Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Synthetic human and ovine corticotropin-releasing hormone (hCRH, oCRH) are commonly used as a diagnostic tool of the hypothalamo-pituitary-adrenal axis. In this paper reports about side effects after various modes of CRH-application are analyzed and compared to our corresponding data of human studies with hCRH and oCRH. Generally, CRH is well tolerated after single administration and interval-application of standard doses, although minor side effects appear sometimes after higher doses (greater than 200 micrograms hCRH, oCRH) of CRH-bolus-injections. Predominantly the cardiovascular system (e.g. tachycardia, hypotension, flushing) is affected; neuropsychological symptoms are only seen sporadically (e.g. dizziness). Long term continuous infusion (several hours) of low CRH-doses (hCRH, oCRH) are well tolerated but side effects appear (see above) when cumulated doses of 200 micrograms-300 micrograms/h are given. Standard doses of hCRH and oCRH are also well tolerated in severely ill patients; it has to be considered that higher doses may provoke marked side effects in persons with neurologic disorders, in subjects with coronary heart disease and in patients with endocrinological disorders of the pituitary-adrenal axis, especially in those subjects in whom the blood-brain-barrier may have been damaged (e.g. head injury, intracranial operation). Single hCRH- and oCRH-bolus-injections in standard doses have a very low rate of complications, "non-standard" doses should provisionally be used only in clinical studies with well designed safety-precautions.
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PMID:Safety and side effects of human and ovine corticotropin-releasing hormone administration in man. 203 13

Many general signs familiar to physicians can be found on the skin in cardiac patients. These include (a) cyanosis, central and peripheral, (b) erythremia, flushing and erythema, (c) digital clubbing and (d) alteration in texture. Specific cardiac conditions often have useful diagnostic cutaneous clues. Of these the association of coronary heart disease, hyperlipidemia and xanthomas is the most important. Rare syndromes such as the "leopard syndrome" often have distinctive skin signs. Multisystemic disorders may affect the heart and skin simultaneously or in sequence. They include collagen vascular diseases, amyloidosis, sarcoidosis and relapsing polychondritis. Finally iatrogenic disease arising from treatment of cardiac or cutaneous disease may induce changes in one or the other organ. The heart and the skin have much in common. These manifestations help elucidate the cause, evaluate the diagnosis, and follow the treatment and progress of these diseases.
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PMID:Cutaneous manifestations of cardiac diseases. 225 49

In coronary heart disease, beta-blockers are beneficial because they limit the increase in heart rate and blood pressure during exercise, and calcium antagonists are useful because they reduce myocardial oxygen demand. Many different pharmacological combinations of a beta-blocker and a calcium antagonist are possible, and beta-blockade may ameliorate reflex tachycardia induced by peripheral vasodilatation due to calcium antagonists, therefore enhancing the benefit. Studies have shown that combination therapy with propranolol and nifedipine, verapamil or diltiazem has greater antianginal efficacy based on symptomatic and objective assessment than either agent alone. A similar result has been reported for nifedipine or verapamil combined with atenolol. In combination, atenolol and nifedipine did not depress cardiac output or change the left ventricular ejection fraction (LVEF) at rest. During exercise atenolol alone resulted in a reduced LVEF response in most patients but the combination did not adversely affect left ventricular function. Nifedipine alone did not significantly change LVEF. When verapamil was combined with atenolol, resting ejection fraction fell, indicating a deterioration in cardiac function. Nifedipine and propranolol combined do not change heart rate significantly. Verapamil and atenolol both reduce resting heart rate and their combination has a greater effect; a combination of propranolol and diltiazem also reduces heart rate to a similar extent. Caution is therefore warranted when prescribing the latter 2 combinations. An increase in side effects can be expected with combination regimens compared with monotherapy; but with the nifedipine-atenolol combination the calcium antagonist can alleviate beta-blocker-induced effects by its vasodilator effect, and beta-blockers may ameliorate nifedipine-induced palpitations and flushing.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Beta-blockers and calcium antagonists in angina pectoris. The potential role of combination therapy. 289 3

