Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.545
Filtrar
1.
Medicine (Baltimore) ; 99(8): e19180, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080100

RESUMEN

INTRODUCTION: Diuretics are a commonly used for the treatment of acute pulmonary edema. However, inappropriate administration of diuretic drugs can result in clinical treatment failure and cause acute pulmonary edema. This is due to rapid decreases in intravascular volume as a result of diuretic treatment. To date, the clinical phenomenon of inappropriate use of diuretics leading to acute pulmonary edema remains unexplored and unrecognized. Here, we report the first case of this problem-pulmonary edema following diuretic therapy. PATIENT CONCERNS: A 71-year-old male patient who was intubated and transferred to the intensive care unit (ICU) due to respiratory failure was initially diagnosed with pneumonia as a complication of acute respiratory distress syndrome (ARDS). After treatments including antibiotics, lung protective ventilation strategies, and restrictive fluid management, his respiratory symptoms improved. However, the patient's dyspnea became more severe after experimental diuretic therapy. DIAGNOSIS: A point-of-care ultrasound (POCUS) examination showed increased extravascular lung water retention during a hypovolemic state. After full examinations and analysis, the diagnosis of acute pulmonary edema was determined. INTERVENTIONS: The most likely cause of acute pulmonary edema was left ventricular (LV) hyperdynamic status due to a hypovolemic status caused by excessive diuretic therapy. Consequently, we administrated intravenous fluids and a ß-receptor blocker to the patient. OUTCOMES: Following these treatment, the patient's respiratory distress improved remarkably. CONCLUSION: We report the first case of pulmonary edema following diuretic therapy to stress the need of physicians to follow guidelines of clinical practice. Maintaining an appropriate volume status and treatment of ß-receptor blockers is the key to reversing the progress of this adverse effect. In this process, POCUS is a reliable diagnostic tool to identify the cause of acute pulmonary edema and can increase the accuracy of clinical evaluations. It is likely that a wider use of POCUS will help physicians to obtain a faster, and more accurate, diagnosis of the etiology of acute pulmonary edema, thus allowing a more appropriate therapy.


Asunto(s)
Diuréticos/efectos adversos , Edema Pulmonar/inducido químicamente , Anciano , Agua Pulmonar Extravascular , Humanos , Masculino , Edema Pulmonar/terapia
2.
Expert Opin Drug Saf ; 19(1): 59-67, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31795777

RESUMEN

Introduction: The objective of this study was to review the current status of drug-induced hypomagnesemia and its adverse effects on cardiovascular disease (CVD) and hypertension. Since magnesium is a potent vasodilator, which modulates vasomotor tone, peripheral blood flow, and hypertension, its deficiency could have significant cardiovascular and blood pressure (BP) effects.Areas covered: Studies have shown that several factors can contribute to magnesium deficiency including age, diet, disease, and certain drugs such as diuretics and proton-pump inhibitors (PPIs). For an updated perspective of drug-induced hypomagnesemia, a Medline search of the English language literature was conducted between 2010 and 2019 using the terms diuretics, proton-pump inhibitors, hypomagnesemia, cardiovascular disease, hypertension, and 35 pertinent papers were retrieved.Expert opinion: The data showed that magnesium deficiency is difficult to occur since it is plentiful in green leafy vegetables, cereals, nuts, and the drinking water. However, magnesium deficiency can occur with the use of diuretics for the treatment of hypertension and heart failure, or the use of PPIs for the treatment of gastroesophageal reflux disease. Therefore, magnesium deficiency should be detected and treated to prevent the aggravation of hypertension and the onset of CVD and serious cardiac arrhythmias including torsades de points.


Asunto(s)
Diuréticos/efectos adversos , Deficiencia de Magnesio/inducido químicamente , Inhibidores de la Bomba de Protones/efectos adversos , Animales , Arritmias Cardíacas/inducido químicamente , Presión Sanguínea/efectos de los fármacos , Enfermedades Cardiovasculares/inducido químicamente , Enfermedades Cardiovasculares/fisiopatología , Diuréticos/administración & dosificación , Humanos , Hipertensión/etiología , Deficiencia de Magnesio/complicaciones , Deficiencia de Magnesio/diagnóstico , Inhibidores de la Bomba de Protones/administración & dosificación
3.
Lancet ; 394(10211): 1816-1826, 2019 11 16.
Artículo en Inglés | MEDLINE | ID: mdl-31668726

