Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The causes of Datura intoxication include medication overdose, misuse of edible vegetables, deliberate abuse as a hallucinogen, homicidal or robbery and accidental intoxication from contaminated food. We report an incident of 14 people with Datura intoxication caused by ingesting wild Datura suaveolans for food. The incubation period was 15 to 30 min. The symptoms/signs were dizziness, dry mouth, flushed skin, palpitation, nausea, drowsiness, tachycardia, blurred vision, mydriasis, hyperthermia, disorientation, vomiting, agitation, delirium, urine retention, hypertension and coma. Three patients were hospitalized for 2-3 days. Thirteen persons received supportive fluid therapy. One patient did not receive medical therapy, he induced vomiting and drank a lot of water. Four patients presented with delirium/coma and 3 received physostigmine therapy with good response. One patient was intubated because of coma and respiratory depression. Three persons needed Foley catheterization for urine retention or coma status. One patient had a complication of urinary tract infection and antibiotic management. All patients recovered with no sequelae.
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PMID:Poisoning by Datura leaves used as edible wild vegetables. 1043 80

Centrally acting antihypertensive drugs, or sympatholytics, (reserpine, methyldopa and clonidine) have a long history of efficacy but are now little used in most countries. One of the most important reasons for this is relatively poor tolerability compared to many newer agents. In the case of clonidine there is also the potential danger of rebound hypertension. The most prominent adverse effects have been dry mouth, sedation, dizziness and oedema. These reactions, especially the first two, are thought to be associated with activation of central nervous system and salivary gland alpha2-adrenergic receptors. In the last 15 years it has become possible to produce drugs with selective agonist effect on another class of brainstem receptors, the imidazoline I1-receptors, which appear to have modulate sympathetic activity and blood pressure without affecting alertness or salivary flow: however, they still have some action on alpha2-receptors. Moxonidine and rilmenidine are moderately selective imidazoline agonists which have been in clinical use for several years in many European countries. Trial evidence and postmarketing surveillance indicate that moxonidine may cause dry mouth or sedation in a minority (<10%) of patients, significantly less than with the older drugs. There is no significant incidence of oedema and unexpected or idiosyncratic adverse effects are extremely rare. Moxonidine may improve aspects of glucose and lipid metabolism. In conclusion, moxonidine is a safe as well as an effective antihypertensive, with considerably improved patient tolerability compared to the older sympatholytics.
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PMID:Moxonidine: a review of safety and tolerability after seven years of clinical experience. 1048 97

Central regulation of the sympathetic nervous system plays an important role in the maintenance of blood pressure. In a subset of patients with essential hypertension, sympathetic activation may contribute to the development and maintenance of hypertension. Unlike the first generation of centrally active antihypertensive drugs, the second generation may be superior because of its selectivity to I1-imidazoline receptor and selective binding to the vasomotor center. Lack of a2 effects differentiates moxonidine from clonidine with respect to monoxidine"s superior side-effect profile (little or no sedation or dry mouth). Clinical trials show that moxonidine is as effective as angiotensin-converting enzyme inhibitors (eg, enalapril and captopril), b-blockers (e.g., atenolol), calcium-channel blockers (e.g., long-acting nifedipine), and diuretics (eg, hydrochlorothiazide) in lowering blood pressure and that it has superior tolerability. Thus, central modulation of the sympathetic nervous system has re-emerged as an exciting target for blood pressure reduction. Given the multiple adverse effects of sympathetic stimulation in various disease processes, including congestive heart failure, moxonidine may be the next therapeutic option for the management of hypertension and the prevention of target organ dysfunction.
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PMID:Centrally acting antihypertensive drugs: re-emergence of sympathetic inhibition in the treatment of hypertension. 1098 Oct 82

