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Chronic hypertension and acute hypertensive crisis
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
William F. Rayburn, Lauren Plante
Methyldopa was the first antihypertensive used during pregnancy and remains the most commonly prescribed central adrenergic antagonist for pregnant women. Because of its long-term safety, methyldopa is considered by many authorities to be the initial drug of choice for pregnant women with chronic hypertension and the standard by which other drugs are measured (15). Long-term follow-up evaluations of outcomes are reassuring, and studies of children exposed in utero to methyldopa reported normal mental and physical development at 71/2 years of age (16).
Cardiovascular Medications in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Beta blockers are an additional option for BP control. Although literature notes that fetal exposure to beta blockers may be associated with low birthweight, labetalol is a pregnancy class-C alpha- and beta-adrenergic antagonist that has traditionally been a first-line agent against hypertensive disorders in pregnancy. Labetalol has been shown to effectively reduce maternal BP and decrease both maternal and fetal morbidity and mortality in mild to moderate hypertension [18]. Metoprolol succinate is a beta-selective adrenergic antagonist in pregnancy class C. An open controlled trial for its use in moderate hypertension in pregnancy showed significantly better BP control than placebo without increases in preterm labor or maternal and fetal complications [19]. Carvedilol is dependent on renal elimination, which can lead to greater amounts of drug excretion and thus higher doses during pregnancy given increases in GFR. Atenolol is a pregnancy class-D beta-adrenergic antagonist, which should be avoided in pregnancy, especially in the first trimester [20,21].
Recognition, treatment, and prevention of systemic allergic reactions and anaphylaxis *
Published in Richard F. Lockey, Dennis K. Ledford, Allergens and Allergen Immunotherapy, 2020
Emma Westermann-Clark, Stephen F. Kemp, Richard D. deShazo
β-Adrenergic antagonists (β-blockers) are used to treat cardiovascular disease, arrhythmias, hypertension, migraine headaches, anxiety, glaucoma, and thyrotoxicosis. Numerous cases of unusually severe or refractory anaphylaxis are reported in patients taking topical or oral β-adrenergic blockers [2]. Subjects taking β-adrenergic antagonists may be more likely to experience severe anaphylaxis characterized by paradoxical bradycardia, severe hypotension, and bronchospasm. These agents may also impede epinephrine treatment. Use of selective β1-antagonists does not eliminate the risk for anaphylaxis [2,145]. The use of glucagon in subjects on β-blockers who experience anaphylaxis was discussed earlier.
A review on pharmacological options for the treatment of erectile dysfunction: state of the art and new strategies
Published in Expert Opinion on Pharmacotherapy, 2023
Mattia Longoni, Alessandro Bertini, Nicolò Schifano, Emanuele Zaffuto, Paolo Maggio, Rossi Piercarlo, Sara Baldini, Giulio Carcano, Gabriele Antonini, Andrea Salonia, Francesco Montorsi, Federico Dehò, Paolo Capogrosso
Phentolamine is a nonselective α-adrenergic antagonist that decreases arterial resistance and promotes vasodilatation by inhibiting smooth muscle cell contraction [75]. The commercial preparation of Bimix, approved for clinical use in some European countries, contains papaverine hydrochloride (15 mg/mL) and phentolamine mesylate (0.5 mg/mL) in 2-mL vials [61]. The combination of these two drugs has shown the same efficacy and equal rate of prolonged erection compared to PGE1 30 μg alone, whereas it caused significantly less injection pain (15% vs 35%, p < 0.05) [76]. The addition of alprostadil (Trimix) provides the highest efficacy rates, reaching up to 92% [77,78]. This three-drug combination has similar adverse effects as alprostadil monotherapy, although fibrosis is more common when a higher dose of papaverine is used (5–10%) [77]. Noteworthy, hypotension could potentially occur with higher concentrations of the compounds [53]. In a randomized clinical trial, the combination of papaverine 17.64 mg + phentolamine 0.58 mg + PGE1 5.8 μg had a twofold efficacy rate compared to PGE1 40 μg monotherapy (50% vs 22%), with very low pain (12.5% vs 22%) due to the reduced dose of alprostadil being used [79]. Therefore, Trimix could be a suitable option for patients who underwent radical pelvic surgery as pain or tenderness after PGE1 is accentuated by an underlying cavernous nerve injury [53,63]. Unfortunately, no commercially marketed preparation for Trimix is available, due to the low stability of the combined agents.
Evaluation of anti-scorpion (Hottentota tamulus) venom potential of native plants extracts using mice model
Published in Toxin Reviews, 2022
Samima Asad Butt, Hafiz Muhammad Tahir, Shaukat Ali, Muniba Tariq, Ali Hassan, Muhammad Summer, Chand Raza, Shafaat Yar Khan
Different treatments such as anti-venom, prazosin, inotropic agents, atropine, vasodilators and benzodiazepines are used to treat scorpion sting clinically (Bouaziz et al. 2008, Boyer et al. 2009, Bawaskar and Bawaskar 2011). Prazosin is a very potent adrenergic antagonist which lowers the blood pressure and peripheral resistance by vasodilating the peripheral vessels (veins and arteries), without raising the heart rate and disturbing the functions of sympathetic nervous system (Cohen 1970, Hess 1975, Reynolds 1982, Goodman 1996).The effect of vasodilation not only has relaxant effect on blockade of post synaptic but also on the vascular smooth muscles (Arky 1996). Prazosin inhibits the cyclic nucleotide phosphodiesterases.16. The outcome of prazosin may include the rise of intracellular cyclic AMP at vascular points and cyclic GMP level at cholinergic receptor sites of heart (Hess 1975).
Current and new pharmacotherapeutic approaches for glaucoma
Published in Expert Opinion on Pharmacotherapy, 2020
Wesam Shamseldin Shalaby, Vikram Shankar, Reza Razeghinejad, L. Jay Katz
The secretion of aqueous humor and regulation of its outflow are physiologically important processes for the normal function of the eye [7]. In the healthy eye, flow of aqueous humor against resistance maintains the average IOP [7], so topical glaucoma medications lower the IOP through alteration of aqueous humor dynamics, either decreasing its production and/or enhancing its outflow. The current lineup of pharmacologic treatment options includes the following classes: alpha-adrenergic agonists, beta-adrenergic antagonists, cholinergic agonists, carbonic anhydrase inhibitors, and prostaglandin analogs. This spectrum has been expanded with the recent approval of nitric oxide donating prostaglandins [8] and rho kinase inhibitors [9] for the treatment of ocular hypertension and OAG. Although these medications added novel mechanisms of action, they did not resolve the existing issues with topical medications in terms of patient adherence, problems with administration, side effects, cost, and the need of multiple medications to reach the target IOP with lower fluctuation.