RESUMEN

BACKGROUND: Uncertainty remains about the optimal monotherapy for hypertension, with current guidelines recommending any primary agent among the first-line drug classes thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, dihydropyridine calcium channel blockers, and non-dihydropyridine calcium channel blockers, in the absence of comorbid indications. Randomised trials have not further refined this choice. METHODS: We developed a comprehensive framework for real-world evidence that enables comparative effectiveness and safety evaluation across many drugs and outcomes from observational data encompassing millions of patients, while minimising inherent bias. Using this framework, we did a systematic, large-scale study under a new-user cohort design to estimate the relative risks of three primary (acute myocardial infarction, hospitalisation for heart failure, and stroke) and six secondary effectiveness and 46 safety outcomes comparing all first-line classes across a global network of six administrative claims and three electronic health record databases. The framework addressed residual confounding, publication bias, and p-hacking using large-scale propensity adjustment, a large set of control outcomes, and full disclosure of hypotheses tested. FINDINGS: Using 4·9 million patients, we generated 22 000 calibrated, propensity-score-adjusted hazard ratios (HRs) comparing all classes and outcomes across databases. Most estimates revealed no effectiveness differences between classes; however, thiazide or thiazide-like diuretics showed better primary effectiveness than angiotensin-converting enzyme inhibitors: acute myocardial infarction (HR 0·84, 95% CI 0·75-0·95), hospitalisation for heart failure (0·83, 0·74-0·95), and stroke (0·83, 0·74-0·95) risk while on initial treatment. Safety profiles also favoured thiazide or thiazide-like diuretics over angiotensin-converting enzyme inhibitors. The non-dihydropyridine calcium channel blockers were significantly inferior to the other four classes. INTERPRETATION: This comprehensive framework introduces a new way of doing observational health-care science at scale. The approach supports equivalence between drug classes for initiating monotherapy for hypertension-in keeping with current guidelines, with the exception of thiazide or thiazide-like diuretics superiority to angiotensin-converting enzyme inhibitors and the inferiority of non-dihydropyridine calcium channel blockers. FUNDING: US National Science Foundation, US National Institutes of Health, Janssen Research & Development, IQVIA, South Korean Ministry of Health & Welfare, Australian National Health and Medical Research Council.


Asunto(s)
Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Adolescente , Adulto , Anciano , Antagonistas de Receptores de Angiotensina/efectos adversos , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/efectos adversos , Bloqueadores de los Canales de Calcio/efectos adversos , Bloqueadores de los Canales de Calcio/uso terapéutico , Niño , Estudios de Cohortes , Investigación sobre la Eficacia Comparativa/métodos , Bases de Datos Factuales , Diuréticos/efectos adversos , Diuréticos/uso terapéutico , Medicina Basada en la Evidencia/métodos , Femenino , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/prevención & control , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Infarto del Miocardio/prevención & control , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Adulto Joven
4.
Yakugaku Zasshi ; 139(11): 1457-1462, 2019.
Artículo en Japonés | MEDLINE | ID: mdl-31685742

RESUMEN

Recently, there have been reports that the combination of renin angiotensin inhibitors, diuretics, and non-steroidal anti-inflammatory drugs increases the risk of acute kidney injury (AKI). This combination has been dubbed the "Triple Whammy". However, there have been no reports about its chronic effects on the kidney. In this study, we investigated the chronic effects of the "Triple Whammy" on kidney function. There were 203 outpatients who were prescribed this combination in our hospital for 5 years. We excluded patients who could also confirm the combination in the previous year and patients for whom laboratory data were unavailable, thus, leaving a target patient group of 95 patients. The average estimated glomerular filtration rate (eGFR) decreased significantly from 62.6 to 58.9 mL/min/1.73 m2 immediately after administering the combination (p<0.01). Although no patients were diagnosed with AKI within 90 days after being administered the combination, 7.4% of patients exhibited a ≥25% reduction in eGFR compared with that before commencing the combination. Correlation analysis of gender, age, past renal function, and renal function change demonstrated that eGFR before administration of the combination negatively correlated with changes in eGFR (p<0.01). Considering the effects of individual differences, eGFR changes before and after administering the combination were compared using a case-crossover design and eGFR after administering the combination was found to be significantly reduced (p<0.01). Therefore, it appears that the "Triple Whammy" may cause not only AKI but also chronic renal degeneration.


