BETA
BLOCKERS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R EFERENCES
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2003 by ICON Group International, Inc. Copyright ©2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Beta Blockers: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83783-X 1. Beta Blockers-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.
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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on beta blockers. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.
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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON BETA BLOCKERS ........................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Beta Blockers ............................................................................... 21 The National Library of Medicine: PubMed ................................................................................ 29 CHAPTER 2. ALTERNATIVE MEDICINE AND BETA BLOCKERS ........................................................ 73 Overview...................................................................................................................................... 73 National Center for Complementary and Alternative Medicine.................................................. 73 Additional Web Resources ........................................................................................................... 74 CHAPTER 3. PATENTS ON BETA BLOCKERS ..................................................................................... 77 Overview...................................................................................................................................... 77 Patents on Beta Blockers .............................................................................................................. 77 Patent Applications on Beta Blockers .......................................................................................... 80 Keeping Current .......................................................................................................................... 82 CHAPTER 4. BOOKS ON BETA BLOCKERS ........................................................................................ 83 Overview...................................................................................................................................... 83 Book Summaries: Federal Agencies.............................................................................................. 83 Book Summaries: Online Booksellers........................................................................................... 84 The National Library of Medicine Book Index ............................................................................. 85 Chapters on Beta Blockers............................................................................................................ 85 CHAPTER 5. MULTIMEDIA ON BETA BLOCKERS.............................................................................. 91 Overview...................................................................................................................................... 91 Bibliography: Multimedia on Beta Blockers................................................................................. 91 CHAPTER 6. PERIODICALS AND NEWS ON BETA BLOCKERS........................................................... 93 Overview...................................................................................................................................... 93 News Services and Press Releases................................................................................................ 93 Newsletter Articles ...................................................................................................................... 94 Academic Periodicals covering Beta Blockers .............................................................................. 97 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 101 Overview.................................................................................................................................... 101 NIH Guidelines.......................................................................................................................... 101 NIH Databases........................................................................................................................... 103 Other Commercial Databases..................................................................................................... 105 APPENDIX B. PATIENT RESOURCES ............................................................................................... 107 Overview.................................................................................................................................... 107 Patient Guideline Sources.......................................................................................................... 107 Finding Associations.................................................................................................................. 111 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 113 Overview.................................................................................................................................... 113 Preparation................................................................................................................................. 113 Finding a Local Medical Library................................................................................................ 113 Medical Libraries in the U.S. and Canada ................................................................................. 113 ONLINE GLOSSARIES................................................................................................................ 119 Online Dictionary Directories ................................................................................................... 121 BETA BLOCKERS DICTIONARY ............................................................................................. 123 INDEX .............................................................................................................................................. 179
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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with beta blockers is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about beta blockers, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to beta blockers, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on beta blockers. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to beta blockers, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on beta blockers. The Editors
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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.
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CHAPTER 1. STUDIES ON BETA BLOCKERS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on beta blockers.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and beta blockers, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “beta blockers” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •
Bleeding Esophageal Varices: How to Treat This Dreaded Complication of Portal Hypertension Source: Postgraduate Medicine. 109(2): 75-76, 81-86, 89. February 2001. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Summary: Bleeding esophageal varices, one of the most feared complications of portal hypertension (high blood pressure in the liver venous system), contribute to the estimated 32,000 deaths annually attributed to cirrhosis (liver scarring). This article describes the care of patients with this complication. The authors stress that successful control requires knowledge of the pertinent anatomy, underlying pathophysiology of portal hypertension, and natural history of gastroesophageal varices. The authors
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Beta Blockers
discuss the various prophylactic (preventive) and therapeutic approaches to management, including pharmacologic agents (drug therapy), endoscopic sclerotherapy, and transjugular intrahepatic portosystemic shunt (TIPS). Nonselective beta blockers are the treatment of choice for prevention of the first bleeding episode. Active bleeding is managed with octreotide and endoscopic sclerotherapy. Goals in the management of active bleeding are hemodynamic resuscitation, prevention and treatment of complications, and control of bleeding. Complications related to bleeding or its treatment can substantially increase the risk of death in each episode. TIPS and shunt surgery are reserved for those in whom octreotide and endoscopic surgery have failed. Endoscopic band ligation (tying off) should be used for prevention of recurrent bleeding. If endoscopic band ligation fails, patients can be offered TIPS or surgical therapy; they should be evaluated for liver transplantation. 4 figures. 4 tables. 11 references. •
Effects of Losartan on Renal and Cardiovascular Outcomes in Patients with Type 2 Diabetes and Nephropathy Source: New England Journal of Medicine. 345(12): 861-869. September 20, 2001. Summary: Diabetic nephropathy (diabetes associated kidney disease) is the leading cause of end stage renal disease (ESRD). Interruption of the renin angiotensin system slows the progression of renal (kidney) disease in patients with type 1 diabetes, but similar data are not available for patients with type 2, the most common form of diabetes. This article reports on a study that assessed the role of the angiotensin II receptor antagonist losartan in patients with type 2 diabetes and nephropathy. A total of 1,513 patients were enrolled in this randomized, double blind study comparing losartan (50 to 100 milligrams once daily) with placebo, both taken in addition to conventional antihypertensive treatment (calcium channel antagonists, diuretics, alpha blockers, beta blockers, and centrally acting agents) for a mean of 3.4 years. The primary outcome was the composite of a doubling of the baseline serum creatinine concentration, end stage renal disease, or death. Secondary end points included a composite of morbidity (related illness or complications) and mortality from cardiovascular causes, proteinuria, and the rate of progression of renal disease. A total of 327 patients in the losartan group reached the primary end point, as compared with 359 in the placebo group. Losartan reduced the incidence of a doubling of the serum creatinine concentration and end stage renal disease, but had no effect on the rate of death. The benefit exceeded that attributable to changes in blood pressure. The composite of morbidity and mortality from cardiovascular causes was similar in the two groups, although the rate of first hospitalization for heart failure was signficantly lower with losartan. The level of proteinuria (protein in the urine) declined by 35 percent with losartan. The authors conclude that losartan conferred significant renal benefits in patients with type 2 diabetes and nephropathy, and it was generally well tolerated. 3 figure. 3 tables. 34 references.
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Effects of ACE Inhibitors on Renal Function in Incipient and Overt Diabetic Nephropathy Source: Journal of Diabetes and Its Complications. 10(3): 133-135. May-June 1996. Contact: Available from Elsevier Science, Inc. Journal Fulfillment Department, 655 Avenue of the Americas, New York, NY 10010. (212) 633-3950. Fax (212) 633-3990. Summary: Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria, a relentless decline in glomerular filtration rate (GFR), and elevated
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systemic blood pressure. This article discusses the effects of ACE inhibitors on renal function in incipient and overt diabetic nephropathy. Previous studies have shown that the diabetes patients with the most marked proteinuria have the worse prognosis. Recently, it has been suggested that proteinuria is not simply a marker of the extent of glomerular damage, but proteinuria itself may contribute to glomerular damage. The importance of this finding highlights data that show that ACE inhibition has an antiproteinuric effect, independent of the effect on systemic blood pressure. And, raised blood pressure accelerates both the development and the progression of nephropathy in both IDDM (insulin-dependent) and NIDDM (noninsulin-dependent) patients. The author reminds readers that, when prescribing antihypertensive drugs to patients with diabetes, one must take into account the possible adverse effects on metabolic control, subjective awareness of hypoglycemia, plasma lipids, sexual function, orthostatic hypotension, and peripheral blood flow. Hyperlipidemia, autonomic neuropathy, and micro-and macroangiopathy are frequently present in longterm diabetes patients. The author concludes by recommending a stepped-care approach to drug treatment. ACE inhibitors can be recommended as a first step in IDDM or NIDDM patients with incipient and overt nephropathy. Addition of diuretics is nearly always required to control fluid retention. If blood pressure is not controlled, the addition of calcium antagonists or beta blockers is suggested. 1 figure. 23 references. •
Gastroesophageal Variceal Hemorrhage Source: New England Journal of Medicine. 345(9): 669-681. August 30, 2001. Summary: Gastroesophageal variceal hemorrhage (bleeding from enlarged veins or arteries, called varices, in the esophagus and stomach), a major complication of portal hypertension (high blood pressure) resulting from cirrhosis (liver scarring), accounts for 10 to 30 percent of all cases of bleeding from the upper gastrointestinal tract. Variceal hemorrhage is associated with more substantial morbidity and mortality than other causes of gastrointestinal bleeding, as well as with higher hospital costs. This article reviews the pathogenesis of gastroesophageal varices, the predictions of variceal hemorrhage, primary prevention, management of acute variceal hemorrhage (drug therapy, endoscopic therapy, balloon tamponade, transjugular intrahepatic portosystemic shunt, surgery), prevention of recurrent bleeding, and the cost effectiveness of available therapies. Treatment of patients with gastroesophageal varices includes the prevention of the initial bleeding episode (primary prophylaxis), the control of active hemorrhage, and the prevention of recurrent bleeding after a first episode (secondary prophylaxis). Although the role of endoscopic variceal band ligation is not established, treatment with beta blockers is well accepted. The treatment of acute variceal hemorrhage is aimed at volume restoration and ensuring hemostasis with pharmacologic agents, endoscopic techniques (ligation or sclerotherapy), or both. 5 figures. 3 tables. 111 references.
