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Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Angiotensin II receptor blockers (ARBs) are a new class of ACE inhibitors used to treat hypertension. The ARBs include: valsartan, losartan, telmisartan, candesartan, omlesartan, tasosartan, and eprosartan. Based upon case reports, the ARBs have a collection of fetal complications strikingly similar to the ACE inhibitor fetopathy. The risk of congenital anomalies following use during the first trimester is unknown, but use during the second and third trimesters is associated with a significant risk of fetal-neonatal complications. The complications include oligohydramnios, fetal/neonatal renal failure, and decreased calcification of the cranium (Friedman and Polifka, 2006).
Hypertensive Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
There are significant risks associated with hypertension and pre-eclampsia in pregnancy. All women should be counseled appropriately regarding the possible complications and preventive and management strategies for hypertensive disorders in pregnancy. ACE inhibitors and angiotensin type II (AII) receptor antagonists should be discontinued. Some beta-blockers need to be replaced. A complete evaluation and workup, as described earlier, should be done, especially if she has a several-year history of hypertension and/or hypertension never fully evaluated. Modifiable associated factors should be identified and treated. Baseline tests can also be obtained for later comparison. Abnormalities should be addressed and managed appropriately (see specific chapters). If, for example, serum creatinine (Cr) is >1.4 mg/dL, the woman should be aware of increased risks in pregnancy (pregnancy/fetal loss, reduced birth weight, preterm delivery, and accelerated deterioration of maternal renal disease). Even mild renal disease (Cr = 1.1–1.4 mg/dL) with uncontrolled HTN is associated with 10 times higher risk of fetal loss (see Chap. 17).
Primary hyperaldosteronism
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Vivek Alaigh, Amanda Fernandes
Pregnancy is associated with significant physiologic changes in the cardiovascular system to meet the increasing metabolic demands of the mother and fetus.5 The renin-angiotensin-aldosterone system (RAAS) plays a key role in meeting these demands. RAAS activation starts around 6–8 weeks into pregnancy and peaks around 28–30 weeks.
Targeting of radio-enhancing drugs
Published in International Journal of Radiation Biology, 2022
Nanoparticles (1–100 nm diameter) have been demonstrated to have an important role in the selective treatment of cancer because of the nature of the tumor vasculature which allows the passage of particles too large to pass through the walls of normal blood vessels. This characteristic of tumor blood vessels, referred to as the EPR effect, allows molecules (typically liposomes, nanoparticles, and macromolecular drugs) to readily move through the walls of tumor blood vessels and to accumulate in tumor tissue while being excluded from normal tissues. Newly formed tumor vessels are frequently abnormal in form and architecture, with gaps between poorly aligned, defective endothelial cells, and a wider than normal lumen. These vessels lack a smooth muscle layer and innervation and have impaired functional receptors for angiotensin II. (Angiotensin is a peptide hormone that causes vasoconstriction and an increase in blood pressure. It is part of the renin–angiotensin system, which regulates blood pressure).
Effect of Soluplus® on γ-cyclodextrin solubilization of irbesartan and candesartan and their nanoaggregates formation
Published in Pharmaceutical Development and Technology, 2022
Hay Man Saung Hnin Soe, Suppakan Sripetch, Thorsteinn Loftsson, Einar Stefánsson, Phatsawee Jansook
Hypertension is a common disorder in adults and is one of the leading global risks for mortality in worldwide. Angiotensin II receptor blockers (ARBs) represent the most recent class of antihypertensive agents, which have a mechanism of action by inhibiting angiotensin II type 1 (AT1) at the receptor level and are an effective agent with excellent tolerability profiles (Barreras and Gurk-Turner 2003). At present, eight commercially available ARBs have variable clinical efficacy when used for treating hypertension (See 2001; Abraham et al. 2015). Candesartan cilexetil (CAC) and irbesartan (IRB) block the AT1 receptor with noncompetitive antagonism. In comparison with IRB, CAC has a higher affinity for the AT1 receptor (Oparil 2000). In ophthalmology, the primary mechanism of action of ARBs is selectively blocking the binding of angiotensin II to the angiotensin I receptor, thereby decreasing aqueous humor production and reducing intraocular pressure (IOP) (Van Haeringen 1996). Currently, there has been published evidence that the topical eye drop formulations containing IRB and CAC exhibited IOP-lowering effects and antiglaucoma activity in rabbits (Lorenzo-Soler et al. 2021). Both IRB and CAC belong to the class II Biopharmaceutic Classification System, which means that both drugs have low aqueous solubility and high permeability to lipophilic membranes. The bioavailability of these drugs may be hampered by their limited aqueous solubility.
Vitamin D and immuno-pathology of COVID-19: many interactions but uncertain therapeutic benefits
Published in Expert Review of Anti-infective Therapy, 2021
Anindita Banerjee, Upasana Ganguly, Sarama Saha, Suddhachitta Chakrabarti, Reena V Saini, Ravindra K Rawal, Luciano Saso, Sasanka Chakrabarti
The renin–angiotensin–aldosterone system or RAAS regulates the physiology of fluid and electrolyte retention, blood flow, and blood pressure. ACE2 degrades angiotensin II to angiotensin (1–7) and thereby prevents the excessive effects of angiotensin II such as vasoconstriction, sodium and water retention, cardiomyocyte hypertrophy and cardiac fibrosis, lung inflammation, pulmonary edema, and pulmonary hypertension [22,28]. Besides, angiotensin (1-7) derived from angiotensin II has vasodilatory, anti-inflammatory, and various cardio-protective functions mediated through Mas receptors and other mechanisms [22,28,76,77]. Functional dysregulation of RAS accompanied by enhanced ACE/Angiotensin II expression (mRNA and protein) levels in lung tissue and reduced levels of ACE2 and angiotensin (1–7) in serum and lungs has been reported to contribute to ischemia-reperfusion-induced Acute Lung Injury (ALI) in mice [78]. In LPS induced acute lung injury (ALI) the role of angiotensin II acting through its receptor angiotensin II receptor type I (AT1) has been confirmed in multiple studies [79,80].