Asunto(s)
Antagonistas de Receptores de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Antiinflamatorios no Esteroideos/efectos adversos , Diuréticos/efectos adversos , Tasa de Filtración Glomerular/efectos de los fármacos , Insuficiencia Renal Crónica/inducido químicamente , Lesión Renal Aguda/inducido químicamente , Anciano , Anciano de 80 o más Años , Antagonistas de Receptores de Angiotensina/administración & dosificación , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Estudios Cruzados , Diuréticos/administración & dosificación , Combinación de Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/fisiopatología
5.
Rev Cardiovasc Med ; 20(3): 111-120, 2019 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-31601085

RESUMEN

Randomized controlled trials have demonstrated the benefits of guideline-directed medical therapy in the outpatient setting for treatment of chronic heart failure. However, the benefits of continuation (or discontinuation) of major chronic heart failure therapies when treating acute heart failure during hospitalization are less clear. Real and anticipated worsening renal function, hyperkalemia and hypotension are the three major reasons for discontinuation of renin-angiotensin-aldosterone system inhibitors during hospitalization, and a failure to resume renin-angiotensin-aldosterone system inhibitors before discharge could worsen cardiovascular outcomes. Available data, mostly observational, shows that continuation or initiation of renin-angiotensin-aldosterone system inhibitors appears efficacious, safe, and well tolerated in majority of acute heart failure patients during hospitalization. Worsening renal function portends poor prognosis only if associated with congestion in acute heart failure, and clinicians should not de-escalate diuretic therapy routinely for worsening renal function.


Asunto(s)
Antagonistas de Receptores de Angiotensina/administración & dosificación , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Síndrome Cardiorrenal/tratamiento farmacológico , Diuréticos/administración & dosificación , Insuficiencia Cardíaca/tratamiento farmacológico , Admisión del Paciente , Sistema Renina-Angiotensina/efectos de los fármacos , Antagonistas de Receptores de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Síndrome Cardiorrenal/diagnóstico , Síndrome Cardiorrenal/mortalidad , Síndrome Cardiorrenal/fisiopatología , Toma de Decisiones Clínicas , Diuréticos/efectos adversos , Esquema de Medicación , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Humanos , Factores de Riesgo , Resultado del Tratamiento
6.
Lancet ; 394(10208): 1540-1550, 2019 10 26.
Artículo en Inglés | MEDLINE | ID: mdl-31533906

RESUMEN

BACKGROUND: Spironolactone is effective at reducing blood pressure in patients with uncontrolled resistant hypertension. However, the use of spironolactone in patients with chronic kidney disease can be restricted by hyperkalaemia. We evaluated use of the potassium binder patiromer to allow more persistent use of spironolactone in patients with chronic kidney disease and resistant hypertension. METHODS: In this phase 2 multicentre, randomised, double-blind, placebo-controlled study, we enrolled participants aged 18 years and older with chronic kidney disease (estimated glomerular filtration rate 25 to ≤45 mL/min per 1·73 m2) and uncontrolled resistant hypertension from 62 outpatient centres in ten countries (Bulgaria, Croatia, Georgia, Hungary, Ukraine, France, Germany, South Africa, the UK, and the USA). Patients meeting all eligibility criteria at the final screening visit were stratified by local serum potassium measurement (4·3 to <4·7 mmol/L vs 4·7 to 5·1 mmol/L) and history of diabetes. Participants were randomly assigned (1:1) with an interactive web response system to receive either placebo or patiromer (8·4 g once daily), in addition to open-label spironolactone (starting at 25 mg once daily) and their baseline blood pressure medications. Participants, the study team that administered treatments and measured blood pressure, and the investigators were masked to assigned treatment groups. Dose titrations were permitted after 1 week (patiromer) and 3 weeks (spironolactone). The primary endpoint was the between-group difference at week 12 in the proportion of patients on spironolactone. Efficacy endpoints and safety were assessed in all randomised patients (intention to treat). The study was registered with Clinicaltrials.gov, NCT03071263. FINDINGS: Between Feb 13, 2017, and Aug 20, 2018, we screened 574 patients. 295 (51%) of 574 patients met all inclusion criteria and were randomly assigned to spironolactone in addition to double-blind treatment with either placebo (n=148) or patiromer (n=147). At week 12, 98 (66%) of 148 patients in the placebo group and 126 (86%) of 147 patients in the patiromer group remained on spironolactone (between-group difference 19·5%, 95% CI 10·0-29·0; p<0·0001). Adverse events were mostly mild or moderate in severity and occurred in 79 (53%) of 148 patients in the placebo group and 82 (56%) of 147 patients in the patiromer group. INTERPRETATION: In patients with resistant hypertension and chronic kidney disease, patiromer enabled more patients to continue treatment with spironolactone with less hyperkalaemia. Persistent spironolactone enablement in this population of patients has clinical relevance for the treatment of resistant hypertension. FUNDING: Relypsa, a Vifor Pharma Group Company.