In recent years evidence has accumulated for the existence of central imidazoline (I1) receptors that influence blood pressure. While there is some controversy, it has been suggested that clonidine exerts its blood pressure-lowering effect mainly by activation of imidazoline I1 receptors in the rostral ventrolateral medulla, while its sedative effect is mediated by activation of central alpha2-receptors. Moxonidine and rilmenidine are 2 imidazoline compounds with 30-fold greater specificity for I1 receptors than for alpha2-receptors. In comparison, clonidine displays a 4-fold specificity for I1 receptors compared with alpha2 receptors. Moxonidine and rilmenidine lower blood pressure by reducing peripheral resistance. They reduce circulating catecholamine levels and moxonidine reportedly reduces sympathetic nerve activity in patients with hypertension. Moxonidine and rilmenidine modestly reduce elevated blood glucose levels and moxonidine has been reported to reduce insulin resistance in hypertensive patients with raised insulin resistance. Small reductions in plasma levels of total cholesterol, low density lipoprotein-cholesterol and triglycerides have been reported with rilmenidine. Both moxonidine and rilmenidine are well absorbed after oral administration and are eliminated unchanged by the kidneys. The elimination half-life (t(1/2)) of rilmenidine and moxonidine is 8 and 2 hours, respectively, but trough/peak plasma concentration ratios indicate that moxonidine can be administered once daily, suggesting possible CNS retention. As would be expected, t(1/2) values are increased in patients with reduced renal function, and in elderly individuals. Both drugs have been compared with established antihypertensive drugs from all the major groups. Studies, almost all of which were of a double-blind, parallel-group design, indicate that blood pressure control with moxonidine or rilmenidine is similar to that with established drugs, i.e. alpha-blocking drugs, calcium antagonists, ACE inhibitors, beta-blocking drugs and diuretic agents. There have been few studies conducted solely in elderly patients. However, evidence clearly suggests that the antihypertensive effect of the imidazoline compounds is not reduced in elderly patients. The overall adverse effect profile of moxonidine and rilmenidine compares reasonably with established agents. In accord with the receptor-binding studies, drowsiness and dry mouth are observed less often with these drugs than with other centrally acting drugs, although the symptoms occur more often than with placebo. An overshoot of blood pressure was seen when treatment with clonidine, but not moxonidine, was abruptly discontinued in conscious, spontaneously hypertensive rats. Clinical evidence of withdrawal reaction with moxonidine or rilmenidine is scant but caution should be observed pending more formal studies.
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PMID:I1 imidazoline agonists. General clinical pharmacology of imidazoline receptors: implications for the treatment of the elderly. 1098 1

Geriatric patients with major depression present clinical challenges not encountered in younger individuals, including a greater incidence of medical comorbidity, higher rates of multiple medication use, changes in drug metabolism due to age or physical illness, and increased sensitivity to antidepressant side effects. Nevertheless, successful treatment of depressive disorders in the elderly improves mental and physical functioning, decreases morbidity and perhaps mortality, and enhances quality of life. Recent research indicates that newer antidepressants are effective for late life depression and safer for older individuals. Among newer antidepressants, venlafaxine has a pharmacological profile that makes it an attractive choice for geriatric patients. It has limited potential to interact with other medications because it only weakly inhibits the cytochrome P450 system and binds to plasma proteins at a low level. Dosing may have to be adjusted for patients with renal failure, but typically not for those with liver disease or other medical conditions. Data from three double-blind and four open clinical trials support the safety and efficacy of venlafaxine for geriatric depression. Patients may experience transient, generally tolerable side effects such as insomnia, nausea, agitation, or dry mouth early in treatment, but more serious problems such as falls or cardiac rhythm disturbances seem to be rare. Treatment emergent hypertension occurs in a small percentage of older patients, generally at doses above 150 mg/day. Finally, emerging data suggest that venlafaxine may be effective for conditions such as stroke, anxiety, and neuropathic pain that frequently accompany depressive disorders in the elderly.
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PMID:Efficacy of venlafaxine in geriatric depression. 1109 16