Coronary angioscopy (CA) using ultrathin fiberscopes was performed in 30 patients with coronary heart disease during cardiac catheterization and in 11 patients during bypass surgery. For percutaneous CA the angioscope was introduced from the femoral artery through a 9F guiding catheter. During short-time occlusion of the coronary ostium by the tip of the guiding catheter the viewing field was flushed with Ringer's solution. Intraoperative CA was performed both by the retrograde and antegrade way during flushing with cardioplegic solution. Percutaneous CA was successful in 57% of patients. 13 patients showed eccentrically and irregularly shaped stenoses and 3 of these patients had an additional plaque rupture. In 2/5 patients CA after PTCA revealed intimal dissections not visualized by angiography. Intraoperative CA was successful in 9/11 patients. In 3 patients nonocclusive thrombi were found at the site of the coronary lesion. Additionally we studied the efficacy of angioscopic guidance during intravascular radiofrequency application. In 11/11 thrombotically occluded peripheral vessels this new method allowed a nearly complete recanalization. There was only one perforation of the vessel. We conclude, that CA is a powerful diagnostic tool providing prognostically relevant information in the diagnosis of coronary heart disease.
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PMID:[Diagnostic significance of angioscopy in patients with coronary heart disease]. 326 58

In the body the essential fatty acid (EFA) linoleic acid (18:2, omega-6) is desaturated and chain elongated to form homo-gamma-linoleic acid (20:3, omega-6) and arachidonic acid (20:4, omega-6). Apart from their structural function in cell membranes, the EFAs serve as precursors to the prostaglandins and related substances. The prostaglandins can, in general terms, be described as a defensive regulatory system of importance for cardiovascular, gastrointestinal and urogenital function. Acute intake of ethanol gives facial flushing, inhibition of platelet aggregation and elevation of tissue c-AMP. These effects are consistent with release of vasodilatory and antiaggregating PGs. In epidemiological studies, moderate ethanol intake offers some protection against coronary heart disease. Chronic intake high doses of ethanol is associated with damage to, e.g., liver, heart, brain, immunoregulation and various hormonal systems. Decreased tissue levels of 18:2, 20:4 and PGs have been observed both in animals and man. The conversion of 18:2 to 20:4 is inhibited by chronic ethanol exposure. It is suggested that ethanol depletes the PG precursor pool by a dual mechanism of releasing precursor acids and by inhibiting their synthesis. This would lead to a functional EFA-deficiency, manifested by a hypoactive PG system.
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PMID:Ethanol, essential fatty acids and prostaglandins. 641 73

Sildenafil is the first orally administered available treatment for erectile dysfunction. It produces a selective vasodilatation of corpus carvernosum, mediated by the inhibition of phosphodiesterase 5, an enzyme that degrades GMPc. Its therapeutic efficacy has been demonstrated in organic as well as psychogenic or mixed erectile dysfunction. Most of its adverse effects, such as headache, flushing, gastroesophageal reflux and color vision disturbances, are related to the mechanism of action. Its interactions with other medications, can have severe adverse consequences. The concomitant use of sildenafil with drugs that release nitric oxide in their molecule, can produce severe hypotension. In patients with coronary heart disease or cardiac failure, this interaction can cause death. Sildenafil is metabolized in the liver through cytochrome P-450. This enzymatic system can be inhibited by cimetidine, ketoconazole or erythromycin. These drugs can increase plasma concentrations of sildenafil. We must identify the groups of patients that will have a better response to the drug and those in whom the drug will be useless. We must also know more about the security profile of the drug. With time, we will know the real role of sildenafil in the treatment of erectile dysfunction.
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PMID:[Sildenafil (viagra) at the time of warnings]. 1034 69