Asunto(s)
Diuréticos/administración & dosificación , Hipertensión/tratamiento farmacológico , Polímeros/administración & dosificación , Espironolactona/administración & dosificación , Adulto , Anciano , Diuréticos/efectos adversos , Método Doble Ciego , Quimioterapia Combinada , Femenino , Humanos , Hiperpotasemia/prevención & control , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Potasio/sangre , Insuficiencia Renal Crónica/complicaciones , Espironolactona/efectos adversos , Resultado del Tratamiento
8.
Int J Clin Pharmacol Ther ; 57(10): 483-488, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31426904

RESUMEN

AIM: The aim of this study was to investigate the potential association between antihypertensive therapy and the incidence of Parkinson's disease (PD) in patients followed in general practices in Germany. MATERIALS AND METHODS: This study included patients aged ≥ 40 who had received initial diagnoses of PD in 1,203 general practices in Germany between January 2013 and December 2017 (index date). After applying similar inclusion criteria, PD cases were matched to non-PD controls using propensity scores based on age, sex, and treating physician. The primary outcome of the study was the incidence of PD as a function of the use of antihypertensive drugs (diuretics, ß-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers). Logistic regression models were conducted to study the association between the use of antihypertensive drugs and the incidence of PD after adjusting for codiagnoses and antihypertensive cotherapy. RESULTS: The present study included 9,127 patients with PD and 9,127 patients without PD (mean age: 75.8 years; 48.4% women). The at-least-once use of diuretics (44.8% versus 38.4%; odds ratio (OR) = 1.23 (1.15-1.32)) was associated with an increased incidence of PD. However, this effect was not maintained for a therapy duration of at least 3 years, and no association was observed between the diuretic therapy duration and PD incidence. For all other antihypertensive drug classes, we found no significant associations with PD incidence. CONCLUSION: No association was found between antihypertensive therapy duration and PD incidence. Further epidemiological studies are needed to compare the effects of subclasses of antihypertensives on PD.


Asunto(s)
Antihipertensivos/efectos adversos , Hipertensión/tratamiento farmacológico , Enfermedad de Parkinson/complicaciones , Antagonistas Adrenérgicos beta/efectos adversos , Antagonistas Adrenérgicos beta/uso terapéutico , Anciano , Antagonistas de Receptores de Angiotensina/efectos adversos , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Bloqueadores de los Canales de Calcio/efectos adversos , Bloqueadores de los Canales de Calcio/uso terapéutico , Diuréticos/efectos adversos , Diuréticos/uso terapéutico , Femenino , Medicina General , Alemania , Humanos , Hipertensión/complicaciones , Incidencia , Masculino
9.
Dermatol Online J ; 25(7)2019 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-31450282

RESUMEN

Interstitial granulomatous drug reaction is a rare condition presenting as erythematous-to-violaceous plaques on the lateral trunk, axillae, buttocks, and thighs. Calcium-channel blockers, angiotensin converting enzyme inhibitors, beta-blockers, and statins have been described as drugs that can trigger interstitial granulomatous drug reaction. We present a case of interstitial granulomatous drug reaction related to hydrochlorothiazide and our approach to management of this condition. The diagnosis was confirmed with a skin biopsy and a rechallenge of hydrochlorothiazide, which exacerbated the patient's symptoms. The patient improved significantly with rigorous photoprotection, combination dapsone-alitretinoin therapy, and discontinuation of hydrochlorothiazide.


Asunto(s)
Dermatitis Fotoalérgica/etiología , Diuréticos/efectos adversos , Erupciones por Medicamentos/etiología , Granuloma/inducido químicamente , Hidroclorotiazida/efectos adversos , Anciano , Biopsia , Dermatitis Fotoalérgica/patología , Erupciones por Medicamentos/patología , Granuloma/patología , Humanos , Masculino , Inhibidores de los Simportadores del Cloruro de Sodio/efectos adversos
10.
J UOEH ; 41(2): 145-151, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31292358

RESUMEN

Constipation is very common and can be caused by adverse drug reactions as a result of many drugs. While the adverse effects of several medications such as opioids and anticholinergic agents are well established and well known, other commonly prescribed drugs, such as hypnotics, are less well understood. This review presents the results of an analysis of the relationship between constipation and drugs.


Asunto(s)
Antagonistas Colinérgicos/efectos adversos , Estreñimiento/inducido químicamente , Hipnóticos y Sedantes/efectos adversos , Antiinflamatorios no Esteroideos/efectos adversos , Anticonvulsivantes/efectos adversos , Antidepresivos Tricíclicos/efectos adversos , Bloqueadores de los Canales de Calcio/efectos adversos , Diuréticos/efectos adversos , Antagonistas de los Receptores Histamínicos/efectos adversos , Humanos , Parasimpatolíticos/efectos adversos
11.
Trials ; 20(1): 389, 2019 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-31262348

