Ethnic Factors in Hypertension
Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei in Manual of Hypertension of the European Society of Hypertension, 2019
In blacks, thiazide-type diuretics and calcium channel blockers are more effective in lowering BP when given as monotherapy or as initial agents in multidrug regimens (41). In addition, thiazide-type agents are superior to drugs that inhibit the renin-angiotensin system (i.e. angiotensin converting enzyme [ACE] inhibitors, angiotensin-receptor blockers [ARBs], renin inhibitors, and beta-blockers) for prevention of selected clinical outcomes in blacks (42). The calcium antagonist amlodipine is as effective as chlorthalidone and more effective than the ACE inhibitor lisinopril in reducing BP, CV disease and stroke events but less effective in preventing heart failure (43). Blacks have a greater risk of angioedema with ACE inhibitors (43), and Asian Americans have a higher incidence of ACE inhibitor – induced cough (44). ACE inhibitors and ARBs are recommended more generally as components of multidrug antihypertensive regimens in blacks with CKD (9), with the addition of beta-blockers in those with heart failure (9). Beta-blockers are recommended for treatment of patients with coronary heart disease who have had a myocardial infarction. Most patients with hypertension, especially blacks, require ≥2 antihypertensive medications to achieve adequate BP control. A single-tablet combination that includes either a diuretic or a calcium antagonist may be particularly effective in achieving BP control in blacks. Racial and ethnic differences should not be the basis for excluding any class of antihypertensive agent in combination therapy (9).
Drug therapy problems in pediatric and geriatric patients at Farmasi Airlangga Pharmacy
Elida Zairina, Junaidi Khotib, Chrismawan Ardianto, Syed Azhar Syed Sulaiman, Charles D. Sands, Timothy E. Welty in Unity in Diversity and the Standardisation of Clinical Pharmacy Services, 2017
Table 3 lists the 10 most prescribed drugs for pediatric and geriatric patients. Drugs that were most commonly prescribed for pediatric patients were medications to treat many health disorders that occur in children, such as cough, fever, and cold, whereas the most commonly prescribed drugs for geriatric patients were antihypertensive drugs of Ca channel blocker. The National Institute for Health and Clinical Excellence (NICE) guidelines state that, for patients aged ≥ 55, the treatment of choice is a Ca channel blocker (NICE 2011). In addition, the number of amlodipine prescribed was in accordance with the number of health problems experienced by the respondents, namely hypertension. The second most prescribed drugs were neurotrophic vitamins, consisting of vitamins B1, B6, and B12. Neurotrophic vitamins serve to maintain and normalize nerve function by repairing nerve cell metabolism disorders and providing the necessary intake enabling the nerves to work well. Therefore, the drugs serve their functions appropriately when administered to the elderly (PERDOSSI 2013).
Renal problem
Anne Stephenson, Martin Mueller, John Grabinar, Janice Rymer in 100 Cases in General Practice, 2017
A 68-year-old Afro-Caribbean man attends the surgery for a routine appointment. He holds a letter from the surgery asking him to return for a follow-up appointment because of abnormalities found in his blood test: ‘I have been so worried doctor. When I got this letter I phoned up and asked the receptionist about the results. She talked with the nurse who said that my kidney function tests are abnormal and that I have got Stage 3 chronic kidney disease (CKD). My mother had to have dialysis for kidney disease and she died from it so quickly’. The general practitioner checks the history. ‘I can see that we arranged a blood test as part of routine monitoring of your blood pressure treatment. According to my records, your blood pressure has been well-controlled by your amlodipine tablets over the last year. All your blood pressure readings have been below the target value of 135/80 mmHg’. Checking the prescription record, he finds that the patient had ordered and collected his prescription for amlodipine regularly at 8-week intervals. ‘My records show that your high blood pressure was detected 15 years ago. I can't find any other recorded past medical problems. Is that correct? Good. My records also show that you have a family history of diabetes. It says your mother suffered from it. Did she have high blood pressure as well? I can't find any abnormal results looking through your previous blood tests. Your kidney function has always been within normal limits. However, the specialists have developed a way of combining your age, sex and creatinine to estimate your kidney function called the estimated glomerular filtration rate or eGFR. Your result came back as 53. Values below 60 put you at Stage 3 CKD’.
Iguratimod is effective in refractory rheumatoid arthritis patients with inadequate response to methotrexate–cyclosporin A–hydroxychloroquine–prednisone
Published in Scandinavian Journal of Rheumatology, 2018
N Zheng, C Guo, R Wu
Patients’ characteristics are shown in Table 1. At baseline, the patients had long-duration, moderate to severe disease activity with high-frequency rheumatoid factor and anti-citrullinated peptide antibody positivity. After 24 weeks on a combination of IGU with MTX-CsA-HCQ-prednisone, the RA patients showed a significant improvement in mean DAS28 score from baseline. The mean erythrocyte sedimentation rate dropped from 32.23 mm/h to 25.8 mm/h, the CRP level decreased from 15.11 mg/dL to 8.8 mg/dL, and the Health Assessment Questionnaire (HAQ) score dropped from 0.61 to 0.30, with a significant difference from baseline (p < 0.05); 18 (78%), 15 (65%), and 12 (50%) patients, respectively, met the American College of Rheumatology (ACR) ACR20, ACR50, and ACR70 response criteria (Figure 1). Three patients got remission with DAS28 < 2.6 in continued 2 months, in these patients prednisone were tapered from 7.5 mg/day to 5mg/day at weeks 14, 18, 19 respectively. No serious adverse events were reported during the 24 weeks. One patient had mild gastrointestinal symptoms with stomach ache and stopped taking IGU at week 6. One patient had mild oedema on the legs but continued throughout the study. One patient had mild hypertension which was controlled by amlodipine besylate tablets.
Amlodipine and celecoxib for treatment of hypertension and osteoarthritis pain
Published in Expert Review of Clinical Pharmacology, 2018
Fabio Angeli, Monica Trapasso, Sara Signorotti, Paolo Verdecchia, Gianpaolo Reboldi
Amlodipine is indicated for treatment of hypertension and stable angina. The recommended initial dose of amlodipine besylate is 5 mg once daily. If necessary, dose can be increased after 1–2 weeks to a maximum dose of 10 mg once daily. Following oral administration, bioavailability is 60–65% and plasma concentrations rise gradually to peak 6–8 h after administration. Amlodipine is extensively metabolized in the liver and is slowly cleared with a terminal elimination half-life of 40–50 h. Volume of distribution is large and there is a high degree of protein binding (98%). Amlodipine shows linear dose-related pharmacokinetic characteristics and, at steady-state, there are relatively small fluctuations in plasma concentrations across a dosage interval. The pharmacokinetic properties of amlodipine are not significantly influenced by renal impairment [29,31].
Directly compressible formulation of immediate release rosuvastatin calcium tablets stabilized with tribasic calcium phosphate
Published in Pharmaceutical Development and Technology, 2022
Daniel Zakowiecki, Tobias Hess, Krzysztof Cal, Barbara Mikolaszek, Grzegorz Garbacz, Dorota Haznar-Garbacz
On the other hand, properly selected excipients can protect drug substances from adverse environmental factors and enhance the stability of finished dosage forms during storage. The ways of such chemical stabilization can be different and depend on the nature of the drug substance itself. For example, oxidation of lovastatin can be inhibited by employing antioxidants such as butylated hydroxyanisole (BHA) or alpha-tocopherol. Incorporation of titanium dioxide in film coatings can stabilize nifedipine included in tablet cores (Kaufman 1990; Béchard et al. 1992; Yoshioka and Stella 2002). Regulation of the microenvironmental pH of a solid dosage form can significantly impact both chemical stability of a drug and its dissolution behavior. It has been reported that the use of acidic agents in a tablet formulation improved stability of acetylsalicylic acid. Stability and solubility of an acid-labile drug, clarithromycin, were enhanced by addition of alkalinizing agents such as magnesium oxide or dibasic sodium phosphate (Delonca et al. 1975; Badawy and Hussain 2007; Park et al. 2015). Aforementioned amlodipine besylate is a highly hygroscopic drug, which absorbs moisture leading to its degradation. The degradation is pH dependent, faster in acidic and basic conditions. Various strategies to improve chemical stability of this drug were reported. Application of an anhydrous, non-hygroscopic substances having neutral pH, such as some grades of anhydrous dibasic calcium phosphate, seems to be advantageous (Lemmens et al. 2006; Singh et al. 2006).
Related Knowledge Centers
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