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  • Glyceryl trinitrate spray  (1)
  • Key words Digital pulse plethysmography; nitroglycerin  (1)
  • Key words Phenprocoumon  (1)
  • 1
    Electronic Resource
    Electronic Resource
    Age-dependent differences in the anticoagulant effect of phenprocoumon in patients after heart valve surgery (1997)
    Springer
    European journal of clinical pharmacology 52 (1997), S. 31-35 
    Details
    ISSN: 1432-1041
    Keywords: Key words Phenprocoumon ; Thromboembolism prophylaxis; anticoagulant drugs ; age-dependence ; postoperative dosage requirement ; individual metabolism/sensitivity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract Objective: An enhanced response to warfarin and an increased risk of major bleeding has been observed in older patients. The reason for this increase in sensitivity remains unknown. It could be due to pharmacodynamic reasons, pharmacokinetic reasons, or both. Methods: We therefore followed an anticoagulant regimen with phenprocoumon in 19 older (76 years) and 19 younger patients (50 years) following heart valve replacement. INR values were determined frequently. At the 4th and around the 24th day after starting treatment with phenprocoumon, we also measured the total and unbound plasma concentration of phenprocoumon. Results: The dose requirement to obtain the desired anticoagulant effect was significantly lower in the older patients than in the younger patients (26.3 vs. 37.3 μg · kg−1 · day−1). The total plasma concentration (2.19 vs. 2.43 μg · ml−1), the percentage unbound drug in the plasma (0.61 vs. 0.64%) and the unbound plasma concentration (13.8 vs. 15.1 ng · ml−1) did not differ significantly between older and younger patients. The dose-adjusted INR (INR/dose) was higher in the older patients (110 vs. 67) but the INR adjusted for the unbound plasma concentration (INR/Cuss) which reflects the intrinsic sensitivity to the drug, was not significantly different (192 vs. 173). However, the older patients had an about 30% significantly lower metabolic clearance based on unbound drug (84 vs. 115 ml · kg−1 · h−1). Conclusions: Older patients (〉 70 years) require a dose approximately 30% lower than younger patients (〈 160␣years). Pharmacokinetic reasons (reduced metabolic clearance) are mainly responsible for the lower dose requirement of the older patients after heart valve surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002280050245
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Digital pulse plethysmography as a non-invasive method for predicting drug-induced changes in left ventricular preload (1996)
    Springer
    European journal of clinical pharmacology 50 (1996), S. 279-282 
    Details
    ISSN: 1432-1041
    Keywords: Key words Digital pulse plethysmography; nitroglycerin ; nifedipine ; left ventricular preload
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract Objective: Changes in the contour of the plethysmographically recorded digital pulse curve after nitrate ingestion are well known, but it has not been fully established whether these changes reflect nitrate action on left ventricular (LV) preload or afterload. Therefore, we compared the pulse wave contour after administration of equieffective doses of nitroglycerin and nifedipine. Methods: In 20 patients with coronary artery disease we measured aortic blood pressure curve in the aorta ascendens, digital volume pulse curve with a photoelectric pulse pickup, Riva Rocci blood pressure and heart rate after administration of either 0.8 mg nitroglycerin or 10 mg nifedipine. Results: Peak plasma concentrations of nitroglycerin and nifedipine were achieved 5 min and 20 min after ingestion of the drugs. Systolic aortic blood pressure decreased after both nitroglycerin and nifedipine to 19.4 mmHg, but diastolic blood pressure decreased only after nifedipine by 10.5 mmHg (P 〈 0.05). Riva Rocci blood pressures showed a similar time course. Heart rate increased from 67.4 to 70.9 beats⋅min−1 after nitroglycerin and from 58.9 to 69.4 beats⋅min−1 after nifedipine. The calculated a/b ratio of the aortic pressure curve increased after both medications (nitroglycerin, from 1.66 to 1.99; nifedipine, from 1.66 to 1.93) and its time course mimicked that of the systolic blood pressure. The a/b ratio of the digital pulse curve did not change after nifedipine, but showed a pronounced rise after nitroglycerin from 1.29 to 1.84. With regard to pharmacological actions, nitroglycerin causes a reduction in LV preload and afterload, whereas nifedipine has only LV-afterload-reducing activity. Conclusion: We conclude, that the reduction in afterload did not cause the typical changes in wave contour of the peripheral pulse curve which occur with organic nitrates. Most likely changes in the a/b ratio reflect changes in LV preload.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002280050108
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Comparison of the effects of two different galenical preparations of glyceryl trinitrate on pulmonary artery pressure and on the finger pulse curve (1993)
    Springer
    European journal of clinical pharmacology 44 (1993), S. 451-456 
    Details
    ISSN: 1432-1041
    Keywords: Glyceryl trinitrate spray ; pharmacokinetics ; a/b-ratio ; pulmonary artery diastolic pressure ; finger pulse curve ; bioavailability
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The time course and the magnitude of the effect of glyceryl trinitrate (GTN) on central venous (pulmonary artery diastolic pressure-PAPd) and peripheral arterial (a/b-ratio of the finger pulse wave) haemodynamics were compared in a randomized double-blind cross-over study in 12 patients suffering from congestive heart failure (NYHA II–III) with elevated PADd at rest (≥15 mm Hg). The data were obtained in a bioavailability study of two sprays of glyceryl trinitrate, which differed in their galenical characteristics and in the dose of GTN (0.4 mg vs. 0.8 mg). Following sublingual administration of each spray, PAPd, a/b-ratio and the plasma concentrations of GTN and its metabolites were measured up to 30 min. The relative bioavailability of GTN of the test preparation was estimated to be 157%, 161% and 147%, when calculated from the plasma concentration-time data or the integrated effect of GTN on a/b-ratio or PAPd, respectively. The mean time courses of the decrease in PAPd and the increase in the a/b-ratio of the finger pulse curve were mirror images. Thus, there was a strong correlation between the mean values of PAPd and a/b-ratio following the administration of glyceryl trinitrate. Since the slope of the relationship differed considerably between the patients, the magnitude of effect of GTN on PAPd in the individual patient could not be predicted from the changes in a/b-ratio.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00315542
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
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