By Adam Schneeweiss MD, Marija Weiss DSc (auth.)

ISBN-10: 0387527982

ISBN-13: 9780387527987

ISBN-10: 3642758347

ISBN-13: 9783642758348

ISBN-10: 3642758363

ISBN-13: 9783642758362

Nitrates were for a few years the cornerstone of cardiovascular treatment for varied symptoms. not just have nitrates stood the try of time for therapy of power good angina pectoris, however the symptoms for them have markedly ex­ panded. They now contain all kinds of angina pectoris and myocardial ischemia, congestive middle failure and hypertensive emergencies. The valuable results of nitrates in these types of stipulations consequence from their vasodilatory homes, however it continues to be doubtful no matter if the primary or peripheral results predominate within the thera­ peutic mechanism. lately nitrates were proven to meet an important requirement for every and each drug - to minimize mortality. a wide scale research published that isosorbide dinitrate, mixed with hydralazine, diminished long term mortality by means of 28% in sufferers with congestive middle failure. This discovering will surely stimulate study on nitrates, and it would be anticipated that curiosity in those medicines will markedly raise. The essentially used nitrates in medical perform are nitroglycerin and the com­ plex natural nitrates, as a rule isosorbide dinitrate. The natural mononitrates are actually below scientific research, and isosorbide-5-mononitrate (IS-5-MN) seems to be specially promising.

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In the specific case of antianginal drugs associated therapeutic goals, such as the role of the drug in preventing infarction and sudden death and in treating hypertension, should be considered. 5. Mechanism of Angina and Selection of Drugs In patients with angina at rest the main mechanism of ischemia is vasospasm in the coronary arteries. As vasospastic angina was extensively investigated at the time of introduction of the calcium antagonists, particularly nifedipine, into clinical practice, these agents became associated, in the opinion of many clinicians, with treatment of vasospastic angina.

Beta-Blockers Sublingual nitroglycerin cannot be compared with beta-blockers because they are not used for the same indications. A comparative study of intravenously administered nitroglycerin and esmolol in unstable angina is now planned. Comparative studies of transdermal nitroglycerin patches and beta-blockers in long-term prevention of angina have not been performed. 4. General Considerations in Comparative Evaluation 0/ Antianginal Therapy The availability of three different classes of antianginal agents (nitrates, betablockers and calcium antagonists), each with distinct pharmacologic properties, provides the cardiologist with the opportunity to use a selective and rational approach to the individualized therapy of angina pectoris.

1 mg) nifedipine in 37 patients with suspected vasospastic angina. 8 mm. Sublingual nifedipine did not alter the luminal diameter of the coronary arteries within 10 minutes after the ergonovine test. Intracoronary administration of nifedipine increased the coronary luminal diameter to the same extent as achieved by sublingual ISDN. Intracoronary nifedipine reduced aortic blood pressure and increased heart rate, but it did not alter the left ventricular pump function. Hence, sublingual ISDN was found as potent as intracoronary nifedipine in releasing the ergonovine-induced coronary constriction and more potent in counteracting the effects of ergonovine on left ventricular pump function.

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Advances in Nitrate Therapy by Adam Schneeweiss MD, Marija Weiss DSc (auth.)

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