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Current Hypertension Reviews 2014Perioperative hypertension has been shown to be a risk factor for the development of perioperative morbidity and mortality. The time spent outside acceptable blood... (Review)
Review
Perioperative hypertension has been shown to be a risk factor for the development of perioperative morbidity and mortality. The time spent outside acceptable blood pressure ranges, in a state of hypertension or hypotension, is correlated with the incidence of stroke, acute coronary syndrome, renal dysfunction, and death. The ideal perioperative treatment of hypertension would include an easily titratable agent, with fast onset and offset and minimal side effects. Several medication classes are routinely used in the operating room, including, but not limited to, beta-blockers, calcium channel blockers, nitrates, and angiotensin-converting enzyme (ACE) inhibitors.Proper treatment of chronic hypertension and continuation of chronic anti-hypertensive medications in the perioperative period has been demonstrated to improve patient outcomes. This review article will outline the importance of perioperative blood pressure management, the treatment pitfalls, and the novel medications being used in the perioperative setting.
Topics: Adrenergic alpha-2 Receptor Agonists; Adrenergic beta-Antagonists; Antihypertensive Agents; Calcium Channel Blockers; Humans; Hypertension; Perioperative Period
PubMed: 25392141
DOI: 10.2174/157340211001141111145658 -
Journal of the American Dental... May 1999Adrenergic vasoconstrictors are commonly used by dentists to enhance the pain-relieving action of local anesthetics and to control local bleeding. Although normally... (Review)
Review
BACKGROUND
Adrenergic vasoconstrictors are commonly used by dentists to enhance the pain-relieving action of local anesthetics and to control local bleeding. Although normally considered safe for these applications, vasoconstrictors can participate in drug interactions that potentially are harmful to patients.
METHODS
The faculty of a March 1998 symposium entitled "Adverse Drug Interactions in Dentistry: Separating the Myths From the Facts" extensively reviewed the literature on drug interactions. They then established a significance rating of alleged adverse drug interactions pertaining to dentistry, based on the quality of documentation and severity of effect. The author of this article focused on the adrenergic vasoconstrictors epinephrine and levonordefrin.
RESULTS
Vasoconstrictor drug interactions involving tricyclic antidepressants, nonselective beta-adrenergic blocking drugs, certain general anesthetics and cocaine are well-documented in both humans and animals as having the potential for causing serious morbidity or death. Evidence for adverse interactions involving adrenergic neuronal blocking drugs, drugs with alpha-adrenergic blocking activity, local anesthetics and thyroid hormones is much less compelling, suggesting for the most part that clinically significant reactions may occur only when both the vasoconstrictor and the interacting drug are used in excessive doses. In the case of monoamine oxidase inhibitors, there is no credible evidence of a significant interaction with epinephrine or levonordefrin.
CONCLUSIONS
Potentially serious adverse drug interactions involving adrenergic vasoconstrictors can occur in dental practice. In most circumstances, careful administration of small doses of vasoconstrictors and avoidance of gingival retraction cord containing epinephrine, coupled with monitoring of vita signs, will permit these drugs to be used with no risk or only minimally increased risk. Only in the case of cocaine intoxication must adrenergic vasoconstrictors be avoided completely.
CLINICAL IMPLICATIONS
For optimal patient safety, dentists must recognize potential drug interactions involving adrenergic vasoconstrictors and modify their use of these agents accordingly.
