Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Oxprenolol is a nonselective beta-adrenergic blocking agent that also possesses intrinsic sympathomimetic activity (ISA) and membrane stabilizing effects. Oxprenolol undergoes first pass metabolism with only 30% of an oral dose reaching the systemic circulation. The drug is approximately 80% protein bound and is eliminated primarily by glucuronidation in the liver. Less than 4% of oxprenolol is excreted unchanged in the urine. Oxprenolol may reduce the heart rate and prolong the effective and functional atrioventricular nodal refractory period. Oxprenolol has less negative inotropic and chronotropic effects than propranolol. Plasma renin activity is reduced; however, changes in plasma aldosterone level are not significant. Long term metabolic effects require further study. Oxprenolol appears to be comparable to other beta blockers in the treatment of hypertension and angina pectoris with no additional adverse reactions. If its partial agonist effect proves useful, it may have an advantage over other agents in treating patients with borderline cardiac reserve. Because of limited data, the use of oxprenolol for the treatment of arrhythmias, migraine, thyrotoxicosis, anxiety, and glaucoma cannot be recommended at this time.
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PMID:Oxprenolol hydrochloride: pharmacology, pharmacokinetics, adverse effects and clinical efficacy. 634 36

Diltiazem, nifedipine, and verapamil inhibit calcium entry into cells via different mechanisms with different pharmacologies. They display different relative effects on different cardiovascular functions, a complex interplay of direct actions and adrenergic reflexes. Peripheral arterial vasorelaxation causes adrenergic reflex activity which opposes their direct negative chronotropic, dromotropic, inotropic, and hypotensive actions. Verapamil's most potent activity is electrophysiologic, and nifedipine's effects are hemodynamic; diltiazem acts like a less-potent combination of verapamil and nifedipine. All three drugs are efficacious in angina. These three drugs may not be interchangeable in all patients, but individualization of therapy is possible. Future indications for calcium channel blocker therapy may include hypertrophic cardiomyopathy, cerebral vasospasm, migraine headaches, pulmonary hypertension, asthma, esophageal spasm, intestinal ischemia, Raynaud's phenomenon, dysmenorrhea, and premature labor.
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PMID:Calcium channel blockers in emergency medicine. 638 Mar 52

Angiographic, clinical, and five-year follow-up study of 20 cases of myocardial infarction with normal coronary angiograms (MI-NCA) and 20 cases of myocardial infarction with single vessel obstruction (MI-SVO) are presented. MI-SVO patients differed from MI-NCA in being older (53.7 vs 44.5 years, p = 0.025), predominantly male (90 percent vs 40 percent, p = 0.001), frequently having large left ventricular akinetic segments (50 percent vs 15 percent, p = 0.01), and frequently having antecedent typical angina (55 percent). MI-NCA was more frequently associated with definite mitral valve prolapse (25 percent vs 10 percent, NS); migraine, or Raynaud's phenomenon (45 percent vs 5 percent, p = 0.001); birth control pill ingestion in women (33 percent vs 0 percent, p = 0.05); paroxysmal atrial flutter (25 percent vs 0 percent, p = 0.01); and antecedent atypical angina (25 percent). Frequency of cigarette smoking and hypertension and the mean serum cholesterol levels were similar in both groups. On follow-up, MI-NCA patients more commonly had neurologic events (25 percent vs 5 percent, p = 0.05) and second myocardial infarction (15 percent vs 0 percent, p = 0.02), but deaths occurred infrequently in both groups. These data suggest a variety of pathophysiologic causes for MI-NCA.
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PMID:Transmural myocardial infarction with normal coronary angiograms and with single vessel coronary obstruction. Clinical-angiographic features and five-year follow-up. 682 1