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Short-Term Effects of Protein Intake, Blood Pressure, and Antihypertensive Therapy on Glomerular Filtration Rate in the Modification of Diet in Renal Disease Study Source: JASN. Journal of the American Society of Nephrology. 7(10): 2097-2109. October 1996. Summary: Glomerular filtration rate (GFR) is often used to assess the level of renal function and the progression of renal disease. However, the shortterm effects of dietary protein restriction, blood pressure reduction, and specific classes of antihypertensive agents on GFR may be opposite in direction from their observed longterm beneficial effects on the progression of renal disease. This article reports on a study in which the
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Beta Blockers
researchers characterized these shortterm effects and determined whether they can obscure the relationship between renal structure and function in patients with slowly progressive renal disease. The data are from the Modification of Diet in Renal Disease Study, a randomized trial of the effect of dietary protein restriction and strict blood pressure control on the decline in GFR in 840 patients. Starting treatment with diuretics, beta blockers, or ACE inhibitors was associated with a greater GFR decline than was stopping these treatments. The effect of changes in protein intake, mean arterial pressure (MAP), and diuretics was greater in patients with higher initial GFR. After controlling for initial GFR, there were no significant differences between the shortterm effects observed during the first 4 months of followup and the shortterm effects during subsequent followup. The authors conclude that changes in protein intake, blood pressure, and antihypertensive agents have small but statistically significant shortterm effects on GFR. These effects can lead to clinically significant changes in renal function in patients undergoing multiple interventions and are large enough to confound the results of clinical trials in patients with slowly progressive renal disease. The authors note that future studies using GFR to assess the progression of renal disease should take into account these shortterm effects when the length of followup is being planned. 2 figures. 5 tables. 50 references. (AA-M). •
Beta-Blockers in the Diabetic Patient Source: Practical Diabetology. 22(1): 20-23. March 2003. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. Summary: Hypertension (high blood pressure) is more prevalent in patients with diabetes (both type 1 and type 2) than in nondiabetic individuals at every age. This article reviews the mechanisms of diabetic hypertension and its treatment with beta blockers. Topics include the causes of hypertension in patients with diabetes, the goals of therapy for hypertension, the rationale for the use of beta blockers, the mechanisms of action of beta blockers, disadvantages of beta blockers, and the advantages of thirdgeneration beta blockers. The author concludes that patients with hypertension and diabetes who are already taking an ACE inhibitor and a diuretic, in whom hypertension remains uncontrolled, should have a beta blocker added to their regimen. Beta blockers are even more cardioprotective in diabetes and insulin-resistant patients than in nondiabetic patients because they shift the substrate utilized by the myocardium from free fatty acids to glucose. As a result of this change in myocardial metabolism, beta blockers decrease myocardial workload. The vasoconstricting and metabolic side effects associated with first and second generation beta blockers can be circumvented by using a third generation beta blocker. 6 references.
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How I treat Dyslipidemia in Diabetes Mellitus: Two Views Source: Clinical Diabetes. 13(5): 86-90. September-October 1995. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: In this article, Dr. Byron Hoogwerf describes his usual approach to dealing with dyslipidemia in patients with diabetes. Topics include screening for dyslipidemias; the control of diabetes and the effect on diet; exercise; pharmacotherapy; the specific drug therapy used for the lipid disorders; and other issues, including treatment of postmenopausal women, and the use of beta blockers, antioxidants, and vitamin E. The
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article concludes with a commentary by Dr. Abhimanyu Garg, who describes a few variations in approach to the patient with dyslipidemia. •
Antihypertensive Therapy in Diabetic Hypertensive Patients Source: American Journal of Hypertension. 14(5 Part 2): 12S-16S. May 2001. Contact: Available from Elsevier Science. Customer Support Department, P.O. Box 945, New York, NY 10159-0945. (212) 633-3730 or (888) 437-4636. Fax (212) 633-3680. E-mail:
[email protected]. Summary: In this article, the authors analyzed a literature review to assess the benefits of antihypertensive therapy in hypertensive (high blood pressure) patients with diabetes mellitus. The authors conducted a MEDLINE search of English language articles published until 1999, using the terms diabetes mellitus, hypertension or blood pressure (BP), and therapy. Included were only prospective randomized studies of more than 12 months' duration that evaluated the effect of drug treatment on morbidity (associated illness or complications) and mortality (death) in patients with diabetes and hypertension. The results showed that coeixstence of diabetes mellitus doubled the risk of cardiovascular events, cardiovascular mortality, and total mortality in patients with hypertension. Intensive BP control to levels lower than 130 over 85 mm Hg was beneficial in this population. All four drug classes (diuretics, beta blockers, ACE inhibitors and calcium antagonists) were effective in reducing cardiovascular events in patients with diabetes and hypertension. In elderly patients with diabetes and isolated systolic hypertension, calcium antagonists reduced the rate of cardiac end points by 63 percent, stroke by 73 percent, and total mortality by 55 percent. In more than 60 percent of patients with diabetes and hypertension, combination therapy (more than one drug) was required to control BP. 3 figures. 2 tables. 40 references.
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Slowing the Course of Renal Failure in Patients with Diabetes Source: Physician Assistant. 16(10): 79-85. October 1992. Summary: In this article, the authors discuss the incidence and costs involved in diabetes-associated renal disease; the typical course of renal disease in patients with diabetes; the mechanisms of said renal disease; nonpharmacologic intervention; and pharmacologic intervention, including the use of diuretics, beta blockers, vasodilators, ACE inhibitors and calcium antagonists, and combination therapy. The authors conclude that aggressive early blood pressure control has been shown to postpone the development of end-stage renal disease significantly and hypothesize that the ACE inhibitors and certain classes of calcium antagonists have the potential to modify the course of diabetic nephropathy even more than traditional antihypertensive therapy. 43 references.