A controlled study was carried out in mid-Sweden with the aim of comparing oral self-care and self-perceived oral health in 102 randomly sampled type 2 diabetic patients with that of 102 age-and-gender-matched non-diabetic controls. Oral health variables were also related to glycemic control (HbA1c), duration, anti-diabetic treatment, and late complications. Questionnaires were used to collect data on oral self-care and self-perceived oral health. Diabetes-related variables were extracted from medical records. Eighty-five percent of the diabetic subjects had never received information about the relation between diabetes and oral health, and 83% were unaware of the link. Forty-eight percent believed that the dentist/ dental hygienist did not know of their having diabetes. Most individuals, but fewer in the diabetic group, were regular visitors to dental care and the majority felt unaffected when confronted with dental services. More than 90% in both groups brushed their teeth daily and more than half of those with natural teeth did proximal cleaning. Subjects in the diabetic group as well as in the control group were content with their teeth and mouth (83% vs 85%. Those with solely natural teeth and those with complete removable dentures expressed most satisfaction. Sensation of dry mouth was common among diabetic patients (54%) and subjects with hypertension exhibited dry mouth to a greater extent (65%) than those who were normotensive. Our principal conclusion is that efforts should be made to give information about diabetes as a risk factor for oral health from dental services to diabetic patients and diabetes staff.
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PMID:A controlled study of oral self-care and self-perceived oral health in type 2 diabetic patients. 1131 42

Classic centrally acting drugs such as clonidine and alpha-methyldopa induce peripheral sympatho-inhibition via the stimulation of alpha(2)-adrenoceptors in the brainstem. From a haemodynamic point of view this appears to be a useful mechanism to lower elevated blood pressure in hypertensives. Although not known in full detail, a complex relationship exists between the sympathetic nervous system and hypertensive disease; sympathetic inhibition therefore appears to be a logical target of antihypertensive drug treatment. Numerous attempts have been made to improve the unfavourable side-effect profile of the centrally actingalpha(2)-adrenoceptor stimulants. None of these attempts were successful, since both the central antihypertensive activity and the major side-effects (sedation, dry mouth) are mediated by alpha(2)-adrenoceptors. A new approach in this field has been offered by the introduction of centrally acting antihypertensives which interact with central imidazoline (I(1))-receptors and thus cause peripheral sympatho-inhibition. As such they offer haemodynamic benefits similar to those of the classic alpha(2)-adrenoceptor agonists. However, it is hoped that their side-effect profile will be more favourable because of their much weaker affinity for alpha(2)-adrenoceptors. Moxonidine and rilmenidine are the prototypes of centrally acting I(1)-receptor stimulants. The antihypertensive activity of these agents is caused by vasodilatation and a reduction of peripheral vascular resistance. Left ventricular end-diastolic and end-systolic volumes are reduced, whereas heart rate, stroke volume, cardiac output and pulmonary artery pressures are largely unchanged. Left ventricular hypertrophy (LVH) is reduced in the long term. Both drugs when applied in a once-daily dosage schedule appear to control hypertension in most patients. Both drugs have been compared with representative agents from the major classes of antihypertensives in controlled trials and have been found to be equally effective with respect to blood pressure control. The incidence and severity of side-effects is lower than for clonidine, in particular with respect to sedation. A rebound (withdrawal) phenomenon has so far not been reported for moxonidine and rilmenidine. In conclusion, I(1)-receptor stimulants appear to offer the potential to be developed as centrally acting agents with a better side-effect profile than the classic alpha(2)-adrenoceptor stimulants, but with similar haemodynamic properties.
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PMID:Renewed interest in centrally acting antihypertensive drugs. 1144 83