RESUMEN

BACKGROUND: Hypertension is an important risk factor for cardiovascular disease, even in the elderly. Fimasartan is a new non-peptide angiotensin II receptor blocker with a selective type I receptor blocking effect. The objective of this study is to confirm the safety and the non-inferiority of the blood pressure-lowering effect of fimasartan compared with those of perindopril, which has been proven safe and effective in elderly patients with hypertension. METHODS: This is a randomized, double-blind, active-controlled, two-parallel group, optional-titration, multicenter, phase 3 study comparing the efficacy and safety of fimasartan and perindopril arginine. The study population consists of individuals 70 years old or older with essential hypertension. The primary outcome will be a change in sitting systolic blood pressure from baseline after the administration of the investigational product for 8 weeks. The secondary outcomes will be a change in sitting diastolic blood pressure from baseline and changes in sitting systolic blood pressure and diastolic blood pressure from baseline after the administration of the investigational product for 4, 16, and 24 weeks. The sample size will be 119 subjects for each group to confer enough power to test for the primary outcome. DISCUSSION: Research to confirm the efficacy and safety of a new medicine compared with those of previously proven anti-hypertensive drugs is beneficial to guide physicians in the selection of therapeutic agents. If it is confirmed that the new drug is not inferior to the existing drug, the drug will be considered as an option in the treatment of hypertension in elderly patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03246555 , registered on July 25, 2017.


Asunto(s)
Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Compuestos de Bifenilo/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Diuréticos/uso terapéutico , Hipertensión Esencial/tratamiento farmacológico , Perindopril/uso terapéutico , Pirimidinas/uso terapéutico , Tetrazoles/uso terapéutico , Factores de Edad , Anciano , Anciano de 80 o más Años , Bloqueadores del Receptor Tipo 1 de Angiotensina II/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Antihipertensivos/efectos adversos , Compuestos de Bifenilo/efectos adversos , Ensayos Clínicos Fase III como Asunto , Diuréticos/efectos adversos , Método Doble Ciego , Quimioterapia Combinada , Estudios de Equivalencia como Asunto , Hipertensión Esencial/diagnóstico , Hipertensión Esencial/fisiopatología , Femenino , Humanos , Masculino , Estudios Multicéntricos como Asunto , Perindopril/efectos adversos , Pirimidinas/efectos adversos , República de Corea , Tetrazoles/efectos adversos , Factores de Tiempo , Resultado del Tratamiento
12.
Presse Med ; 48(11 Pt 1): 1222-1228, 2019 Nov.
Artículo en Francés | MEDLINE | ID: mdl-31303372

RESUMEN

Erectile dysfunction (ED) is not routinely discussed with patients in cardiology practices whereas it may impact the ability of patients to stay on therapy. Most of the studies about ED and antihypertensive therapies have several methodological limitations. Diuretics and beta-blockers have been shown to have a deleterious effect on ED. ISRA inhibitors, calcium antagonists, vasodilator beta-blockers and alpha-blockers have been shown to have a neutral impact on ED. Angiotensin 2 inhibitors, nebivolol and alpha-blockers use has sometimes beneficial effect on ED. In case of ED due to antihypertensive treatment, drugs can be switched each other but careful attention in patients with a high cardiovascular risk is required.


Asunto(s)
Antihipertensivos/efectos adversos , Hipertensión/tratamiento farmacológico , Disfunciones Sexuales Fisiológicas/inducido químicamente , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapéutico , Antagonistas Adrenérgicos beta/efectos adversos , Antagonistas Adrenérgicos beta/uso terapéutico , Bloqueadores del Receptor Tipo 2 de Angiotensina II/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Bloqueadores de los Canales de Calcio/efectos adversos , Bloqueadores de los Canales de Calcio/uso terapéutico , Enfermedades Cardiovasculares/tratamiento farmacológico , Diuréticos/efectos adversos , Diuréticos/uso terapéutico , Sustitución de Medicamentos , Humanos , Masculino , Antagonistas de Receptores de Mineralocorticoides/efectos adversos , Factores de Riesgo , Disfunciones Sexuales Fisiológicas/prevención & control
13.
Rev Alerg Mex ; 66(2): 254-256, 2019.
Artículo en Español | MEDLINE | ID: mdl-31200423

RESUMEN

BACKGROUND: Furosemide is the most commonly prescribed loop diuretic worldwide. Although, its extended use, furosemide rarely induces allergic reactions. Until 2013, only 49 cases of furosemide allergy had been described. CLINICAL CASE: We have reported on a patient who developed a delayed, erythematous and pruritic skin eruption after the ingestion of furosemide. The implication of furosemide in the reaction was established by a positive lymphocyte transformation test (LTT). CONCLUSION: This is the first reported case of hypersensitivity to furosemide in which this drug was confirmed as the trigger by a positive LTT. LTT could become a decent diagnostic alternative for patients who experience delayed reactions to furosemide.