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Are Calcium Antagonists Effective in Preventing Complications of Hypertension and Progression of Renal Disease? Source: Current Opinion in Nephrology and Hypertension. 9(5): 489-495. September 2000. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 223-2300. Fax (301) 223-2400. Website: www.currentopinion.com. Summary: Long acting calcium antagonists have been shown to be safe and effective in lowering blood pressure, both as first line agents and in combination with other classes
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of antihypertensive drug. This article explores recent research exploring whether calcium antagonists are effective in preventing complications of hypertension and progression of renal disease. Calcium antagonists have been shown to reduce the incidence of cerebrovascular and cardiovascular events in elderly patients with predominantly systolic hypertension (high blood pressure). It is clear that reduced morbidity and mortality in hypertension is related to the degree to which blood pressure is reduced, regardless of the therapy used. This is the single most important conclusion of all recent trials, especially in the subgroup of hypertensive patients with diabetes. The World Health Organization (WHO) International Society of Hypertension guidelines acknowledge this and do not make specific recommendations as to initial therapy in the absence of other medical factors. However, the use of thiazide diuretics and beta blockers has strong support from large placebo controlled trials in patients with mild to moderate essential hypertension. The British Hypertension Society and JNC VI guidelines restrict their recommendations for the use of calcium antagonists to isolated systolic hypertension and angina, or when other agents have failed, are contraindicated, or are not tolerated. However, the efficacy of calcium antagonists in lowering blood pressure, their tolerability and potentially beneficial secondary effect on proteinuria (protein in the urine), especially in combination with an ACE inhibitor, still make them attractive antihypertensive agents. Unlike ACE inhibitors, the antiproteinuric effect of calcium antagonists, even that of the non dihydropyridine type, seems to depend on an adequate and stable reduction in blood pressure. Calcium channel blockers include nifedipine, amlodipine, verapamil, and diltiazem. 5 figures. 52 references. •
Prediabetic Problem: Development of Non-Insulin-Dependent Diabetes Mellitus and Related Abnormalities Source: Journal of Diabetes and Its Complications. 11(2): 69-76. March-April 1997. Contact: Available from Elsevier Science, Inc. Journal Fulfillment Department, 655 Avenue of the Americas, New York, NY 10010. (212) 633-3950. Fax (212) 633-3990. Summary: Noninsulin dependent diabetes mellitus (NIDDM, or Type II) is associated with approximately twofold increase in coronary heart disease (CHD) in men and fourfold increase in CHD in women. This review article emphasizes the epidemiology of cardiovascular disease in NIDDM, with an emphasis on the prediabetic syndrome. In most studies, the duration of diabetes and severity of glycemia are only weakly related to CHD in NIDDM, suggesting that the prediabetic period may be important for the increased CHD in NIDDM subjects. Both hyperinsulinemia and insulin resistance predict the development of NIDDM. A number of studies have shown that increased cardiovascular risk factors (especially high triglyceride, blood pressure, and small dense low-density lipoprotein and low high-density lipoprotein cholesterol) precede the onset of NIDDM. Recent data from the San Antonio Heart Study suggest that the atherogenic pattern of cardiovascular risk factors is more marked in prediabetic women than in prediabetic men, thus partially explaining the higher risk of CHD in prediabetic women than in prediabetic men. The atherogenic changes in cardiovascular risk factors appear to be mainly due to increased hyperinsulinemia and insulin resistance in nondiabetic subjects. The authors conclude that interventions to reduce cardiovascular disease in NIDDM subjects should emphasize the primary prevention of NIDDM and very aggressive treatment of traditional cardiovascular risk factors in prediabetic subjects. Treatment of hypertension and dyslipidemia in high risk patients for NIDDM should avoid agents that further worsen insulin resistance (nicotinic acid, beta blockers, and
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thiazides) as subjects with hypertension and dyslipidemia are already at increased risk of NIDDM. 106 references. (AA-M). •
Hypertension and the Progression of Renal Disease Source: Dialysis and Transplantation. 29(4): 187-188, 191. April 2000. Contact: Available from Dialysis and Transplantation. Subscriptions. P.O. Box 10535, Riverton, NJ 08076. (800) 624-4196 or (609) 786-0871. Summary: The incidence of people starting dialysis in the United States continues to rise, as does the cost to fund dialysis programs. All efforts thus far to alter the incidence of renal disease have been less than successful. This is due, in part, to a failure to adequately lower and maintain blood pressure to levels now recognized as slowing renal disease progression. This article explores the interplay between hypertension and the progression of renal disease. The author notes that reducing blood pressure without reducing proteinuria (protein in the urine) does not maximally reduce cardiovascular events or renal (kidney) disease progression. Antihypertensive agents that reduce both blood pressure and proteinuria include ACE inhibitors, angiotensin receptor blockers, nondihydropyridine calcium antagonists, and beta blockers. Other agents have not been shown to have such a benefit. Interestingly, these classes of agents, when used either alone or combined, have shown marked reduction in both cardiovascular events as well as renal disease progression. The average number of different types of blood pressure medications needed to achieve the aforementioned levels of blood pressure control is 3.2 agents. The author encourages all primary care physicians, as well as nephrologists, to try to achieve such blood pressure goals in their patients, in order to reduce the high cardiovascular risk and increasing incidence of end stage renal disease (ESRD).
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Are Angiotensin-Converting Enzyme Inhibitors the Best Treatment for Hypertension in Type 2 Diabetes? Source: Current Opinion in Nephrology and Hypertension. 9(2): 173-179. March 2000. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 223-2300. Fax (301) 223-2400. Website: www.currentopinion.com. Summary: The influence of hypertension on the clinical course and complications of type 2 diabetes is well established. With a special focus on ACE inhibitors, this article reviews recently published results of prospective studies addressing two important aspects: the degree of blood pressure control and the choice of antihypertensive regimen in the prevention of complications in patients with hypertension and type 2 diabetes. None of the recent studies have shown worse outcomes in patients treated with ACE inhibitor based regimens compared with alternative treatments. Some studies have suggested that ACE inhibitors may be superior to alternative treatments in reducing the risk of micro and macrovascular complications, whereas other studies found similar effects for beta blockers or calcium antagonists. Several trials showed beneficial effects of ACE inhibitors over calcium antagonists. However, it remains to be determined whether there should be more reserved use of calcium antagonists in such patients. The degree of reduction of blood pressure rather than the choice of a particular drug may be the most important factor. Studies focusing on renal endpoints suggest that ACE inhibitors have a better antiproteinuric effect than other agents, but this phenomenon is not always reflected by a more beneficial effect of ACE inhibitors on the decline in glomerular filtration rate (GFR). The authors conclude that ACE inhibitors are
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sufficiently safe and are equally or more effective than other classes of agents. Tight blood pressure control is usually achievable only with a combination of agents. It appears that ACE inhibitors, together with a low dose cardioselective beta blocker and a diuretic, should be used in most hypertensive type 2 diabetes patients, with calcium antagonists serving as reserve drugs in case of insufficient blood pressure control. 40 references (12 annotated). •
Portal Hypertension Source: Current Opinion in Gastroenterology. 6(3): 370-375. June 1990. Summary: The mortality rate from the initial bleeding episodes of ruptured esophageal varices is 36-70 percent, depending on the patient's hepatic reserve. This, coupled with a 1-year survival rate of 30 percent, has encouraged the identification of patients with varices that have not bled, but who are at a high risk for a bleed. This article discusses the factors that predict the first bleed, the management of varices, congestive gastropathy, and pulmonary hypertension complicating portal hypertension. The author notes that patients who seem to be at high risk for bleeding may benefit from prophylactic treatment (sclerotherapy and/or beta blockers) to prevent an impending hemorrhage. 2 tables. 33 annotated references.
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Cardiovascular Disease: How to Reduce the Risk in Patients with Diabetes Source: Consultant. 41(3): 461-470. March 2001. Contact: Available from Cliggott Publishing Company. 55 Holly Hill Lane, Box 4010, Greenwich, CT 06831-0010. Summary: The risk of myocardial infarction (MI, heart attack) in patients with diabetes mellitus, even in those who have no coronary artery disease (CAD), is similar to that in patients who have previously experienced an MI. This article helps primary care physicians work with their patients with diabetes to reduce their risks for cardiovascular disease. Factors that increase the risk that a patient with type 2 diabetes will sustain a cardiovascular event include smoking, poorly controlled glucose levels, elevated systolic blood pressure, elevated low density lipoprotein (LDL) cholesterol levels, low high density lipoprotein (HDL) cholesterol levels, and elevated triglyceride levels. The author stresses that to reduce the risk of MI and other cardiovascular events in patients with diabetes, they must maintain tight control of blood pressure, lipid (fats) levels, and glucose (sugar) levels. For most patients, multidrug therapy will be needed, in addition to appropriate diet and exercise (and smoking cessation) to achieve treatment goals. ACE (angiotensin converting enzymes) inhibitors are first line antihypertensive therapy in patients with diabetes; selective beta blockers, calcium antagonists, and low dose diuretics can be added as needed to control blood pressure. Aspirin prophylaxis (preventive therapy) is warranted if the patient has no contraindications. For patients with diabetes who have abnormal low density lipoprotein cholesterol levels, statins are recommended as initial therapy. 4 figures. 1 table. 42 references.