The therapeutic indications for propranolol have been steadily increasing in recent years. Propranolol and other beta-adrenergic blocking agents are now generally acknowledged to be helpful in the management of hypertension, certain cardiac arrhythmias, migraine, essential tremor, angina pectoris, and most recently, immediately after myocardial infarction (Frishman, 1981; Norwegian Multicenter Study Group, 1982). Because of the myriad clinical settings in which propranolol has been found to be of benefit, the interactions of these drugs with other commonly utilized pharmacological agents is of great pragmatic interest. In this report we describe the successful concomitant clinical use of propranolol and an antidepressant drug. This finding is also of interest because of recent theories concerning the mechanism of action of antidepressant drugs. Because propranolol readily penetrates into the CNS, it blocks beta-adrenergic receptors in both the periphery and the CNS (Weiner, 1980). Much attention has been focused recently on the effects of long-term antidepressant therapy on central beta-adrenergic receptors in the brain as a possible mechanism of action of these drugs. The concurrent use of propranolol and an antidepressant drug in the patient described in this report did not attenuate the therapeutic effects of the antidepressant.
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PMID:Concurrent use of antidepressants and propranolol: case report and theoretical considerations. 683 Sep 33

In six diseases considered psychosomatic (asthma, angina pectoris, migraine, duodenal ulcer, ulcerative colitis and anorexia nervosa), two factors have been studied: social background and social mobility. For none of the first five has any influence of social status on the disease been demonstrated. This means that social learning (norms and values) does not influence the disease. The psychological conflict is rooted earlier in life, before formative learning takes place. For anorexia nervosa, on the other hand, there is a marked difference. Social status plays a significant role, especially middle-class values, those of sexuality being the most important.
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PMID:Social class and psychosomatic illness. 714 73

Verapamil 99 is a commonly prescribed medicine for treatment of hypertension, angina, and migraine headache. Toxicity with sustained-release verapamil may be prolonged, and manifest with hypotension, bradycardia, metabolic acidosis, and hyperglycemia. Currently, because of the lack of a specific antidote management of verapamil, toxicity is mainly supportive. Treatment with inotropic support, glucagon, calcium, and cardiac pacing may be effective in some cases. A review of 20 cases and a case report of sustained-release verapamil overdose are described. The authors describe a patient who ingested 24 g of slow-release verapamil. This is the largest overdose of sustained-release verapamil reported in English literature. The patient was managed aggressively with gastric lavage, inotropic support, and continuous infusion of calcium and glucagon. The patient's survival may have been due to the continuous intravenous calcium gluconate and glucagon infusion. Both of these treatment modalities should be considered in patients with moderate to severe calcium channel blocker overdose.
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PMID:Massive overdose of sustained-release verapamil: a case report and review of literature. 750 8

Calcium antagonists block calcium entry into cells, resulting in relaxation of smooth muscle and limitation of the cytotoxic effects of ischaemia in various organ systems. They are most frequently used for clinical conditions requiring vasodilatation, i.e. hypertension and Raynaud's phenomenon, and this also suggests that the most common adverse effect of these drugs for noncardiovascular indications is an unwanted decline in blood pressure. Other uses include treatment of supraventricular arrhythmias and angina. There is some evidence that these drugs retard the development of atherosclerosis. Calcium channel blockers also improve renal reperfusion and may reduce renal insufficiency due to various nephrotoxins, and are particularly useful in renal transplantation for protection against cyclosporin toxicity and post-transplant acute tubular necrosis. These drugs are also useful in pregnancy-induced hypertension and unwanted uterine contraction. Affective disorders and malignancies may be other conditions which benefit from calcium antagonist therapy. Calcium antagonists, in particular nimodipine which is most selective for the cerebral vasculature, have been approved for treating vasospasm after subarachnoid haemorrhage. They are probably also effective for treatment of migraine. Calcium channel blockers may be effective for treating acute cerebral infarction, but results of clinical trials to date have been equivocal, largely because it has been difficult to recruit patients within the short interval after the onset of stroke when these drugs would be most effective, and because of the unwanted hypotensive effect of high doses.
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PMID:New uses for calcium channel blockers. Therapeutic implications. 751 Jun 13