Advicor (lovastatin and extended-release niacin) is the first cholesterol-lowering combination product to become available for the management of hyperlipidemia. Lovastatin significantly lowers low-density lipoprotein cholesterol, whereas niacin significantly lowers triglycerides and lipoprotein (a) and markedly increases high-density lipoprotein cholesterol. These effects are ideal for managing a variety of lipid disorders, including metabolic syndrome. Lovastatin and niacin reduce coronary heart disease mortality in primary and secondary prevention patients, respectively. The extended-release niacin component uses a unique technology to minimize adverse effects (e.g., flushing and hepatotoxicity) while retaining the same lipid-altering effects as immediate-release niacin. The combination product appears to be well tolerated, with discontinuation due to adverse effects other than flushing occurring in a similar percent of patients as for lovastatin in clinical trials. Approximately 9% of patients discontinued the combination product due to flush. No confined cases of myopathy or hepatotoxicity have been reported with this product. Once-daily dosing provides ease of administration that should improve compliance and result in a greater proportion of patients meeting their low-density lipoprotein cholesterol goals. The nomenclature surrounding niacin products used to treat dyslipidemias is confusing. While only two types of niacin formulations exist (immediate-release formulations and formulations which dissolve more slowly than immediate-release formulations), government regulations allow for slowly dissolved niacin formulations to be divided into two types of niacin products; those that are available over-the-counter (OTC) and those that are available by prescription only. Over-the-counter slowly dissolved niacin preparations are not classified as OTC per se, but are considered "nutritional supplements". For this reason, they fall under the jurisdiction of the Federal Trade Commission and do not fall under the umbrella of the FDA branch that controls dyslipidemic products (Endocrine and Metabolic Division of the Center for Drug Evaluation and Research). The slowly dissolved niacin nutritional supplements have not been reviewed by the FDA for safety nor efficacy in the treatment of dyslipidemia nor are they required to meet generic drug rules (even though various brands are available). These brands are described on their labels as "sustained-release", "timed-release", and "slow-release" for example. Only two slowly absorbed niacin products have been approved by the FDA for the treatment of dyslipidemia; they are Niaspan (Kos Pharmaceuticals, Inc., Miami, FL) and Advicor (Kos Pharmaceuticals, Inc., Miami, FL). The term "extended-release" has been given to these two products to simplify the terminology and differentiate the products from immediate-release niacin. In this review, we will use "extended-release" to refer to the FDA approved slowly dissolving niacin preparation and "sustained-release" to refer to the nutritional supplements (not FDA approved).
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PMID:Lovastatin and extended-release niacin combination product: the first drug combination for the management of hyperlipidemia. 1197 44

Elevated blood pressure is a risk factor for a variety of cardiovascular disorders, including coronary heart disease, peripheral vascular disease, cardiac failure and cerebrovascular disease. The prevailing view is that an elevated systolic rather than diastolic blood pressure is the major contributor in mortality and morbidity attributed to cardiovascular disorders. Isolated high systolic blood pressure, especially in the elderly, is a major risk factor and should undoubtedly be a target for drug treatment. In the general population, systolic and diastolic blood pressure are highly correlated, and thus it is difficult to dissociate the effects of these two components of the blood pressure and specifically ascribe cardiovascular risk factors to just elevated systolic blood pressure. Therefore, the goal in therapy of an individual with hypertension must be to reduce elevated systolic and diastolic blood pressure in order to reduce mortality and morbidity. ACE and neutral peptidase inhibitors are a new class of drugs that may be beneficial in the treatment of patients with hypertension and heart failure. They may also be useful in the treatment of diabetic patients with hypertension and/or heart failure. Drugs of this class are dual inhibitors of ACE and neutral endopeptidase, and are capable of affecting vascular tone and fluid balance. They are capable of producing vasodilatation by virtue of inhibiting the production of angiotensin II, degradation of natriuretic peptides and bradykinin. They also appear to promote natriuresis and diuresis by amplifying the actions of natriuretic peptidase and reducing aldosterone effects. In addition, they should also attenuate trophogenic actions of the renin angiotensin system and the sympathetic nervous system. Omapatrilat is one drug that appears to be at the advanced stages of clinical development. This drug has been shown to be quite effective in the treatment of hypertension. Evidence also seems to indicate that treatment with omapatrilat results in a higher tendency towards preventing death and worsening heart failure when compared with treatment with a pure ACE inhibitor in patients with advanced heart failure. Overall safety with omapatrilat appears to be good, but like other ACE inhibitors the incidence of cough is higher when compared with placebo. Other common adverse effects noted are headaches, facial flushing/warm sensation, dizziness, nausea and dyspnoea. Of greater concern is the occurrence of angio-oedema, the true incidence of which remains to be fully established as part of the published medical literature.
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PMID:Dual ACE and neutral endopeptidase inhibitors: novel therapy for patients with cardiovascular disorders. 1501 94