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Sexual Function in Men with Diabetes Type 2: Association with Glycemic Control Source: Journal of Urology. 163(2): 788-791. March 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This article describes a study that evaluated the association of glycemic control with erectile dysfunction in men with type 2 diabetes. The study population
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consisted of a convenience sample of 78 sexually active male outpatients who had diabetes. Participants completed questions one to five of the International Index of Erectile Function. Details of disease duration, complications, medication use, patient age, and level of glycosylated hemoglobin (HbA1c) were obtained by reviewing the medical record. Mean subject age plus or minus standard deviation was 62.0 plus or minus 12.3 years, mean HbA1c was 8.1 percent plus or minus 1.9 percent, and mean erectile function score decreased as HbA1c increased. The test for linearity was also significant. There were no statistically significant associations of levels of glycemic control with alpha blocker, beta blocker, or diuretic use. However, insulin use was more frequent in men with poor control, in that 70 percent of those with HbA1c greater than 9 percent received insulin. Bivariate analysis showed a significant correlation of HbA1c with neuropathy but not with patient age, duration of diabetes, alpha blockers, beta blockers, or diuretics. Multivariate analysis demonstrated that HbA1c was an independent predictor of erectile function score, even after adjusting for peripheral neuropathy, which was also an independent predictor. When subject age and duration of diabetes were included in multivariate models, only HbA1c and neuropathy were significant independent predictors of erectile function score. The article concludes that the data add to the growing body of literature suggesting that erectile dysfunction correlates with the level of glycemic control. 3 tables. 24 references. (AA-M). •
Prescribed Medications and OTCs: Interactions and Timing Issues Source: Diabetes Spectrum. 15(4): 256-261. October 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article describes some common drug-drug interactions between prescription medications and over the counter medications that people with diabetes might encounter. With each interaction listed, there is a description of how to appropriately manage it. Also, proper timing of the medications in relation to food intake is described. The data presented are not all-inclusive but do detail the common medications used in people with diabetes. Most of the information is presented in tabular format. Drugs covered include ACE inhibitors, beta blockers, calcium channel blockers, loop diuretics, thiazide diuretics, insulins, sulfonylureas, and antihyperlipemic. 4 tables. 11 references.
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Taking It to Heart Source: Diabetes Forecast. 54(2): 35-37. February 2001. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article discusses heart disease in women who have diabetes. The risk of heart disease is three to seven times more likely in women who have diabetes than women without diabetes. Prior to menopause, women are usually protected against heart disease because the estrogen made in the ovaries protects their hearts; however, diabetes overrides or negates this protective effect. Risk factors for developing heart disease, such as high blood pressure, high low density lipoprotein (LDL) cholesterol, and low high density lipoprotein cholesterol, are more common and more powerful in women who have diabetes. Symptoms of a heart attack in women may be different from those in men. The only symptoms that women may experience include extreme fatigue, indigestion, severe nausea, or vomiting. Steps that women can take to reduce their risk of heart attack include quitting smoking or reducing the amount they smoke, controlling
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blood pressure and blood glucose, reducing LDL levels, checking c-reactive protein levels, taking a small amount of aspirin each day, taking beta blockers, and exercising. •
Management of Diabetes in the Elderly Source: Clinical Diabetes. 17(1): 19-25. 1999. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article discusses the management of diabetes in the elderly. The management of older adults who have type 2 diabetes requires careful consideration of the effects that advancing age and changes in health status can have on the competing risks and benefits of therapeutic interventions. Although tight glycemic control is not always an appropriate treatment goal, many older people who have diabetes are undertreated and could benefit from improved glycemic control and more aggressive management of risk factors for macrovascular disease because morbidity and mortality associated with macrovascular events far outweigh the risks of microvascular complications. The goal for many otherwise healthy older people who have diabetes should probably be near normal fasting plasma glucose levels without hypoglycemia. In elderly patients whose care is complicated by other factors, a more realistic therapeutic goal may be reducing the signs and symptoms of hyperglycemia rather than attaining euglycemia. The article presents strategies for reducing macrovascular disease, including improving glycemic control, treating hypertension and hyperlipidemia, quitting smoking, and using beta blockers. Microvascular disease control is discussed in terms of improved glycemic control and blood pressure control. The article then presents specific interventions for the management of hyperglycemia, including lifestyle interventions and pharmacological interventions with biguanides, sulfonylureas, alphaglucosidase inhibitors, thiazolidinediones, meglitinides, and insulin. In addition, the article highlights other components of comprehensive care, including regular foot care, annual dilated retinal examination, education regarding diet and exercise, and enhancement of self-management skills. 2 tables. 41 references. (AA-M).
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Beta-blockers Source: Diabetes Forecast. 44(5): 13-14. May 1991. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article discusses the use of beta-blockers as antihypertensive medications and how they can affect diabetes control. Topics include the different types of beta blockers, the range of side effects associated with beta blockers, and suggestions for people with diabetes who are using beta-blockers.
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Drugs Used to Manage Cardiovascular Disease: Part I-Diuretics Source: Access. 15(2): 30-32. February 2001. Contact: Available from American Dental Hygienists' Association. 444 North Michigan Avenue, Chicago, IL 60611. Summary: This article familiarizes dental hygienists with the drugs that may be used to manage cardiovascular disease; this first entry in an ongoing series focuses on diuretics. The series addresses the classes of medications used to manage a variety of cardiac conditions, including hypertension (HTN), angina, myocardial infarction, arrhythmias,
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heart murmurs, and stroke. Drug interactions, oral side effects, and general side effects of these cardiac medications are discussed, along with recommendations for client management and risk assessment strategies. In this article, the author focuses on HTN and the role of diuretics. Currently, use of a diuretic with a beta blocker is the standard first line approach to treating HTN. Diuretics act upon the kidney to increase sodium and water excretion in the urine, thereby lowering blood volume; decreasing blood volume lowers blood pressure. Diuretics are given at low doses, and are safe and effective in preventing myocardial infarction, heart failure, stroke, and mortality from heart disease. The author covers thiazides, loop diuretics, potassium sparing diuretics, and combination therapies. Research suggests that the thiazide diuretics reduce the risk of stroke better than beta blockers, ACE inhibitors, and calcium channel blockers, and should be considered the best choice of treatment for managing HTN. 3 tables. 7 references. •
Renovascular Hypertension Source: AJN. American Journal of Nursing. 100(2): 46-52. February 2000. Contact: Available from Lippincott Williams and Wilkins. AJN, P.O. Box 50480, Boulder, CO 80322-0480. (800) 627-0484 or (303) 604-1464. Summary: This article familiarizes nurses with renovascular hypertension, the most common secondary form of hypertension (the elevation of blood pressure). Renovascular hypertension is treatable and results from renal arterial obstruction, which has several causes: atherosclerosis, fibromuscular dysplasia, or Takayasu's syndrome. The author discusses mechanisms of the disease, the frontline diagnostic tests used (glomerular filtration rate, BUN, urinalysis), additional diagnostic testing that may be utilized, and how nurses can help with patient preparation for these tests. One sidebar discusses the treatment options, noting that ACE inhibitors, calcium antagonists, beta blockers, and certain alpha blockers may lower blood pressure in patients with renal artery stenosis. Each drug has a unique efficacy and adverse effects profile. The author cautions that renovascular hypertension, if unchecked, will progress to complete renal failure; pharmacologic interventions do not correct the underlying cause. Another sidebar reports on a clinical trial of ramipril, an ACE inhibitor currently under study. In high risk patients, ramipril was shown to prevent cardiovascular death, stroke, myocardial infarction, heart failure, diabetic microvascular complications, the development of diabetes, and the need for cardiac revascularization. Appended to the article is a posttest with which readers can earn continuing education credit. 1 figure.
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Common Drug Pathways and Interactions Source: Diabetes Spectrum. 15(4): 249-255. October 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article focuses on common prescription drug interactions in the treatment of diabetes, dyslipidemia, hypertension, and erectile dysfunction (ED). The author highlights mechanisms of the drug interactions and recommendations for clinical practice. Because of concerns about potentially negative effects some prescription medications may have on glycemic control in people with diabetes, some of these drugdisease interactions are also addressed. Drugs considered include metformin (Glucophage), corticosteroids, niacin, diuretics, beta blockers, atypical antipsychotics, statins, bile acid sequestrants, combination antilipemic agents, and sildenafil. The author includes two illustrative case studies. 1 table. 42 references.