Asunto(s)
Diuréticos/efectos adversos , Erupciones por Medicamentos/etiología , Furosemida/efectos adversos , Hipersensibilidad Retardada/etiología , Activación de Linfocitos/efectos de los fármacos , Anciano , Diuréticos/farmacología , Femenino , Furosemida/farmacología , Humanos
14.
PLoS One ; 14(5): e0217911, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31150512

RESUMEN

PURPOSE: To inform future outcomes research on diuretics, we sought to describe modern patterns of diuretic use in the intensive care unit (ICU), including diuretic type, combination, and dosing. We also investigated two possible quality improvement targets: furosemide dosing in renal impairment and inclusion of an initial bolus with continuous furosemide infusions. MATERIALS AND METHODS: In this descriptive study, we retrospectively studied 46,037 adult ICU admissions from a publicly available database of patients in an urban, academic medical center. RESULTS: Diuretics were employed in nearly half (49%, 22,569/46,037) of ICU admissions. Mechanical ventilation, a history of heart failure, and admission to the post-cardiac surgery unit were associated with a higher frequency of diuretic use. Combination use of different diuretic classes was uncommon. Patients with severely impaired kidney function were less likely to receive diuretics. Furosemide was by far the most common diuretic given and the initial intravenous dose was only 20 mg in more than half of ICU admissions. Among patients treated with a continuous infusion, 30% did not receive a bolus on the day of infusion initiation. CONCLUSIONS: Patterns of diuretic use varied by patient-specific factors and by ICU type. Diuretic dosing strategies may be suboptimal.


Asunto(s)
Diuréticos/uso terapéutico , Furosemida/uso terapéutico , Unidades de Cuidados Intensivos , Anciano , Diuréticos/efectos adversos , Relación Dosis-Respuesta a Droga , Femenino , Furosemida/efectos adversos , Insuficiencia Cardíaca/tratamiento farmacológico , Administración Hospitalaria , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad
15.
Ter Arkh ; 91(1): 101-107, 2019 Mar 11.
Artículo en Inglés | MEDLINE | ID: mdl-31090380

RESUMEN

In conditions of climate warming with an increase in heat waves associated with an increase in cardiovascular morbidity and mortality, the particular interest is the effect of cardiovascular drugs on adaptation to high temperatures. The review reflects the results of European and domestic studies on the safety of therapy during long and short heat waves. Recommendations for the correction of therapy during this period are given. Self-control of blood pressure (SCAD) is a mandatory component of the therapy of arterial hypertension during heat waves. With the development of clinically significant hypotension, a reduction in the dose of antihypertensive drugs is necessary. It is recommended to start with a dose reduction and/or withdrawal of diuretics and nitrates. Not recommended the complete abolition of antihypertensive therapy because of the risk of hypertensive crises, characteristic of abnormal heat, as well as due to the increase in blood pressure when the weather changes and the temperature drops. With increasing blood pressure during heat waves, it is recommended to give preference to calcium channel antagonists, angiotensin converting enzyme inhibitors (ACE inhibitors) and selective beta-blockers. It is necessary to inform patients about the additional protective effect of statins in order to increase adherence to therapy. Patients taking diuretics require individual daily monitoring of fluid intake and body weight. An overview of recommendations on sanogenic behavior during heat waves is given. Details are considered rules for the use of air conditioning, methods of diagnosis of dehydration and drinking mode Keywords: heat waves, cardiovascular complications, preventive measures.


Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Antihipertensivos/administración & dosificación , Bloqueadores de los Canales de Calcio/administración & dosificación , Enfermedades Cardiovasculares/tratamiento farmacológico , Calor Extremo/efectos adversos , Hipertensión/tratamiento farmacológico , Rayos Infrarrojos/efectos adversos , Antagonistas Adrenérgicos beta/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Antihipertensivos/farmacología , Bloqueadores de los Canales de Calcio/farmacología , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/mortalidad , Diuréticos/efectos adversos , Diuréticos/farmacología , Humanos , Estaciones del Año
16.
Acta Biomed ; 90(2): 348-352, 2019 05 23.
Artículo en Inglés | MEDLINE | ID: mdl-31125018

RESUMEN

INTRODUCTION: Distal renal tubular acidosis is a rare genetic disease, characterised by deficit in renal tubular transport. Clinical features are metabolic acidosis with hypercloraemia and hypokalemia, and inability in urine acidification. Hypercalciuria may also be present, often treated with the use of a diuretic therapy with thiazides. CASE PRESENTATION: We present a severe disease onset in a neonate with consanguineous parents, both autosomal-recessive for an ATP6VOA4 gene mutation, and a nevertheless severe episode of metabolic alkalosis, occurred in the same patient after few months, during the diuretic therapy. CONCLUSION: Biochemical results lead us to hypothesize a susceptibility to the treatment that need further investigations.