Topics: Adrenergic Agents; Dental Care; Drug Interactions; Humans; Vasoconstrictor Agents
PubMed: 10332135
DOI: 10.14219/jada.archive.1999.0280 -
Israel Journal of Medical Sciences Jun 1991We evaluated the response of 15 male patients with severe chronic obstructive pulmonary disease (COPD) to sequential inhalations of an anticholinergic agent, ipratropium... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
We evaluated the response of 15 male patients with severe chronic obstructive pulmonary disease (COPD) to sequential inhalations of an anticholinergic agent, ipratropium bromide 0.25 mg (IB) and a B2 adrenergic agonist, terbutalin 2.5 mg (TER), in a double-blind crossover study. We found no statistically significant difference in the bronchodilatory response between the two agents when comparing the change in forced vital capacity and forced expiratory volume in 1 sec. The subsequent effect of the sequential inhalation demonstrated some additional bronchodilatory response when IB was given after TER, but not when TER was given after IB. However, the end result after the two protocols was not statistically different. The results indicate that in COPD patients the two agents are equipotent. However, in order to prescribe the best treatment schedule for each patient, it is still necessary to evaluate how each individual patient responds to each of the agents. Sequential inhalation may be beneficial in some patients.
Topics: Adrenergic beta-Agonists; Aged; Double-Blind Method; Forced Expiratory Volume; Humans; Ipratropium; Lung Diseases, Obstructive; Male; Middle Aged; Parasympatholytics; Terbutaline; Vital Capacity
PubMed: 1676394
DOI: No ID Found -
Archivos de La Sociedad Espanola de... Aug 2000
Topics: Adrenergic Agents; Glaucoma; Humans; Terminology as Topic
PubMed: 11151208
DOI: No ID Found -
The American Journal of Cardiology Mar 1997Recent developments in the treatment of chronic heart failure have lead to the use of beta blockers to improve ventricular function and symptoms, and to reverse or slow... (Review)
Review
Recent developments in the treatment of chronic heart failure have lead to the use of beta blockers to improve ventricular function and symptoms, and to reverse or slow pathologic remodeling of the failing heart. Little practical information exists in the literature on how to initiate this therapy and how to select the proper beta-blocking agent. This editorial examines which beta-blocking agents are best tolerated and why, and describes how best to initiate treatment with these agents.
Topics: Adrenergic beta-Antagonists; Chronic Disease; Clinical Trials as Topic; Drug Tolerance; Heart Failure; Humans; Practice Guidelines as Topic
PubMed: 9070564
DOI: 10.1016/s0002-9149(96)00873-9 -
American Heart Journal Nov 1988Therapeutics involves the careful balance between treatment disadvantages and advantages--the so-called risk-benefit ratio. Even after 20 years beta-blockers must be... (Review)
Review
Therapeutics involves the careful balance between treatment disadvantages and advantages--the so-called risk-benefit ratio. Even after 20 years beta-blockers must be selected carefully to suit the patient's needs. This review examines several problems associated with beta-blockade. Generally, beta1-cardioselectivity is considered advantageous, but properties such as partial agonist activity, which limits receptor up-regulation, might be of greater value in reducing the adverse effects associated with abrupt drug withdrawal. Beta-Blockers, either lipophilic or hydrophilic agents, have specific problems: lipophilic drugs provoke adverse central nervous system effects and need careful dose titration; variable gastrointestinal absorption is common with hydrophilic agents, whereas extra care is needed in patients with renal impairment. For most patients, especially those with asymptomatic conditions, once-daily dosing is preferred. For many, the quality of life is of overriding clinical importance. Despite significant pharmacokinetic and pharmacodynamic advances, the final criteria depend largely on a clinical assessment, improvement in the quality of life, and patient preference. We still await the discovery of an ideal beta-adrenoceptor blocking agent; some of the newer beta-blockers, however have many of the properties that clinicians value.
Topics: Adrenergic beta-Agonists; Adrenergic beta-Antagonists; Animals; Humans; Hypertension; Receptors, Adrenergic, beta; Risk Factors
PubMed: 2903650
DOI: 10.1016/0002-8703(88)90130-5 -
The Annals of Pharmacotherapy Jan 1996To compare the similarities and differences among the ocular beta-blockers. Important considerations when comparing these agents are the differences in systemic adverse... (Comparative Study)
Comparative Study Review
OBJECTIVE
To compare the similarities and differences among the ocular beta-blockers. Important considerations when comparing these agents are the differences in systemic adverse effects, local tolerability, and cost.