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Drugs Used to Manage Cardiovascular Disease: Part IV-Nitrates and Other Antianginals Source: Access. 15(5): 64, 66, 68-69. May-June 2001. Contact: Available from American Dental Hygienists' Association. 444 North Michigan Avenue, Chicago, IL 60611. Summary: This article is one in a series that familiarizes dental hygienists with the drugs that may be use to manage cardiovascular disease; this fourth entry in the ongoing series focuses on nitrates and other antianginals. The series addresses the classes of medications used to manage a variety of cardiac conditions, including hypertension (HTN), angina, myocardial infarction, arrhythmias, heart murmurs, and stroke. Drug interactions, oral side effects, and general side effects of these cardiac medications are discussed, along with recommendations for client management and risk assessment strategies. In this article, the author focuses on nitrates, which are used for both the prevention and treatment of angina pectoris (chest pain), a common symptoms of ischemic (lack of blood flow) heart disease. Nitrates relieve the symptoms of angina by relaxing vascular smooth muscle, which vasodilates the large veins and causes pooling of blood on the venous side of the systemic circulation. This effect reduces the amount of blood that is returned to the heart, which in turn reduces the work of the heart. In addition, nitrates produce vasodilation of the coronary arteries, which improves blood flow to the myocardium. Other drugs discussed in this article are beta blockers, calcium channel blockers, and antithrombin and antiplatelet drugs. 5 tables. 9 references.
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Treatment of Elevated Blood Pressure in Diabetic Patients Source: Journal of Diabetes and Its Complications. 11(2): 92-99. March-April 1997. Contact: Available from Elsevier Science, Inc. Journal Fulfillment Department, 655 Avenue of the Americas, New York, NY 10010. (212) 633-3950. Fax (212) 633-3990. Summary: This article outlines lifestyle modifications that can form the basis of hypertension prevention and treatment in people with diabetes. Arterial hypertension is a major contributor to the secondary complications of diabetes. Moreover, prevention or treatment of hypertension reduces the incidence and progression of diabetes complications. Lifestyle modifications include weight management, nutrient modifications, physical activity, moderation of alcohol ingestion, and smoking cessation. The authors also discuss the potential advantages and disadvantages of each type of antihypertensive drug. Conventional therapy with thiazide-type or loop diuretics and or beta blockers can aggravate metabolic alterations. In reducing diabetic microalbuminuria or overt proteinuria, ACE inhibitors are more effective than conventional diuretics or beta blockers. ACE inhibitors also tend to preserve glomerular filtration rate (GFR) better than conventional antihypertensive drugs or nifedipine. The combination of an ACE inhibitor with a calcium antagonist such as verapamil or diltiazem can be more effective in reducing proteinuria and slowing the course of nephropathy than when each drug is used alone. The authors note that little information is available on the common problem of how to treat individuals with diabetes who have hypertension resistant to different drug combinations, including diuretics in the recommended low doses. The authors present a case study and synopsis in which they discuss this issue. 3 figures. 3 tables. 45 references. (AA-M).
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Treatment Rationale for Hypertension in Persons With Diabetes Source: Nurse Practitioner Forum. 2(3): 148-149. September 1991.
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Summary: This article presents a treatment rationale for hypertension in diabetes. Topics included statistics on diabetic nephropathy; the effect of insulin on hypertension; and the use of antihypertensive medications in diabetes, including beta blockers, calcium channel blockers, ACE inhibitors, and alpha-adrenergic antagonists. Specific agents discussed include captopril (Capoten), and doxazosin (Cardura). 13 references. •
Treating Hypertension in Diabetes: Data and Perspectives Source: Clinical Diabetes. 17(4): 148-154. 1999. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article presents evidence from randomized trials supporting the importance of blood pressure control in people who have diabetes. Tightly controlling blood pressure has been shown to reduce cardiovascular risk and delay the development and progression of such microvascular diabetic complications as nephropathy and retinopathy. For example, the Systolic Hypertension in the Elderly Program (SHEP), Systolic Hypertension in Europe study (Syst-Eur), and the Hypertension Optimal Treatment (HOT) trial demonstrated that even small decreases in blood pressure can have a big impact on cardiovascular risk. Various studies have shown that blood pressure control decreases the albumin rate and the rate of decline in renal function. Even in normotensive patients who have diabetes, studies have shown that lowering blood pressure has clear renal benefits. The United Kingdom Prospective Diabetes Study (UKPDS) demonstrated a 34 percent reduction in two-step progression of retinopathy and a 47 percent reduction in risk of decline in visual acuity in the tightly controlled blood pressure group compared with the group with less tight control. The article addresses the issue of whether there is an ideal antihypertensive drug for use in diabetes and evaluates the strength of the data surrounding the reported negative effects of calcium channel blockers (CCBs) and effects of other classes of drugs. Results of the SHEP, Syst-Eur, HOT, Multicenter Isradipine Diuretic Atherosclerosis Study, and UKPDS studies all support the safety and efficacy of the use of low dose diuretics and beta blockers in people who have diabetes. Findings from other studies suggest that the combination of angiotensin-converting enzyme inhibitor (ACEI) plus dihydropyridine CCB provides the best outcome for patients who have type 2 diabetes and hypertension. Other clinical studies provide partial support for specific beneficial effects of ACEIs on microvascular disease. The article offers an approach to management of hypertension that involves initial treatment with an ACEI, followed by a dihydropyridine CCB, then a low dose diuretic or beta blocker added as needed. 2 figures. 1 table. 42 references.
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Blood Pressure: You Are In Control Source: Diabetes Forecast. 51(5): 40-46. May 1998. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article provides people who have diabetes with information about hypertension. The authors note that people with diabetes are twice as likely to develop high blood pressure (hypertension) as people who do not have diabetes. The article addresses six things that people with diabetes can do to prevent or lower high blood pressure: use salt in moderation, reduce stress, become more active, achieve and maintain a reasonable weight, consume alcohol in moderation if at all, and stop smoking. Because people with hypertension may not show any symptoms, it is especially important that blood pressure be monitored. If lifestyle changes alone do not
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lower blood pressure, a medication from one of the following classes may be prescribed: diuretics, beta blockers, ACE inhibitors, calcium-channel blockers, angiotensin II, and alpha blockers. A sidebar lists the features and prices of various types of home blood pressure monitoring devices. •
Hypertension Is Associated with Severe Erectile Dysfunction Source: Journal of Urology. 164(4): 1188-1191. October 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This article reports on a study of the prevalence and severity of erectile dysfunction (ED, formerly called impotence) in patients with hypertension. The authors mailed the International Index of Erectile Function, which includes components that evaluate patient medical history, hypertension status, and erectile dysfunction, to 476 male patients of an outpatient clinic. The questionnaire was completed by 104 (22.3 percent) patients, and mean age was 62.2 years (range 34 to 75 years). Of these patients, 84.8 percent were sexually active, and 68.3 percent had various degrees of ED, which was mild in 7.7 percent, moderate in 15.4 percent, and severe in 45.2 percent. Compared to the general population of ED cases in the literature, the study population with hypertension (high blood pressure) had a higher incidence of severe ED. Although correlations of antihypertensive medications with incidence of ED did not reach statistical significance, there was a clear trend: patients treated with diuretics and beta blockers have the highest incidence of ED and those treated with alpha blockers have the lowest incidence of ED. Finally, although patients with hypertension visited physicians regularly for the treatment of hypertension, the majority did not receive therapy for erectile dysfunction. 5 tables. 23 references.
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Beta-Blockers and ACE Inhibitors: New Data, Old Myths Source: Patient Care. 34(13): 62-64, 67-70, 77-80, 83-84. July 15, 2000. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: This article reports on the myriad of clinical uses for beta blockers and ACE inhibitors. Clinical trials have demonstrated new, safe, efficacious ways to use these cardiovascular agents. Beta blockers are now first line treatment for heart failure, and the Heart Outcomes Prevention Evaluation (HOPE) trial showed that ACE inhibitors reduce morbidity and mortality in patients at high risk of cardiac events. Despite the emergence of the overwhelming benefits of these drugs, the authors note that these agents are thought to be widely underused. Even when they are prescribed, dosages are often too low, probably because of an incomplete understanding of the pathophysiology of cardiovascular disease (CVD) and the pharmacodynamics of these agents. Other issues discussed include how to use the drugs safely at the dosages proven effective in clinical trials, why beta blockers are considered safe for most patients with diabetes, how ACE inhibitors benefit patients with diabetes beyond their proven effect on blood pressure (notably to slow the progression of kidney disease), and how ACE inhibitors and angiotensin II receptor blockers (ARBs) compare. One sidebar summarizes selected clinical trials of beta blockers and ACE inhibitors; a second describes the different types of antihypertensive agents. 1 figure. 1 table. 28 references.