Asunto(s)
Acidosis Tubular Renal/tratamiento farmacológico , Alcalosis/etiología , Diuréticos/efectos adversos , ATPasas de Translocación de Protón Mitocondriales/genética , Tiazidas/efectos adversos , Acidosis Tubular Renal/diagnóstico , Alcalosis/fisiopatología , Análisis Químico de la Sangre , Consanguinidad , Diuréticos/uso terapéutico , Servicio de Urgencia en Hospital , Estudios de Seguimiento , Disgenesia Gonadal 46 XY , Humanos , Recién Nacido , Mutación , Enfermedades Raras , Índice de Severidad de la Enfermedad , Tiazidas/uso terapéutico , Urinálisis/métodos , Pérdida de Peso
17.
Int J Clin Pharmacol Ther ; 57(7): 353-361, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31094316

RESUMEN

OBJECTIVE: In elderly patients, age-related, disease-related, and drug-related factors are associated with chronic kidney disease (CKD). Little is known about which factors are the best predictors for CKD in elderly patients. MATERIALS AND METHODS: The study was based on 784 patients aged 75 years or older for whom the clinical and serum creatinine on admission to our hospital were available. Impaired renal function, including CKD and transient renal insufficiency, was defined as a non-indexed glomerular filtration rate (GFR) below 60 mL/min. A logistic regression model was developed for predictors of CKD and was internally validated using bootstrapping. RESULTS: Approximately 61% of the patients, who had CKD (46%) and transient renal insufficiency (15%), had a non-indexed GFR < 60 mL/min. Synergistic use of 3 drugs potentially impairing renal function, diuretics, ACE-I/ARB, and NSAIDs (odds ratio (OR), 4.66; 95% confidence interval (CI), 1.48 - 17.7, p = 0.012) was a significantly associated factor for CKD in a multivariate logistic regression analysis. Age (OR 1.56, 95% CI 1.04 - 2.33, p = 0.03), female gender (OR 1.58, 95% CI 1.04 - 2.39, p = 0.03), any prescription ACE-I/ARB either alone or in combinations with diuretics or NSAIDs (OR 2.74, 95% CI 1.83 - 4.13, p = 0.0001), and proteinuria (OR 1.98, 95% CI 1.27 - 3.10, p = 0.003), were included as the best model for CKD. The area under the curve (AUC) of the best model and the bootstrapping validation were 0.68 and 0.71, respectively. CONCLUSION: Given the widespread use of ACE-I/ARB for elderly patients, our findings suggest that caution is needed when they are prescribed because of the possibility of the patient developing CKD.


Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Antiinflamatorios no Esteroideos/efectos adversos , Diuréticos/efectos adversos , Prescripción Inadecuada/estadística & datos numéricos , Insuficiencia Renal Crónica/inducido químicamente , Anciano , Creatinina/sangre , Estudios Transversales , Femenino , Tasa de Filtración Glomerular , Humanos , Pacientes Internos , Masculino
18.
Clin Nephrol ; 91(6): 344-352, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30935460

RESUMEN

AIMS: We attempted to classify 115 consecutive nonedematous hyponatremic patients according to their history and saline responsiveness. We hereby describe 6 out of them presenting a transient renal salt wasting (TRSW) state of unknown origin. MATERIALS AND METHODS: Six patients with an initial SNa of 126 ± 3 mEq/L were included in the study. They were treated with 2 L isotonic saline infusion over 24 hours. The evolution of the biochemical data of 5 patients were compared to 6 patients with syndrome of inappropriate antidiuretic hormone (ADH) secretion (SIADH), 6 hyponatremias following the use of thiazides, and to 5 salt-depleted hyponatremic patients of similar age and body weight, treated in the same way. RESULTS: The mean values of FEurea and FEuric acid in the 6 described patients, together with a clearly inappropriate natriuresis suggested SIADH. However, the high mean fractional potassium excretion (FEK = 34 ± 15%) was not observed in SIADH (13 ± 3%) (p < 0.01). Plasma sodium levels improved quickly after saline infusion in most of these patients, while fractional solute excretions and diuresis decreased. Calciuria is increased in patients with renal salt waisting (RSW), while low calciuria values are observed in the thiazide group. Four of the 6 hyponatremic patients were admitted for syncopal malaise or fall. CONCLUSION: We observed in 6 out of 115 consecutive hyponatremic patients a TRSW. RSW as a diagnosis has to be considered when in hyponatremia with excessive natriuresis, high FEK and an intake of diuretics is ruled out. This hyponatremia is saline-responsive, but relapse can be frequently observed.


