Nitrates and Nitrate Tolerance in Angina Pectoris

ISBN-13: 9783642853258 / Angielski / Miękka / 2011 / 172 str.

M. Kaltenbach; G. Kober

Opis

Although nitroglycerin is one of the oldest drugs in cardiology the problem of tolerance is a scientific challenge of today. The proceedings of this symposium highlight the most re- cent questions related to this topic. Apparently, partial tolerance, or rather partial decrease in sensitivity, can arise during nitrate therapy. Probably this is the consequence of a partial readjustment of the vascular system. This readjustment refers particularly to the arterial system, i.e., to the hypoten- sive effect of nitrates in the standing position. A similar effect on the venous side is not present. On the other hand, the results assembled in this volume confirm the experience of many decades that long-term antianginal therapy with nitrates remains effective even when high doses are applied. Thus partial tolerance which also occurs after other vasodilators such as prazosin, does not imply tolerance against antianginal effectiveness. From the information available to- day it is reasonable to treat patients with angina pectoris acutely as well as chronically with nitrates in individually adjusted doses. Frankfurt, November 1982 M. Kaltenbach v Contents Foreword...V Session 1-Pharmacology Tolerance from the Pharmacokinetic and Pharmacodynamic Viewpoints N. Rietbrock, A. Lassmann, B. G. Woodcock ...3 Does Tolerance Develop During Long-Acting Nitrate Therapy? A Critical Review J. Abrams ...13 Pharmacokinetics of Isosorbide Dinitrate During Tolerance Development Ho-Leung Fung ...25 Discussion ...29 ...Session II - Hemodynamics Lack of Tolerance Development to the Hemodynamic Effects of Nitrates in Patients with Chronic Congestive Heart Failure Joseph A. Franciosa ...35 Discussion ...41 ...

Spis treści

Session I — Pharmacology.- Tolerance from the Pharmacokinetic and Pharmacodynamic Viewpoints.- Does Tolerance Develop During Long-Acting Nitrate Therapy? A Critical Review.- Pharmacokinetics of Isosorbide Dinitrate During Tolerance Development.- Discussion.- Session II — Hemodynamics.- Lack of Tolerance Development to the Hemodynamic Effects of Nitrates in Patients with Chronic Congestive Heart Failure.- Discussion.- Hemodynamic Effects of 5-Isosorbide Mononitrate During Acute and Chronic Administration.- Discussion.- Investigations to Demonstrate Nitrate Tolerance in Peripheral Vessels by Means of a Simple Hemodynamic Test.- Discussion.- Hemodynamic and Ventricular Dynamic Investigations of Nitrate Tolerance.- Discussion.- Treatment of Congestive Heart Failure with Vasodilators: Comparison of Acut and Long-Term Effects of Various Agents.- Discussion.- Long-Term Isosorbide Dinitrate Therapy for Pulmonary Hypertension in Patients with Chronic Obstructive Lung Disease.- Discussion.- Development of Tolerance and Peripheral Hemodynamic Effects of Molsidomine.- Discussion.- Session III — Coronary Heart Disease.- Acute and Chronic Effects of Oral Isosorbide Dinitrate in Patients with Angina.- Discussion.- Tolerance in Patients with Coronary Heart Disease Under Chronic Treatment with Isosorbide Dinitrate?.- Discussion.- Long-Term Effects of High-Dose ISDN Therapy in Patients with Coronary Heart Disease.- Discussion.- Evaluation of Cross-Tolerance Between Long-Term Oral Isosorbide Dinitrate and Sublingual Nitroglycerin: Assesssment by Exercise Testing.- Discussion.- The Effects of Long-Acting Nitrates on Ambulatory ECG Changes in Patients with Angina Pectoris Treated for 1 Week.- Discussion.- Chronic Treatment of Ischemic Heart Disease with Isosorbide Dinitrate Retard Tablets: Evidence of Preserved Hemodynamic Response to a Sublingual Dose of 5 mg.- Discussion.