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Review Article: The Pathophysiology and Pharmacological Treatment of Portal Hypertension Source: Alimentary Pharmacology and Therapeutics. 6(5): 521-540. October 1992. Summary: This article reviews current concepts in the pathophysiology of portal hypertension and considers pharmacotherapy for the treatment of variceal bleeding. The authors note that portal hypertension can result in the development of ascites, portalsystemic encephalopathy, and esophageal varices. Topics include the pathogenesis of portal hypertension; the role of glucagon; the adrenergic system; endothelium derived relaxing factor; bile acids; adenosine; angiotensin; prostaglandins; serotonin; treatment for acute variceal hemorrhage; the use of vasopressin and somatostatin; primary prevention and prevention of rebleeding, including the use of beta blockers, other adrenergic drugs, and nitrates; and combination therapy. 1 table. 162 references. (AAM).
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How to Treat Renovascular Hypertension: Pros and Cons of Medical Therapy vs. Revascularization Source: Journal of Critical Illness. 13(7): 409-412, 421-424. July 1998. Contact: Available from Cliggott Publishing Company. 55 Holly Hill Lane, Greenwich, CT 06831-0010. (203) 661-0600. Summary: This article reviews the different therapeutic approaches for treating renovascular hypertension and the role of revascularization in the preservation of renal function. The treatment of renovascular hypertension includes medical therapy (particularly with beta blockers, ACE inhibitors, or angiotensin II receptor antagonists), or revascularization with percutaneous transluminal renal angioplasty (PTRA), stenting, or surgery. Medical therapy is effective in most patients, but revascularization is indicated when the hypertension is refractory to antihypertensives or when renal function is significantly reduced. Because of its low risk to benefit ratio, high success rate, and low incidence of restenosis, PTRA is the treatment of choice for fibromuscular dysplasia that is uncomplicated by branch renal artery disease. PTRA should be attempted in those patients with refractory hypertension resulting from a unilateral atherosclerotic renal artery lesion distal to the os. PTRA with intravascular stenting may be the best option for patients with ostial atherosclerotic renal artery stenosis, particularly for those who are poor candidates for surgery. When PTRA fails or is not feasible, surgery remains the final option. 3 figures. 45 references. (AA-M).
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How to Improve the Cardiac Prognosis for Diabetes Source: Diabetes Care. 22(Supplement 2): B89-B96. March 1999. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article, which is based on a presentation given at a satellite symposium of the 16th International Diabetes Federation Congress, discusses strategies for improving the cardiac prognosis in patients who have coronary artery disease and diabetes. These strategies are based on experiences in the past two decades. Cardiovascular disease is a leading cause of death in people with diabetes. It has been reported to account for almost 80 percent of all deaths in this population. About three fourths of these deaths result from coronary artery disease. Studies have shown that patients who have diabetes and have had an acute myocardial infarction (AMI) have a mortality rate about twice that of patients who do not have diabetes. Various
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medications have been shown to improve the prognosis among patients who have diabetes and ischemic heart disease: beta blockers, thrombolytic agents, aspirin, angiotensin converting enzyme (ACE) inhibitors, and lipid lowering drugs. Experiences indicate that treatment with beta blockers, thrombolytic agents, and ACE inhibitors is particularly advantageous in patients who have diabetes and have suffered an AMI. Also, metabolic control also may be of major importance during the acute cardiac event because it is assumed that fatty acid metabolism is increased with a compromised glycolysis not only in ischemic but also in nonischemic areas. One way to suppress free fatty acid oxidation is by the infusion of insulin-glucose. In the Swedish Diabetes Mellitus and Insulin Glucose Infusion in Acute Myocardial Infarction Study, patients who had diabetes and AMI were randomized to receive insulin-glucose infusion followed by intensive subcutaneous insulin treatment or to be control subjects. The 1 year mortality rate was reduced 30 percent by insulin treatment. The article recommends that patients who have ischemic heart disease be given the same treatment for their heart disease regardless of whether they have type 1 or type 2 diabetes. 1 table. 121 references. (AA-M). •
How Much Do You Know About High Blood Pressure? Source: Diabetes Self-Management. 9(3): 46-47. May-June 1992. Contact: Available from R.A. Rapaport Publishing Company. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This brief article consists of a quiz of ten questions about high blood pressure and a discussion of the answers to each question. Subjects touched upon include how blood pressure levels are influenced, the complications arising from high blood pressure, normal blood pressure readings, systolic and diastolic blood pressure readings, what can be done to reduce blood pressure, the influence of beverages containing alcohol or caffeine, blood pressure medications that are safe and effective for people with diabetes, and beta blockers.
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Renal Artery Stenosis Source: Consultant. 39(12): 3398. December 1999. Contact: Available from Cliggott Publishing Company. 55 Holly Hill Lane, Box 4010, Greenwich, CT 06831-0010. Summary: This brief article presents a case of renal artery stenosis. After suffering with a severe, disabling headache for 2 weeks, the 20 year old patient sought medical treatment. The patient had no significant medical history other than a 6 year history of smoking. The examination revealed no infection or neurologic problems. The patient's blood pressure was 190 over 115. The laboratory work up was negative for hypercalcemia (high blood calcium levels), hyperglycemia (high blood glucose levels), and hyperkalemia (high blood potassium levels); urinalysis was normal. The patient was admitted to the hospital; nifedipine was prescribed. Despite treatment, the blood pressure remained elevated. Renal (kidney) arteriography revealed a normal right renal artery and a 50 to 60 percent concentric stenosis in the proximal third of the left renal artery, with a remarkable poststenotic peripheral dilatation. The patient was referred for angioplasty. The authors comment that renovascular hypertension is the most prevalent form of secondary hypertension. Renovascular hypertension (high blood pressure) is induced by renal ischemia (constriction of the blood vessels) that activates the renin angiotensin system. Treatment is usually invasive; the prognosis for younger patients is excellent; persons with atherosclerotic disease often suffer relapses. Balloon angioplasty
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(which opens up and cleans out the blood vessels) is replacing surgical correction as the treatment of choice. In the case reported in this article, angioplasty was not performed. The patient quit smoking and continues to take prescribed beta blockers. His arterial pressure is normal. 2 figures. 3 references. •
Treatment of Behavioral Symptomatology of Alzheimer's Disease, With Emphasis on Aggression: Current Clinical Approaches Source: International Psychogeriatrics. 4(Suppl 1): 117-130. 1992. Summary: This journal article describes current approaches to the clinical evaluation and management of behavioral problems in geriatric patients with Alzheimer's disease and other dementing illnesses. Many geriatric patients in long term care settings exhibit behavioral problems, often secondary to psychiatric illness. Before patients begin treatment, it is useful to categorize behavioral problems in terms of their amenability to particular treatments. Most behavioral disorders in the geriatric population are not amenable to treatment with psychotherapeutic medications and can be categorized as nonpsychiatric behaviors. Other behavioral problems are amenable to pharmacological treatment and can be labeled psychiatric behavioral disorders. The nonpsychiatric behavioral problems may benefit from behavioral and environmental approaches such as minimizing inciting and aggravating factors, developing substitute behaviors, and maximizing staff and patient involvement in planning an intervention. The psychiatric disorders, especially aggression and assaultive behavior, may be effectively treated using psychotherapeutic medications such as antianxiety agents, neuroleptics, carbamazepine, beta blockers, and lithium. 33 references.
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Use of Ergogenic Aids by Athletes Source: Journal of the American Academy of Orthopaedic Surgeons. 9(1): 61-70. January-February 2001. Summary: This journal article provides health professionals with information on the use of ergogenic aids by athletes. An ergogenic aid is defined as any means of enhancing energy production and utilization. Ergogenic aids have been classified into mechanical, such as lightweight racing shoes; psychological, such as hypnosis; physiologic, such as blood doping; pharmacologic, such as androgenic steroid supplements; and nutritional, such as creatine supplementation. Athletes frequently use ergogenic aids to improve their performance and increase their chances of winning in competition. It is estimated that between 1 and 3 million male and female athletes in the United States have used anabolic steroids. Use of nutritional supplements such as creatine, amino acid supplements, and dehydroepiandrosterone (DHEA) is extensive among collegiate athletes. In response to the problem of drug use, many athletic organizations have established policies prohibiting the use of certain pharmacologic, physiologic, and nutritional aids by athletes and have implemented drug testing programs to monitor compliance. Therefore, it is important for physicians to be knowledgeable about the available ergogenic aids so they can appropriately treat and counsel the athletic patient. The article discusses the mechanism of action and the adverse effects of anabolic steroids, growth hormone, caffeine, recombinant human erythropoietin, beta blockers, creatine, vitamins, carnitine, androstenedione, and blood doping. 3 tables and 47 references. (AA-M).