Asunto(s)
Hiponatremia/sangre , Hiponatremia/etiología , Enfermedades Renales/sangre , Sodio/sangre , Anciano , Anciano de 80 o más Años , Calcio/orina , Diuresis , Diuréticos/efectos adversos , Femenino , Fluidoterapia , Humanos , Hiponatremia/terapia , Hiponatremia/orina , Síndrome de Secreción Inadecuada de ADH/sangre , Síndrome de Secreción Inadecuada de ADH/complicaciones , Síndrome de Secreción Inadecuada de ADH/orina , Soluciones Isotónicas , Enfermedades Renales/complicaciones , Enfermedades Renales/orina , Potasio/orina , Solución Salina/uso terapéutico , Tiazidas/efectos adversos , Urea/orina , Ácido Úrico/orina
19.
J Med Food ; 22(4): 393-407, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30990753

RESUMEN

Although leaves of Anchietea salutaris are used in Brazilian traditional medicine, there is no available data in the literature proving its efficacy and safety. Thus, the aim of the study was to perform a meticulous botanical, phytochemical, toxicological, and pharmacological investigation of A. salutaris in Wistar rats. At first, a morphoanatomical characterization of Anchietea pyrifolia leaves and stems was performed. Then, a purified infusion (ethanol-soluble fraction obtained from A. pyrifolia [ESAP]) was obtained followed by its chemical profile elucidation. Furthermore, an acute toxicity test was performed, and the acute and prolonged diuretic and hypotensive effects were also evaluated in Wistar rats. Finally, the vasodilatory responses of ESAP in mesenteric vascular beds were investigated. The main secondary metabolites identified from ESAP were O-glycosylated flavonoids, chlorogenic acids, and phenylpropanoic acid derivatives. ESAP did not promote any toxic effects in female rats nor increased urinary excretion in male rats after a single exposure. However, ESAP significantly reduced renal elimination of sodium, potassium, and chloride after prolonged treatment. An ESAP highest dose promoted significant acute hypotension without affecting blood pressure levels after prolonged use. Furthermore, its cardiovascular effects seem to be related with the calcium-activated potassium channel activation in resistance vessels.


Asunto(s)
Antihipertensivos/administración & dosificación , Hipertensión/tratamiento farmacológico , Extractos Vegetales/administración & dosificación , Violaceae/química , Animales , Antihipertensivos/efectos adversos , Antihipertensivos/química , Presión Sanguínea/efectos de los fármacos , Brasil , Diuréticos/administración & dosificación , Diuréticos/efectos adversos , Diuréticos/química , Femenino , Humanos , Hipertensión/genética , Hipertensión/metabolismo , Hipertensión/fisiopatología , Masculino , Extractos Vegetales/efectos adversos , Extractos Vegetales/química , Hojas de la Planta/química , Canales de Potasio Calcio-Activados/genética , Canales de Potasio Calcio-Activados/metabolismo , Ratas Wistar
20.
Medicine (Baltimore) ; 98(16): e15300, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31008980

RESUMEN

BACKGROUND: Previous clinical studies have reported that furosemide can be used to treat liver cirrhosis (LC) effectively. However, no study systematically explored this issue. This systematic review aims to investigate the efficacy and safety of furosemide for treatment of LC. METHODS: This study will be conducted through searching the following literature sources from their inception to February 28, 2019 without any language limitations: PUBMED, EMBASE, PsycINFO, Web of Science, Scopus, OpenGrey, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database. In addition, reference lists of relevant reviews and websites of clinical trial registry will also be searched. Only randomized controlled trials of furosemide for treatment of LC will be included in this study. Two reviewers will independently select studies, collect data, and determine risk of bias. RevMan 5.3 software will be used to pool the data and to conduct meta-analysis if sufficient studies will be included with acceptable heterogeneity. RESULTS: This study will investigate the efficacy and safety of furosemide for LC by the assessment of primary and secondary outcomes. The primary outcome includes mortality rate. The secondary outcomes consist of response rate, overall survival, body weight, urinary volume, quality of life, as measured by any relevant scales, and adverse events. CONCLUSION: The results of this study may provide summarized evidence of furosemide for the treatment of LC. ETHICS AND DISSEMINATION: No individual patient data will be used in this study, thus no ethics approval is needed. The findings of this study will be published in peer-reviewed journals.


Asunto(s)
Diuréticos/uso terapéutico , Furosemida/uso terapéutico , Cirrosis Hepática/tratamiento farmacológico , Diuréticos/efectos adversos , Furosemida/efectos adversos , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA