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Mathematical simulation of the structure of pulsed arterial pressure relations with vascular damage factors in patients with arterial hypertension
Published in Waldemar Wójcik, Sergii Pavlov, Maksat Kalimoldayev, Information Technology in Medical Diagnostics II, 2019
O.V. Vysotska, Y.G. Bespalov, A.I. Pecherska, S.M. Koval, O.M. Lytvynova, A.M. Dyvak, M. Maciejewski, A. Kalizhanova
The patients were examined in the dynamics of combined antihypertensive and hypolipidemic therapy before treatment and 1 year after it. A combination of an angiotensin II receptor antagonist, Olmesartan in a daily dose of 20–40 mg and third generation calcium antagonist of prolonged action Lercanidipine in a daily dose of 10–20 mg with addition (if the target arterial pressure levels (AP) less than 140 and 90 mmHg were not reached) of the third drug – a highly selective beta-adrenoblocker with vasodilating activity Nebivolol in a daily dose of 5 mg, was used as antihypertensive therapy. Hypolipidemic therapy was performed with Atorvastatin at a daily dose of 20 mg. Drug therapy was administered against a background of recommendations on hypocaloric diet with restriction of easily digestible carbohydrates, as well as saturated fats and purines.
Case 88: Headache and Jaw Pain
Published in Layne Kerry, Janice Rymer, 100 Diagnostic Dilemmas in Clinical Medicine, 2017
A 68-year-old man presented to the emergency department complaining of a 2-day history of gradual-onset generalised headache, which he had never had before. It was described as a ‘strong pressure’ over the entire head and he said it felt ‘as though my head will explode’. The pain initially developed following a long spell outdoors in the cold weather. There were no exacerbating or relieving features. The headache was associated with left-sided facial numbness and tingling around the mandible. He complained that the left side of the face felt ‘congested’ and was tender to touch. He denied scalp tenderness but did have some jaw pain when he chewed food. His past medical history included lung adenocarcinoma, which was diagnosed 6 years ago and treated (with curative intent) with a lobectomy. His history also included rheumatoid arthritis, which was diagnosed 30 years ago and was previously managed with methotrexate. This had been well controlled until recent weeks when he had noted morning stiffness and widespread joint pain. He used a long-acting tiotropium inhaler and took 10 mg lercanidipine once daily. He was a retired welder and lived with his female partner. He stopped smoking 6 years ago and had an 80 pack year history. He drank 8 units of alcohol per week.
Angiotensin axis antagonists increase the incidence of haemodynamic instability in dihydropyridine calcium channel blocker poisoning
Published in Clinical Toxicology, 2021
Jessica Huang, Nicholas A. Buckley, Katherine Z. Isoardi, Angela L. Chiew, Geoffrey K. Isbister, Rose Cairns, Jared A. Brown, Betty S. Chan
Dihydropyridine calcium channel blockers (CCBs) such as amlodipine, felodipine, lercanidipine and nifedipine are used as first-line treatment for essential hypertension [1]. In 2015, amlodipine was the fourth most commonly dispensed medication in Australia and the second most commonly prescribed antihypertensive medication by defined daily dose per day [2]. Dihydropyridine CCBs are perceived to be safer at therapeutic doses than non-dihydropyridine CCBs, such as verapamil and diltiazem, as they have more vascular selectivity and less negative chronotropy and inotropy [3]. Despite this, amlodipine is the leading contributor to cardiovascular drug related poisoning deaths (31.5%) in the USA [4]. Dihydropyridine overdose involves a loss of vascular selectivity [5,6] and a decrease in systemic vascular resistance to cause haemodynamic instability with hypotension and reflex tachycardia [7]. This may lead to vasodilatory shock [8,9].
COVID-19: a novel menace for the practice of nephrology and how to manage it with minor devastation?
Published in Renal Failure, 2020
Sena Ulu, Ozkan Gungor, Ebru Gok Oguz, Nuri Baris Hasbal, Didem Turgut, Mustafa Arici
Answer: There is limited data about the pharmacokinetics of antivirals (atazanavir, lopinavir/ritonavir, remdesivir, favipiravir, chloroquine, hydroxychloroquine, nitazoxanide, ribavarin, tocilizumab) used in the COVID-19. Concerns may be the followings [32]:ACEIs: Benazepril increases the level of atazanavir, and antiviral drug level monitoring is recommended. Fosinopril may increase the level of lopinavir/ritonavir, but blood level monitoring is not necessary.ARBs: Valsartan increases the level of atazanavir and lopinavir/ritonavir and should be used carefully. Irbesartan and losartan reduce the level of lopinavir/ritonavir slightly.Diuretics: Indapamide increases the blood level of atazanavir and lopinavir/ritonavir; close drug level monitoring is required for concomitant use.Calcium channel blockers: Concomitant use of lercanidipine with atazanavir or lopinavir/ritonavir is contraindicated. Other calcium channel blockers also interact with atazanavir, lopinavir/ritonavir, level monitoring is recommended.
Risk factors for potential drug–drug interactions in patients with myasthenia gravis
Published in Neurological Research, 2021
Dejan Z. Aleksić, Miloš N. Milosavljević, Srđan M. Stefanović, Andriana Bukonjić, Jovana Z. Milosavljević, Slobodan M. Janković, Ivo Božović, Stojan Perić, Dragana Lavrnić
The indication for thymectomy in our study was significantly related to the number of severe pDDIs that among others, involved second-line drugs for MG treatment, such as cyclosporine and azathioprine, with cardiovascular medicines. There is a body of evidence confirming potentially serious consequences of these interactions in terms of major toxicity of both cyclosporine and lercanidipine when combined [30] or anemia and severe leucopenia after concomitant use of azathioprine and angiotensin converting enzyme inhibitors [31–33]. Such combinations should be always avoided regardless of the type of disease being treated.