the internal factors belongs local-self –regulating mechanisms (due to pO2 and/or pCO2 level changes), nervous (activation of α-adrenorecpetors causes vasoconstriction and stimulation of M-cholino- and β2-adrenoreceptors brings to vasodilation of coronary arteries) and humoral factors (EDRF, prostacycline etc.).
    [Show full text]