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Hypertension and Diabetes Source: Practical Diabetology. 14(2): 14-16, 18-19. June 1995.
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Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This review article addresses special concerns that arise in choosing therapy for patients with hypertension and diabetes. The authors present a rationale for choosing between the alternatives, with emphasis on the effect of medication on carbohydrate metabolism, atherosclerotic heart disease, and the complications of diabetes. Concerns covered include coronary artery disease, dyslipidemia, nephropathy, hypoglycemia, and neuropathy. Drug therapies discussed include diuretics, beta blockers, ACE inhibitors, calcium channel blockers, alpha-1 blockers, and alpha-2 agonists. The authors relate their comments to the 1993 recommendations of the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC-V). 1 table. 3 references. •
Hypertension in Patients with Diabetes: Strategies for Drug Therapy to Reduce Complications Source: Postgraduate Medicine. 107(4): 47-52, 54, 60. April 2000. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Summary: This review article discusses the importance of aggressive treatment of hypertension in patients who have diabetes and presents strategies for drug therapies to reduce diabetic complications. A blood pressure lower than 130/85 mm Hg is necessary to reduce the risk of complications of diabetic hypertension. Although lifestyle modification may prevent or delay the onset of hypertension in people who have diabetes, it is usually not sufficient to effectively reduce the risk of complications. Thus, antihypertensive drug therapy is warranted for any person with diabetes and a blood pressure higher than 130/85 mm Hg. Initial drug therapy for hypertension is usually with a diuretic or beta blocker; however, evidence suggests that these are not the most appropriate medications for people who have diabetes and are hypertensive. Therefore, angiotensin-converting enzyme (ACE) inhibitors are the preferred first line agents for treating hypertension in people who have diabetes. Calcium antagonists or low dose thiazide diuretics may be needed if the blood pressure goal of less than 130/85 mm Hg is not achieved with ACE inhibitors alone. Although beta blockers can reduce cardiovascular events and slow renal disease progression, they produce side effects that discourage adherence. Angiotensin II receptor blockers are an alternative to ACE inhibitors. The article provides guidelines for selecting the appropriate drug for managing hypertension in people who have diabetes and discusses the effectiveness of several fixed dose combinations of ACE inhibitors and calcium channel blockers. 1 figure. 3 tables. 19 references.
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Hypertension and Diabetes: A Review Source: Practical Diabetology. 19(2): 36-40. June 2000. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This review article examines the prevalence and treatment of hypertension among people who have diabetes. Various studies suggest that hypertension is a complication of diabetes throughout the world and in all races and ethnic groups. A study conducted in the United States shows that diabetes increased the risk of hypertension among non-Hispanic whites, non-Hispanic blacks, and Hispanics.
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Although various treatments have been studied for hypertension in diabetes, the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommended diuretics and beta blockers as the first line of treatment in general populations, and angiotensin converting enzyme (ACE) inhibitors in patients with diabetes. The Captopril Prevention Project found that ACE inhibitors or beta blockers plus diuretics were equally effective. Studies have also found aspirin to be effective. The United Kingdom Prospective Diabetes Study found that intensive blood pressure control led to decreases in total diabetes endpoints, diabetes related mortality, myocardial infarction, stroke, microalbuminuria, and congestive heart failure. Several studies have examined the role of calcium channel blockers (CCBs) for patients who have diabetes and hypertension. Although some studies have found beneficial results with CCBs, other evidence suggests that CCBs may not be the optimal agents for people who have diabetes. Although CCBs should not be used alone, they do have a role in combination with one or more of the primarily effective hypertensive agents. 28 references.
Federally Funded Research on Beta Blockers The U.S. Government supports a variety of research studies relating to beta blockers. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to beta blockers. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore beta blockers. The following is typical of the type of information found when searching the CRISP database for beta blockers: •
Project Title: AFRICAN AMERICAN STUDY OF KIDNEY DISEASE AND HYPERTENSION Principal Investigator & Institution: Lewis, Julia B.; Professor of Medicine; Medicine; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2001; Project Start 30-SEP-1992; Project End 30-JUN-2003 Summary: There is a disproportionate number of African Americans with hypertension and end-stage renal disease (ESRD) secondary to hypertension. Hypertension is the leading cause of ESRD in African Americans. Despite this, there is little data addressing potential therapeutic maneuvers which may slow or halt development of hypertensive ESRD in this patient population. The goal of this project is to conduct a multi-center study to determine if angiotensin-converting enzyme inhibitors (CEI), calcium channel blockers (CCB) or beta blockers (BB) protect the kidney from progressive damage in
2
Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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African Americans with hypertensive nephrosclerosis and to determine if lowering blood pressure and achieving blood pressure goals considerably below the currently recommended mean arterial blood pressure (MAP) of 107 might slow the rate of decline of renal function in this patient population. The proposed experimental design is a multi- center randomized prospective controlled double masked study. Only African Americans with hypertensive nephrosclerosis and no other major medical illnesses will be enrolled. Following a series of screening tests, patients will be randomized to either receive CEI, CCB, or BB, and other anti-hypertensives as needed to achieve either a MAP goal between 102-107 mm/Hg or less than or equal to 92 mm/Hg. Nonpharmacologic therapeutic interventions will be monitored in all patients. Patients will have monthly clinic visits with quarterly laboratory evaluations. Patients' renal function, the major outcome variable, will be evaluated by measuring glomerular filtration rate (GFR) (Iothalamate). Stop points including: halving initial renal function, uncontrolled blood pressure, or adverse events. This center participated in the pilot study for this trial and was active in the development and implementation of the AASK protocol. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: BETA ADRENERGIC REGULATION OF THE LQTS MUTANT CHANNELS Principal Investigator & Institution: Dumaine, Robert; Masonic Medical Research Laboratory, Inc 2150 Bleeker St Utica, Ny 13501 Timing: Fiscal Year 2001; Project Start 10-JUL-1998; Project End 30-JUN-2002 Summary: (adapted from the applicant's abstract): The sympathetic nervous system has been implicated in the development of life threatening cardiac arrhythmias in a variety of pathophysiological settings, but particularly in the inherited forms of the long QT syndrome. The applicant indicates that a large gap currently exists in our understanding of the mechanisms responsible for the deleterious effects of adrenergic agonists and little is known about the action of the sympathetic system on mutant channels that underlie the long QT syndrome (LQTS). The goal of this proposal is to close this gap by combining electrophysiological and recombinant DNA techniques to characterize the effect of the adrenergic system on normal and mutant ion channels known to be responsible for LQTS (KvLQT1, HERG, SCN5A). The role of beta-1 and beta-2 adrenoceptor activation and phosphorylation by PKA and PKC will be evaluated for each channel in an attempt to establish a link between an abnormal respons of individual mutant channel to sympathetic activity. The study will provide further insights into the use and effectiveness of beta blockers and class 1B antiarrhythmic agents and define alternative pharmacological approaches for the different LQTS genotypes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: DIFFERENTIAL RESPONSES TO ANTIHYPERTENSIVE DRUGS Principal Investigator & Institution: Mann, Samuel J.; Associate Professor of Clinical Medicine; Weill Medical College of Cornell Univ New York, Ny 10021 Timing: Fiscal Year 2001 Summary: The aim of this study is to determine whether biochemical and psychological factors are predictive of response to different antihypertensive drugs. After undergoing biochemical and psychological profiling, and psychosocial interview, subjects receive in randomized order a diuretic, ACE inhibitor and alpha and beta blockers. The blood