Asian Indian dyslipidemia is characterized by: borderline high low-density lipoprotein (LDL) cholesterol and apolipoprotein (apo) B; high triglycerides, low high-density lipoprotein (HDL) cholesterol and apoA1; and high lipoprotein(a) (lp[a]). We performed a controlled multicentric trial in India to evaluate the efficacy and safety of a fixed dose combination of lovastatin and niacin extended release (niacin(ER)) formulation in patients with moderate to severe dyslipidemia. Consecutive subjects that satisfied the selection criteria, agreed to an informed consent, and with no baseline presence of liver/renal disease or heart failure were enrolled in the study. After a 4-week run-in period there were 142 patients with LDL levels > or = 130 mg/dL. Eleven patients were excluded because of uncontrolled hyperglycemia and 131 patients were recruited. After baseline evaluation of clinical and biochemical parameters all subjects were administered lovastatin (20 mg) and niacin(ER) (500 mg) combination once daily. Dose escalation was done on basis of lipid parameters at 8 weeks and in 11 patients increased to lovastatin (20 mg) and niacin(ER) (1000 mg). An intention-to-treat analysis was performed and data was analyzed using nonparametric Wilcoxon signed rank test. Thirteen patients (10%) were lost to follow-up and 4 (3%) withdrew because of dermatological adverse effects: flushing, pruritus, and rash. The mean values of various lipid parameters (mg/dL) at baseline, and at weeks 4, 12, and 24 respectively were: total cholesterol 233.9 +/- 27, 206.3 +/- 27, 189.8 +/- 31, and 174.9 +/- 27 mg/dL; LDL cholesterol 153.4 +/- 22, 127.3 +/- 21, 109.2 +/- 27, and 95.1 +/- 23 mg/dL; triglycerides 171.1 +/- 72, 159.5 +/- 75, 149.2 +/- 45, and 135.2 +/- 40 mg/dL; HDL cholesterol 45.6 +/- 7, 48.9 +/- 7, 51.6 +/- 9, and 53.9 +/- 10 mg/dL; lp(a) 48.5 +/- 26, 40.1 +/- 21, 35.4 +/- 21, and 26.9 +/- 19 mg/dL; and apoA1/apoB ratio 0.96 +/- 0.7, 1.04 +/- 0.4, 1.17 +/- 0.5, and 1.45 +/- 0.5 (p < 0.01). The percentage of decline in various lipids at 4, 12, and 24 weeks was: total cholesterol 11.8%, 18.8%, and 25.2%; LDL cholesterol 17.0%, 28.8%, and 38.0%; triglyceride 6.8%, 12.8%, and 21.0%; lp(a) 17.5%, 26.9%, and 44.5% respectively (p < 0.01). HDL cholesterol and apoA1/apoB increased by 7.2%, 13.1%, and 18.2%; and 7.9%, 21.9%, and 51.6% respectively (p < 0.01). Target LDL levels (< 100 mg/dL in subjects with manifest coronary heart disease or diabetes; < 130 mg/dL in subjects with > 2 risk factors) were achieved in 92 (80.7%) patients. No significant changes were observed in systolic or diastolic blood pressure, blood creatinine, transaminases, or creatine kinase. A fixed dose combination of lovastatin and niacin(ER) significantly improved cholesterol lipoprotein lipids as well as lp(a) and apoA1/apoB levels in Asian Indian dyslipidemic patients. Satisfactory safety and tolerability profile in this population was also demonstrated.
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PMID:Evaluation of efficacy and safety of fixed dose lovastatin and niacin(ER) combination in asian Indian dyslipidemic patients: a multicentric study. 1731 73

Secondary prevention in patients with coronary heart disease includes treatment with platelet inhibitors, beta-blockers, ACE inhibitors or AT (1)-blockers, and statins. Initiation of therapy generally does not require a slow gradual dose increase. In treatment naive patients with acute coronary syndromes, administration of a loading dose of aspirin and/or clopidogrel is recommended. To reduce flushing, nicotinic acid should be initiated at low stepwise increasing dosages. beta-blocker therapy should not be stopped acutely in coronary heart disease patients. If beta-blocker therapy has to be terminated, blood pressure should be monitored closely and, if necessary controlled with other medication. Termination of statin therapy in the acute phase after strokes or acute coronary syndromes is associated with increased cardiovascular events and should therefore be avoided.
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PMID:[Coronary heart disease and dyslipdemia - dosing recommendations at beginning and end of treatment]. 1882 18


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