Cardiac Pharmacology Innovations
The advent of
drugs able to modulate the renin–angiotensin system , and more recently the neprilysin inhibitor sacubitril together with a RAS blocker, has improved the result of the many
cardiovascular and renal conditions. In particular, coronary failure , post-myocardial infarction, and
hypertension are the
cardiovascular clinical syndromes during which RAS inhibition (and in coronary failure , together with neprilysin inhibition) has greatly improved
morbidity and mortality. This chapter aims to provide an appraisal of RAS and neprilysin inhibitors regarding their pharmacological properties with respect to mechanism(s) of action, pharmacokinetics, monitoring, adverse effects, and drug interactions. NTG enhances myocardial oxygen delivery and reduces myocardial oxygen demand.NTG is a smooth muscle relaxant that causes vasculature dilation.2 Nitrate-mediated vasodilation occurs with or without intact vascular endothelium. Nitrites, organic nitrites, nitroso compounds, and other nitrogen oxide–containing substances(e.g., nitroprusside) enter the smooth muscle cell and are converted to reactive nitric oxide (NO) or S-nitrosothiols, which stimulate guanylate cyclase metabolism to produce cyclic guanosine monophosphate (cGMP) . A cGMP-dependent protein kinase is stimulated with resultant protein phosphorylation in the smooth muscle. This leads to a dephosphorylation of the myosin light chain and smooth muscle relaxation. Vasodilation is also associated with a reduction of intracellular calcium. Sulfhydryl (SH) groups are required for formation of NO and the stimulation of guanylate cyclase. When excessive amounts of SH groups are metabolized by prolonged exposure to NTG, vascular tolerance occurs. The addition of N-acetylcysteine, an SH donor, reverses NTG tolerance. The mechanism by which NTG compounds are uniquely better venodilators, especially at lower serum concentrations, is unknown but could also be associated with increased uptake of NTG by veins compared with arteries.
High Impact List of Articles
-
Impella-Supported Cardiac Surgery
Paolo Masiello, Generoso Mastrogiovanni, Mario Colombino, Francesco Cafarelli, Francesco Frunzo, Marco Padula, Donato Triggiani, Gerardo Del Negro, Emanuele Fiore, Severino Iesu
Research Article: Interventional Cardiology
-
Impella-Supported Cardiac Surgery
Paolo Masiello, Generoso Mastrogiovanni, Mario Colombino, Francesco Cafarelli, Francesco Frunzo, Marco Padula, Donato Triggiani, Gerardo Del Negro, Emanuele Fiore, Severino Iesu
Research Article: Interventional Cardiology
-
Outcomes following successful recanalization of chronic total coronary occlusions
GS Werner
Review Article: Interventional Cardiology
-
Outcomes following successful recanalization of chronic total coronary occlusions
GS Werner
Review Article: Interventional Cardiology
-
News in Intreventional Cardiology-1 (2011)
News and Views: Interventional Cardiology
-
News in Intreventional Cardiology-1 (2011)
News and Views: Interventional Cardiology
-
Anterograde techniques for percutaneous revascularization of chronic total coronary occlusions
AR Galassi, SD Tomasello, L Costanzo & C Tamburino
Review Article: Interventional Cardiology
-
Anterograde techniques for percutaneous revascularization of chronic total coronary occlusions
AR Galassi, SD Tomasello, L Costanzo & C Tamburino
Review Article: Interventional Cardiology
-
A new era in interventional cardiology
RS Dieter & A Nanjundappa
Foreword: Interventional Cardiology
-
A new era in interventional cardiology
RS Dieter & A Nanjundappa
Foreword: Interventional Cardiology
Relevant Topics in Clinical