Pharmacology and clinical pharmacology of organic nitrates

Abstract

Current concepts and future aspects of pharmacological interventions in the treatment of coronary heart disease have been compiled. Especially new insights in the pathophysiology of coronary heart disease e.g. the dynamic pathology of coronary atherosclerosis, possible role of endothelin in vasospasm, as well as new pharmacodynamic and pharmacokinetic aspects of organic nitrates are discussed. Also the role of sympathetic nervous system as a pivotal question in pathophysiology and clinical pharmacology in the treatment of angina pectoris has been considered.

Autonomic dysreflexia after spinal cord injury: Systemic pathophysiology and methods of management

“…For acute episodes of AD, it is recommended to apply 2% nitroglycerin paste onto the skin above the level of SCI (Braddom et al, 1991). Vasodilation and subsequent reduction of blood pressure occurs rapidly after transdermal application and the paste can be wiped off once the therapeutic effect has been achieved (Grobecker, 1990). Moreover, a variety of oral and transdermal patch preparations are available and easy for patients and caregivers to administer.…”

Foundations of Pharmacotherapy for Heart Failure With Reduced Ejection Fraction

“…The mechanism of the vasodilatory action of ISDN is mediated primarily through the production of intracellular nitric oxide. 6 Enalapril was associated with a 40% reduction in all-cause mortality at 6 mo compared with placebo (26% vs 44%, respectively; P = .002) and 31% at 1 y (36% vs 50%, respectively; P = .001). to 26%; P = .12), 37% reduction in the development of heart failure (95% CI, 28%Y44%; P < .001), 20% reduction in mortality or heart failure hospitalization (95% CI, 9%Y30%; P < .001), 36% reduction in first heart failure hospitalization (95% CI, 22%Y46%; P < .001), and 29% reduction in all-cause mortality or development of heart failure (95% CI, 21%Y36%; P < .0001 Nitric oxide is an important physiologic mediator that plays a role in maintenance of vascular tone, myocardial hypertrophy, and remodeling.…”

“…Protein kinase G phosphorylates cellular proteins, which results in decreased calcium entry into smooth muscle cells, reduction of vascular smooth muscle cell free calcium, and changes in contractile proteins, resulting in vasorelaxation. 6,7 Patients with HF have elevated levels of reactive oxygen species, which in turn can lower levels of beneficial nitric oxide. 6,7 When NO combines with reactive oxygen radical, a toxic free radical is formed, peroxynitrite, which can induce myocyte apoptosis, cause DNA damage, and increase cell necrosis.…”

“…6,7 Patients with HF have elevated levels of reactive oxygen species, which in turn can lower levels of beneficial nitric oxide. 6,7 When NO combines with reactive oxygen radical, a toxic free radical is formed, peroxynitrite, which can induce myocyte apoptosis, cause DNA damage, and increase cell necrosis. Hydralazine is a potent antioxidant.…”

Disreflexia autonómica: conceptos esenciales desde la medicina física y la rehabilitación

“…Existen recomendaciones de aplicar pasta de nitroglicerina al 2% sobre la piel por encima del nivel de la lesión medular. La vasodilatación y la subsiguiente reducción de la presión arterial ocurren rápidamente después de la aplicación transdérmica y el fármaco se puede limpiar una vez que se logra el efecto terapéutico 18 . Además, se han descrito preparaciones en parches transdérmicos las cuales son fáciles de administrar.…”