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Principles of Heart Failure Pharmacotherapy
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Erika L. Hellenbart, Stephanie Dwyer Kaluzna, Robert J. DiDomenico
Unless otherwise contraindicated, all patients with HFrEF should be prescribed an angiotensin-converting enzyme inhibitor (ACEI), an angiotensin receptor blocker (ARB), or an angiotensin receptor-neprilysin inhibitor (ARNI) in combination with a beta-blocker based on proven reductions in HF progression, morbidity, and mortality.6–10 Adjunctive guideline-directed medical therapies (GDMTs), such as mineralocorticoid receptor antagonists (MRAs) and the combination of hydralazine/isosorbide dinitrate (Hyd/ISDN), should be added for patients with persistent symptoms.6–10 In the absence of dose-limiting adverse effects, upward titration of the dose should be considered every two weeks until doses achieved in clinical trials (e.g., target doses) are reached (Table 5.1).6–10
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
A patient presumably sensitized to isosorbide dinitrate from intravenous administration may have cross-reacted to nitroglycerin, but patch tests with isosorbide dinitrate were not performed (14). In a patient with occupational allergic contact dermatitis from nitroglycerin, cross-reactivity to isosorbide dinitrate may also have occurred (21).
Cardiovascular Drugs
Published in Radhwan Nidal Al-Zidan, Drugs in Pregnancy, 2020
Risk Summary: It should be used with caution because the pregnancy experience in humans is limited and the reproduction studies in animals have shown low risk. Interestingly, isosorbide dinitrate may be beneficial in inverting the effects of increased vascular resistance to flow in the utero-placental circulation, and the generalized vasoconstriction associated with preeclampsia.
A case of immunotactoid glomerulopathy in a patient with monoclonal gammopathy of renal significance
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Victoria Campdesuner, Yeshanew Teklie, Natalia Lattanzio, Christian Lorenzo, Stephen Bell, Yorlenis Rodriguez, Ashok Sastry
Three months later, he complained of worsening fatigue and had undergone a cardiac catheterization with his cardiologist, which revealed no significant obstructive coronary artery disease. This led to a diagnosis of nonischemic cardiomyopathy with a depressed left ventricular function with an ejection fraction (EF) of 35–40%. Metoprolol succinate 25 mg daily and isosorbide dinitrate 30 mg daily were initiated. Physical exam was notable for stable, pitting edema of the lower extremities and diminished breath sounds in the right lower lung. Creatinine rose to 2.37 mg/dL with a protein/creatinine ratio of 10039.0 mg/G. Urinalysis revealed proteinuria, hematuria, and trace amounts of leukocyte esterase. Microscopic evaluation of the urine showed 1–3 hyaline casts, 75–100 red blood cells, and >100 white blood cells. Blood pressure remained stable at 132/84 mm Hg. Subsequent serum immunofixation revealed a monoclonal immunoglobulin G (IgG) lambda protein measuring 0.71 g/dL. Urine immunofixation electrophoresis confirmed the presence of a monoclonal IgG lambda protein measuring 18.7 mg/dL. The patient was scheduled for computed tomography (CT)-guided left kidney biopsy. Pathology revealed immunotactoid glomerulonephritis with IgG1-lambda deposits.
Pre-treatment serum testosterone level can be a useful factor to predict the improvement in bladder outlet obstruction by tadalafil for male patients with lower urinary tract symptoms induced by benign prostatic obstruction
Published in The Aging Male, 2020
Yoshihisa Matsukawa, Yoshie Kanada, Shun Takai, Satoshi Inoue, Tsuyoshi Majima, Yasuhito Funahashi, Masashi Kato, Tokunori Yamamoto, Momokazu Gotoh
Among the treatment-naive men with LUTS/BPH, the patients with BPO in addition to LUTS were analysed in this study. The inclusion criteria were as follows: total international prostate symptom score (IPSS) ≥ 8; IPSS-quality of life (QOL) score ≥ 3; prostate volume ≥ 25 ml as determined by transabdominal ultrasonography; age ≥ 50 years; and bladder outlet obstruction index (BOOI) >40 as determined by pressure flow study (PFS). BOOI was calculated according to the following formula: detrusor pressure at Qmax (PdetQmax) – 2 × maximum urinary flow rate (Qmax), according to the International Continence Society nomogram. Patients were excluded if they had received oral treatment with α1-blockers, anticholinergic agents, 5α-reductase inhibitors, antidepressants, anti-anxiety agents, sex hormone agents, nitroglycerine, amyl nitrite, or isosorbide dinitrate. Medical conditions for exclusion were neurogenic bladder dysfunction, bladder calculi, active urinary tract infection, severe cardiac disease, renal dysfunction (serum creatinine level ≥ 2 mg/dL), and/or hepatic dysfunction (aspartate and alanine aminotransferase concentrations more than twice the normal values). To ensure that only cancer-free patients were included, prostate biopsy was performed in all patients who had prostate-specific antigen (PSA) levels > 4 ng/mL.
Permeation-enhancing effects and mechanisms of O-acylterpineol on isosorbide dinitrate: mechanistic insights based on ATR-FTIR spectroscopy, molecular modeling, and CLSM images
Published in Drug Delivery, 2019
Yan Li, Chunyan Wang, Jian Wang, Tianzhe Chu, Linlin Zhao, Ligang Zhao
The purpose of this study was to explore the feasibility of O-acylterpineol for use as permeation enhancers, and to investigate their advantages in transdermal enhancement by comparison with Azone and NMP. Isosorbide dinitrate (ISDN) which possessed suitable physicochemical properties for transdermal delivery was selected as a model drug to evaluate the enhancing efficiency of the studied compounds (Zhao et al., 2008a,b). In the present study, with the molecular modeling, confocal laser scanning microscopy (CLSM) and attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) analysis, the alterations in the hydrophobic moieties and polar domain of SC lipid after skin treatment with different enhancers, the regulation and the underlying action mechanisms of these chemicals in the skin microstructures, including the barrier properties of SC and the conformational order of the intercellular skin lipids were respectively investigated. Finally, with in vitro skin cells and in vivo erythema models, the skin irritation and toxicity of the synthesized chemicals were also evaluated.