Role of a Third Generation Calcium Antagonist in the Management of HypertensionEpstein, Murray
doi: 10.2165/00003495-199957001-00001pmid: 10529076
Calcium antagonists are uniquely suitable for managing hypertension by virtue of their efficacy, metabolic neutrality and their ability to countervail counter-regulatory adaptive changes, thereby enhancing blood pressure lowering. Recent evidence has accrued underscoring the concept that calcium antagonists are heterogeneous and consist of chemically dissimilar agents. The difference in formulations and pharmacokinetics affect clinical events including the effect on blood pressure, heart rate and the degree with which sympathetic activity is activated. Lacidipine is a new calcium antagonist that is the prototype of the lipophilic dihydropyridines. Of great importance, lacidipine has a slow onset of vasodilator/ antihypertensive effect and does not promote an excessive sympathetic drive. These attributes commend its selection as an antihypertensive agent.
Drug Treatment of Asthma in the 1990sTavakkoli, Aryan; Rees, P.
doi: 10.2165/00003495-199957010-00001pmid: 9951947
Asthma is an inflammatory condition of the airways. First-line therapy involves the use of inhaled corticosteroids as anti-inflammatory agents to control the underlying process. Bronchodilators are used for symptom relief. Short-acting β-agonists provide rapid relief of bronchoconstriction, whereas long-acting β-agonists control the symptoms and reduce the frequency of exacerbations when combined with inhaled corticosteroids. Anticholinergic bronchodilators have a minor role in acute exacerbations and in patients troubled by adverse effects from β-agonists. Theophylline has a bronchodilator action in asthma, but its role as an anti-inflammatory agent needs to be examined further. Because of their toxicity, corticosteroid-sparing agents have a limited role, being restricted to patients with severe uncontrolled asthma.
α-Adrenoceptor Antagonists in the Treatment of Benign Prostatic HyperplasiaCooper, Kimberly; McKiernan, James; Kaplan, Steven
doi: 10.2165/00003495-199957010-00002pmid: 9951948
Lower urinary tract symptoms secondary to benign prostatic hyperplasia (BP have a significant impact on the lifestyle of older men. Transurethral resection of the prostate (TURP) is the most effective surgical therapy for this condition but an increasing number of patients are electing conservative medical therapy. α-Adrenoceptor antagonists and 5α-reductase inhibitors are the 2 categories of drug therapy currently available for BPH. Use of α-adrenoceptor antagonists in the treatment of BPH is based on their ability to prevent the neural stimulation which induces prostate smooth muscle contraction, producing lower urinary tract symptoms. Several studies have demonstrated that α-receptors predominate in the prostatic stroma, capsule and bladder neck. Initial work focused on the use of phenoxybenzamine, a nonspecific α-blocker, in the treatment of BPH. While results were promising, significant adverse effects and concern over potential mutagenicity have resulted in a lack of use of this medication for this indication. Subsequent attention was directed towards the short-acting α-specific antagonist prazosin. Results conflicted regarding whether an actual sustained improvement in lower urinary tract symptoms could be achieved with this medication, and because of twice daily dosing compliance issues were a drawback. Thus, the mainstay in pharmacological treatment of BPH over the past decade has been 2 once-a-day α-specific antagonists, doxazosin and terazosin. Over 75% of all prescriptions written for BPH are for one of these 2 medications. Despite their tremendous success in both decreasing urinary symptoms and increasing urinary flow rates, systemic adverse effects can be bothersome. Recently, efforts have focused on use of α1A-urospecific antagonists such as tamsulosin and alfuzosin in an attempt to achieve similar clinical results as doxazosin and terazosin without systemic adverse effects. Thus far, results are promising, but long term studies must be done to determine whether pharmacological uroselectivity is actually clinically relevant.
Impact of Calcium Antagonists on the Cardiovascular SystemKuschnir, Emilio
doi: 10.2165/00003495-199957001-00002pmid: 10529078
The evaluation of haemodynamic patterns in hypertensive patients by radionuclide techniques and a tomographic gamma camera has revealed differences between older and younger patients. In younger hypertensive patients, the hyperkinetic state is reflected in an increase in heart rate and, consequently, an increased cardiac index and left ventricular ejection fraction (LVEF) in comparison with normotensive controls. Older hypertensive patients, however, show a different haemodynamic pattern, with reduced systolic and diastolic function at rest compared with normotensive elderly people, and marked depression of cardiac reserve during exercise. Elderly hypertensive patients also show strikingly higher hyperresistance and reduced peripheral perfusion in comparison with younger hypertensive patients. These haemodynamic differences need to be taken into account when considering antihypertensive treatment.
Drug Therapy of Postprandial HyperglycaemiaMooradian, Arshag; Thurman, Jerome
doi: 10.2165/00003495-199957010-00003pmid: 9951949
It is widely accepted that the most challenging goal in the management of patients with diabetes mellitus is to achieve blood glucose levels as close to normal as possible. In general, normalising postprandial blood glucose levels is more difficult than normalising fasting hyperglycaemia. In addition, some epidemiological studies suggest that postprandial hyperglycaemia (PPHG) or hyperinsulinaemia are independent risk factors for the development of macro-vascular complications of diabetes mellitus.
Second-Generation AntihistaminesSlater, James; Zechnich, Andrew; Haxby, Dean
doi: 10.2165/00003495-199957010-00004pmid: 9951950
Second-generation histamine H1 receptor antagonists (antihistamines) have been developed to reduce or eliminate the sedation and anticholinergic adverse effects that occur with older H1 receptor antagonists. This article evaluates second-generation antihistamines, including acrivastine, astemizole, azelastine, cetirizine, ebastine, fexofenadine, ketotifen, loratadine, mizolastine and terfenadine, for significant features that affect choice.
Drug Therapy in the Management of Type 1 Autoimmune HepatitisCzaja, Albert
doi: 10.2165/00003495-199957010-00005pmid: 9951951
Prednisone alone or in combination with azathioprine is the treatment of choice for severe type 1 autoimmune hepatitis. The combination regimen is preferred, especially in the elderly, because of a lower incidence of corticosteroid-related complications. Only patients with sustained severe laboratory abnormalities, bridging necrosis or multilobular necrosis on histological assessment, and/or incapacitating symptoms, have absolute indications for treatment based on controlled clinical trials. The institution of therapy must be individualised in other patients, based mainly on symptoms and disease behaviour.
Practical Recommendations for the Management of Adenocarcinoma of the PancreasSporn, Jonathan
doi: 10.2165/00003495-199957010-00006pmid: 9951952
Pancreatic cancer is widely regarded by medical personnel and the lay public as one of the most dreaded of all diagnoses. Although in selected series of operable patients the chance of long term survival may reach 20%, most patients have unfavourable disease at the time of diagnosis, and for the entire group of newly diagnosed patients, 5-year survival is rare. This grim outlook results from a combination of factors, including an anatomical location which makes early detection by screening tests or by symptoms difficult, a high tendency for spread to regional lymphatics and the liver, a poor profile of sensitivity to chemotherapeutic agents and the poor medical condition of many patients at the time of diagnosis. These factors mean that it is particularly important that at the time of diagnosis these patients are carefully evaluated, and that they and their families are fully aware of the treatment options available to them and the associated potential risks and benefits.