DATA SOURCE
Information was retrieved from a MEDLINE search of the English-language literature and bibliographic reviews of review articles. Index terms included beta-blockers, glaucoma, timolol, levobunolol, betaxolol, metipranolol, and carteolol.
STUDY SELECTION
Emphasis was placed on eyedrop studies, as well as properly designed and executed clinical trials that assessed dosage, dosing interval, therapeutic response, adverse effects, and cost.
DATA EXTRACTION
Data from several studies were evaluated according to the study design, therapeutic response, and adverse effects.
DATA SYNTHESIS
Timolol maleate, levobunolol, metipranolol, and carteolol have similar effectiveness in lowering intraocular pressure; however, levobunolol and timolol gel forming solution may have an advantage of once-daily dosing. Studies have not been published comparing the clinical efficacy of timolol hemihydrate with that of other ocular beta-blockers. Metipranolol is cost effective in treating primary open-angle glaucoma; however, it has been associated with more ocular burning, stinging, and granulomatous anterior uveitis than other agents. The intrinsic sympathomimetic activity of carteolol has not yet displayed a definite advantage over the other agents in terms of optic disk perfusion and systemic adverse effects. The control of intraocular pressure with betaxolol has not always been as good as with timolol; however, betaxolol has some advantages over timolol and the other topical beta-blockers in terms of systemic adverse effects.
CONCLUSIONS
Considering cost, efficacy, and safety, timolol maleate is the recommended formulary agent because the other agents cannot consistently show an outstanding advantage.
Topics: Adrenergic beta-Agonists; Adrenergic beta-Antagonists; Animals; Epinephrine; Glaucoma; Humans; Intraocular Pressure
PubMed: 8773166
DOI: 10.1177/106002809603000109 -
Nutrients Nov 2022Isoflavone-rich legumes, including soy, are used for food production, as dietary supplements and in traditional medicine. Soy consumption correlates negatively with...
Isoflavone-rich legumes, including soy, are used for food production, as dietary supplements and in traditional medicine. Soy consumption correlates negatively with benign prostatic hyperplasia (BPH) and voiding symptoms. However, isoflavone effects on the prostate are hardly known. Here, we examined the effects on human prostate smooth muscle contractions and stromal cell growth, which are driving factors of voiding symptoms in BPH. Smooth muscle contractions were induced in prostate tissues from radical prostatectomy. Growth-related functions were studied in cultured stromal cells (WPMY-1). Neurogenic, α1-adrenergic and non-adrenergic contractions were strongly inhibited with 50 µM and by around 50% with 10 µM genistein. Daidzein inhibited neurogenic contractions using 10 and 100 µM. Agonist-induced contractions were inhibited by 100 µM but not 10 µM daidzein. A combination of 6 µM genistein with 5 µM daidzein still inhibited neurogenic and agonist-induced contractions. Proliferation of WPMY-1 cells was inhibited by genistein (>50%) and daidzein (<50%). Genistein induced apoptosis and cell death (by seven-fold relative to controls), while daidzein induced cell death (6.4-fold) without apoptosis. Viability was reduced by genistein (maximum: 87%) and daidzein (62%). In conclusion, soy isoflavones exert sustained effects on prostate smooth muscle contractions and stromal cell growth, which may explain the inverse relationships between soy-rich nutrition, BPH and voiding symptoms.
Topics: Male; Humans; Prostate; Genistein; Adrenergic Agents; Muscle, Smooth; Muscle Contraction; Prostatic Hyperplasia; Stromal Cells; Isoflavones
PubMed: 36500973
DOI: 10.3390/nu14234943 -
Journal of Ocular Pharmacology and... Mar 2022Anesthesia is necessary to conduct rodent electroretinograms (ERGs). We evaluated utility of the α2-agonist medetomidine versus xylazine for ERG studies in nondiabetic...