Sumatriptan is a potent and selective agonist at a vascular serotonin1 (5-hydroxytryptamine1; 5-HT1) receptor subtype (similar to 5-HT1D) and is used in acute treatment of migraine and cluster headache. Following administration of sumatriptan 100mg orally, relief of migraine headache (at 2 hours) was achieved in 50 to 67% of patients compared with 10 to 31% with placebo in controlled clinical trials. In a comparative study, oral administration of sumatriptan 100mg consistently achieved significantly greater response rates than a fixed combination of ergotamine 2mg plus caffeine 200mg during 3 consecutive migraine attacks (66 vs 48% for first attack). Oral sumatriptan 100mg was also more effective than aspirin 900mg plus metoclopramide 10mg orally in a similar study. In the majority of controlled clinical trials, headache relief (at 1 hour after administration) was achieved in 70 to 80% of patients with migraine receiving sumatriptan 6mg subcutaneously compared with 18 to 26% of placebo recipients. Approximately 40% of patients who initially responded to oral or subcutaneous sumatriptan experienced recurrence of their headache, usually within 24 hours, but the majority of these patients responded well to a further dose of sumatriptan. Patients with cluster headache were treated for acute attacks with sumatriptan 6mg subcutaneously or placebo in 2 crossover trials. Headache relief was achieved within 15 minutes in 74 and 75% of patients receiving sumatriptan in these studies compared with 26 and 35%, respectively, with placebo. Patients receiving sumatriptan 12mg had a similar response rate as those receiving 6mg, but the higher dose was associated with an increased incidence of adverse events. Based on extensive safety data pooled from controlled clinical trials, sumatriptan is generally well tolerated and most adverse events are transient. The most frequently reported adverse events following oral administration include nausea, vomiting, malaise, fatigue and dizziness. Injection site reactions (minor pain and redness of brief duration) occur in approximately 40% of patients receiving subcutaneous sumatriptan, although the incidence appears to be markedly reduced when patients self-administer the drug with an auto-injector. Chest symptoms (mainly tightness and pressure) occur in 3 to 5% of sumatriptan recipients, but have not been associated with myocardial ischaemia except in a few isolated cases. Sumatriptan is contraindicated in patients with ischaemic heart disease, angina pectoris including Prinzmetal (variant) angina, previous myocardial infarction and uncontrolled hypertension, but is not contraindicated in patients with migraine and asthma. Data from long term studies in acute treatment of migraine and cluster headache suggest that sumatriptan remains effective and well tolerated over several months.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Sumatriptan. A reappraisal of its pharmacology and therapeutic efficacy in the acute treatment of migraine and cluster headache. 751 61

Chest pain because of a disorder of the coronary circulation is assumed to be ischemic in nature. Irrespective of the underlying pathophysiological mechanism, it is accepted that all routes lead to myocardial ischemia in the pathway to anginal pain. The authors describe a patient with a history of vasoactive disorders including migraine, asthma, documented variant angina with prolonged episodes of chest pain, and scintigraphic evidence of inferior and posterior wall ischemia during exercise and ergonovine testing in the absence of significant underlying stenoses. Remarkably, severe retrosternal chest pain, ST segment depression in multiple leads, and relative increased uptake in the inferior and posterior walls on Tc-99m sestamibi tomographic images developed during pharmacologic coronary vasodilatation with dipyridamole, leading the authors to speculate as to the possible existence of a nonischemic chest pain syndrome caused by coronary vasodilatation either in association with variant angina or as a separate entity.
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PMID:Is cardiac migraine a clinical entity? 762 41

A 75 year-old man with a well known opioid abuse is described. Within the last 10 years the patient had 161 acute admissions to hospital--in total 942 in-hospital days. The diagnoses were either angina pectoris, low back pain or migraine. With time, the patient had become very skilled in mimicking these three diseases, knowing all subjective and objective signs even better than most of his doctors. In connection with all admissions he received the opioids he wanted. Nevertheless, he was astonished that it was so easy to fool the doctors. It is recommended that the patients' own doctor should be the coordinator and the only person responsible for prescription of opioids to these patients. In case of admissions to hospital, this should only be possible to a few selected departments who know the patient.
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PMID:[Abuse--of hospital services too]. 764 15


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