Past and current drug therapies for weight loss are discussed. More than 50% of Americans can be categorized as overweight or obese. Obesity is associated with increased mortality and with comorbidities such as hypertension, hyperglycemia, dyslipidemia, coronary artery disease, and certain cancers. According to guidelines for identification, evaluation, and treatment of obesity, patients with a body mass index (BMI) of > or = 30 kg/m2 should attempt to lose weight. Patients with a BMI of > or = 25 kg/m2 plus two or more risk factors or patients with an excessive waist circumference plus two or more risk factors should also attempt to lose weight. The initial goal is a 10% weight reduction in six months achieved through lifestyle changes. If lifestyle changes alone are not effective, then drug therapy may be indicated. Pharmacotherapeutic options for obesity have decreased over the past few years. Fenfluramine, dexfenfluramine, and phenylpropanolamine have been withdrawn because of severe adverse effects, leaving only sympathomimetics, sibutramine, and orlistat as anorectics with FDA-approved labeling. Phentermine has been shown to cause a 5-15% weight loss if given daily or intermittently. Compared with sibutramine and orlistat, phentermine is cheaper, and specific formulations allow once-daily administration. However, phentermine is indicated only for short-term treatment, and tolerance often develops. Common adverse effects associated with phentermine are dry mouth, insomnia, increased blood pressure, and constipation. Sibutramine increases norepinephrine and serotonin levels in the CNS and should not be taken with many antidepressants because of the risk of increased norepinephrine and serotonin levels. Its use is also contraindicated in patients with cardiovascular disease. Orlistat is not systemically absorbed; therefore, it does not cause the systemic adverse effects or drug interactions of phentermine and sibutramine. Orlistat has a cholesterol-lowering effect not seen with other diet medications. However, the three-times-daily administration and frequent gastrointestinal effects limit its use. Sibutramine, phentermine, and orlistat have both positive and negative properties. Choosing among the medications will depend on concurrent disease states and medications, ease of administration, and cost.
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PMID:Pharmacologic options for the treatment of obesity. 1147 77

Rilmenidine is an imidazoline derivative that appears to lower blood pressure (BP) by an interaction with imidazoline (I1) receptors in the brainstem (and kidneys). Rilmenidine is as effective in monotherapy as all other first-line classes of drugs, including diuretics, beta-blockers, angiotensin converting enzyme (ACE) inhibitors, and calcium antagonists. It is well tolerated and can be taken in combination for greater efficacy. Sedation and dry mouth are not prominent side effects and withdrawal hypertension is not seen when treatment is stopped abruptly. Recently, in addition to a reduction in BP, this agent has been shown to improve glucose tolerance, lipid risk factors, and insulin sensitivity. These changes would be consistent with a reduction in long-term cardiovascular risk, as would recently described actions on the heart (reducing left ventricular hypertrophy) and the kidney (reducing microalbuminuria). Although no data are yet available from prospective long-term outcome studies, rilmenidine could represent an important new development in antihypertensive therapy and the prevention of cardiovascular disease.
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PMID:Update on rilmenidine: clinical benefits. 1172 91

This review illustrates, through a series of case histories, how oral medicine insights aid the diagnosis and management of patients with excessive tooth wear. The cases reviewed are drawn from the records of 500 southeast Queensland patients referred to the author over a 12 year period. Patients most at risk of dental erosion have work and sports dehydration, caffeine addiction, gastro-oesophageal reflux, asthma, diabetes mellitus, hypertension or other systemic diseases or syndromes that predispose to xerostomia. Saliva protects the teeth from the extrinsic and intrinsic acids which cause dental erosion. Erosion, exacerbated by attrition and abrasion, is the main cause of tooth wear. These cases illustrate that teeth, oral mucosa, salivary glands, skin and eyes should be examined for evidence of salivary hypofunction and attendant medical conditions. Based on comprehensive oral medicine, dietary analyses and advice, it would seem patients need self-management plans to deal with incipient chronic tooth wear. The alternative is the expensive treatment of pain, occlusal damage and pulp death required to repair the effects of acute severe tooth wear.
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PMID:The oral medicine of tooth wear. 1183 70


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