Anesthesia is necessary to conduct rodent electroretinograms (ERGs). We evaluated utility of the α2-agonist medetomidine versus xylazine for ERG studies in nondiabetic and diabetic rats. Pentobarbital was included as a comparator. Male Sprague-Dawley rats, with and without streptozotocin (STZ)-induced diabetes, were anesthetized with medetomidine (1 mg/kg), xylazine (10 mg/kg) (both with ketamine 75 mg/kg), or pentobarbital (70 mg/kg). The depth of anesthesia was assessed, and if adequate, scotopic ERGs were recorded. Blood glucose was monitored. In nondiabetic rats, all three agents induced satisfactory anesthesia, but with differing durations: medetomidine > pentobarbital > xylazine. ERG responses were similar under medetomidine and xylazine, but relatively reduced under pentobarbital. Both α2-agonists (but not pentobarbital) elicited marked hyperglycemia (peak values 316.1 ± 42.6 and 300.3 ± 29.5 mg/dL, respectively), persisting for 12 h. In diabetic rats, elevated blood glucose concentrations were not affected by any of the agents, but the depth of anesthesia under medetomidine and xylazine was inadequate for ERG recording. In nondiabetic rats, medetomidine and xylazine elicited comparable effects on ERGs that differ from pentobarbital, but both perturbed glucose metabolism, potentially confounding experimental outcomes. In STZ-diabetic rats, neither α2-agent provided adequate anesthesia, while pentobarbital did so. Problems with α2-anesthetic agents, including medetomidine, must be recognized to ensure meaningful interpretation of experimental results.
Topics: Adrenergic Agents; Anesthesia; Animals; Diabetes Mellitus, Experimental; Male; Medetomidine; Pentobarbital; Rats; Rats, Sprague-Dawley; Xylazine
PubMed: 34964655
DOI: 10.1089/jop.2021.0084 -
European Journal of Psychotraumatology 2024Clonidine is a centrally acting anti-adrenergic agent that may have applications in post-traumatic stress disorder (PTSD), particularly for sleep. In this systematic... (Review)
Review
Clonidine is a centrally acting anti-adrenergic agent that may have applications in post-traumatic stress disorder (PTSD), particularly for sleep. In this systematic review, we aimed to summarize the effect of clonidine on sleep quality and duration, nightmares, and PTSD symptom severity in adults with PTSD. PubMed (Medline), Embase, PsycINFO, CINAHL, and clinicaltrials.gov were searched up to April 2023. Studies on clonidine use in adult PTSD patients reporting data on the effect on sleep, nightmares, and PTSD symptoms were included. A narrative summary and a meta-analysis of the study findings are presented. Ten reports, accounting for = 569 patients with PTSD (145 on clonidine and 436 controls), were included in the final selection. There were four case reports, four observational studies, one non-blind clinical trial, and one crossover randomized controlled trial (RCT). Median clonidine dose was 0.15 mg/day (range: 0.1-0.5 mg/day). Median follow-up time was 31 days (range: 3 days to 19 months). The quality of the evidence was rated from very low to low. There was marked between-study heterogeneity and low power in the individual studies, but many reported improved sleep quality, nightmare reduction, and improvement of PTSD symptoms for patients treated with clonidine. Meta-analysis was only possible for two studies reporting the effect of clonidine on nightmares, and showed no difference from the comparator (i.e. prazosin or terazosin) (odds ratio: 1.16; 95% confidence interval: 0.66 to 2.05), potentially pointing towards non-inferiority between these medications. Future research, such as well-powered RCTs, is needed to identify the efficacy in the lower dose range and the most suitable treatment group, and to obtain good evidence on the effects of clonidine in the treatment of sleep disorders related to PTSD.
Topics: Clonidine; Humans; Stress Disorders, Post-Traumatic; Dreams; Sleep Quality; Adrenergic alpha-2 Receptor Agonists
PubMed: 38941125
DOI: 10.1080/20008066.2024.2366049