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pressure response to each is assessed by BP measurement at home. The purpose is to determine what factors are predictive of responses to each of the study drugs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DRUG AND NON-DRUG TREATMENT OF SEVERE MIGRAINES Principal Investigator & Institution: Holroyd, Kenneth A.; Professor; Psychology; Ohio University Athens Athens, Oh 45701 Timing: Fiscal Year 2001; Project Start 30-SEP-1994; Project End 31-AUG-2005 Summary: (Adapted from investigator's abstract) The proposed study evaluates the effectiveness of preventive drug (beta-blocker) therapy and non-drug (behavioral migraine management) therapies for frequent migraine, both separately and when combined. The specific aims are to: (1) Evaluate the separate and combined effects of Preventive Drug Therapy and limited-contact Behavioral Migraine Management, with reference to Placebo in a (n=220) prospective outcome study; (2) Evaluate the effectiveness of these treatments of individuals with frequent (4-15 migraine days/month) disabling (above the population median in disability) migraine; (3) Evaluate the effects of these treatments on multiple outcome measures, including migraine activity, disability, quality of life, psychological symptoms and beliefs about migraines; (4) Evaluate the effects of these treatments on the use, effectiveness and cost of acute (5HT1 antagonist) therapy; (5) Evaluate intermediate (6 months) and long-term (1-year) treatment effects. Examine psychological variables hypothesized to be associated with the maintenance of treatment effects. Two hundred twenty patients meeting International Headache Society (Olesen, 1988) diagnostic criteria for migraine (w or w/o aura) and who experience frequent (4 to 15 migraine/days month) and disabling (above the median of migraine sufferers in disability) migraine will participate in the following three phases of this study: (1) pretreatment evaluation that includes structured diagnostic and psychosocial interview, neurological evaluation, psychosocial testing and at least 5 weeks baseline daily monitoring of migraine activity, migrainerelated disability and medication use; (2) a three-month treatment (administration/dose adjustment) phase where standard acute therapy plus one of the following four preventive therapies are administered in a 2 x 2 factorial design: Preventive Drug Therapy with beta-blockers, or Preventive Drug Therapy with placebo, or Behavioral Migraine Management Therapy + beta blockers, or Behavioral Migraine Management + placebo and, (3) a 12-month long evaluation phase where continuing care is provided and treatment efficacy is assessed at 1-month, 6-months and 12-months follow follow-up evaluations (with neurological & psychosocial evaluations and 5 additional weeks of daily headache, disability and medication recordings). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ECONOMICS AND QUALITY OF LIFE IN THE OCCLUDED ARTERY TRI Principal Investigator & Institution: Mark, Daniel B.; Medicine; Duke University Durham, Nc 27706 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-AUG-2004 Summary: This revised application proposes to establish an Economics and Quality of Life Coordinating Center for the Open Artery Trial, (OAT), a multi-center, randomized trial of late (3-21 days) percutaneous revascularization versus standard medical therapy in 3200 asymptomatic high-risk acute myocardial infarction (MI) survivors and who are found at diagnostic catheterization to have an occluded infarct-related artery. All
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patients will receive standard medical therapy (including aspirin, beta blockers, ACE inhibitors). Qualifying patient will be randomized in equal proportions to either percutaneous revascularization of the occluded infarct related artery or medical therapy alone. Patients will be recruited into the trial over a 2 year period, with a subsequent minimum follow-up period of 2.25 years. The primary endpoint of the trial is a composite of all cause mortality, non-fatal MI and hospitalization for class IV heart failure. Cost, cost effectiveness and health-related quality of life are secondary endpoints. In collaboration with the Clinical Coordinating Center and the Statistical and Data Coordinating Center, the Economics and Quality of Life Coordinating Center will perform the following major functions: 1) obtain baseline economic status and quality of life data from all patients enrolled at each participating study site at the time of randomization; 2) collect detailed health resource consumption data from the index hospitalization; 3) assess detailed economic, functional status and quality of life outcomes during follow-up telephone contacts by study site coordinators at 4 months, 1 year and 2.25 years after enrollment; 4) assess angina- and heart failure-related functional status by telephone contacts every 4 months during study follow-up; 5) identify all major medical encounters that occur during follow-up and collect detailed health care resource consumption data and cost data for each; 5) compare cost and quality of life outcomes for the two treatment arms according to intention-to-treat; 7) estimate the incremental cost effectiveness ratio for the experimental arm and perform extensive sensitivity analyses. If efficacy is demonstrated for the primary study endpoint, then the economic and quality of life data collected as part of this proposal will clearly be pivotal in determining how the results of this study are viewed and whether the findings of the trial receive widespread implementation. We propose to use state-of-the-art methods for measuring cost and quality of life and for estimating cost effectiveness. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EFFECT OF BETA BLOCKERS ON MYOCARDIAL ENERGY METABOLISM IN CARDIOMYOP Principal Investigator & Institution: Wallhaus, Thomas R.; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2001 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: GENERAL CLINICAL RESEARCH CENTER Principal Investigator & Institution: Mccurdy, Layton; None; Medical University of South Carolina 171 Ashley Ave Charleston, Sc 29425 Timing: Fiscal Year 2001; Project Start 01-MAR-1977; Project End 01-MAR-2001 Summary: This renewal application is a request for continuing support of the General Clinical Research Center at the Medical University of South Carolina. The GCRC is composed of an eight-bed inpatient unit and an outpatient facility featuring eight examination rooms. Major areas of research include: the pathobiology and treatment of severe congenital osteopetrosis; the genetic basis of insulin resistance in noninsulin dependent diabetics; the pathophysiology and treatment of hypertension; the role of hyperhomocyteinemia in vascular disease; the biochemical, hormonal and genetic characterization of the difference in bone and mineral metabolism in blacks compared to whites, the etiology of growth failure in sickle cell disease; the treatment of advanced
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mitral insufficiency with beta blockers; the effect of pentoxyphylline on renal function after cardiac transplantation; the etiology of panic disorder, the psychobiology of depression in children; the treatment of alcoholism; the treatment of Raynaud's Phenomenon; the role of thromboxane A2 in prostate hypertrophy, the molecular basis of prostatic cancer; the molecular basis of pancreatic cancer; the role of nutrition in breast cancer therapy; immunotoxin therapy of T cell ALL, the role of CEA virus vaccination in treating lung, breast, and gastrointestinal adenocarcinoma; dietary therapy of obesity; the stereospecific metabolism of beta blockers; neonatal adrenal function; and treatment of patients with HIV infections. The goal of the GCRC is to support existing clinical research, provide facilities and programs which stimulate the development of new areas of clinical research, facilitate the movement of basic science to clinical reality, and to train clinical investigators and support staff to ensure that patient oriented studies continue to be the ultimate level of medical research. Molecular biology, immunotherapy, cytokine therapies, and computer technology complement the traditional strengths of this GCRC. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IS MYOCARDIUM?
PROGRESSIVE
FIBROSIS
FATE
OF
HIBERNATING
Principal Investigator & Institution: Chen, Chunguang; Newark Beth Israel Medical Center 201 Lyons Ave Newark, Nj 07112 Timing: Fiscal Year 2001; Project Start 01-APR-1999; Project End 31-MAR-2003 Summary: (adapted from the applicant's abstract): The applicant points out that myocardial dysfunction associated with coronary artery disease may be due to infarction, viable but stunned or viable but hibernating myocardium. The applicant seeks to determine whether hibernating myocardium that is not treated with revascularization will result in progressive myocardial cell death and fibrosis, resulting in worsening heart failure. He describes the pig model of hibernation developed in his laboratory in which a chronic partial stenosis is placed on the coronary artery of a pig. The hypotheses are: 1. That myocyte cell death and fibrosis worsen as the duration of hibernation is prolonged, 2) that frequent episodes of demand ischemia will worsen the outcome; and 3) that beta blockers will attenuate the phenomenon. Daily dobutamine infusions will be used to try to exacerbate the progression of cell death and fibrosis. Beta blockers will be used to ameliorate the proposed worsening. It is hoped that this study will provide strategies for treating ischemic cardiomyopathy and end-stage heart failure. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MEDICATION USE, COMORBIDITY AND OUTCOMES IN OLDER PEOPLE Principal Investigator & Institution: Glynn, Robert J.; Associate Professor; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 15-MAY-2002; Project End 30-APR-2005 Summary: (provided by applicant): Patient characteristics including age, comorbidity and prognosis affect prescribing decisions and may be associated with under-use of many valuable drug therapies, particularly in frail older persons. The investigators propose epidemiologic studies that will: a) identify demographic and health-related factors associated with the decision to initiate specific drug regimens and to maintain adherence to previously prescribed therapies; and b) clarify the relationships between
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use of specific drugs and mortality in the elderly. Studies will focus on specific drug classes that are commonly under-utilized in spite of their demonstrated therapeutic value including: lipid lowering agents, beta blockers, angiotensin converting enzyme inhibitors, hypoglycemic agents, and glaucoma drugs. Additional methodologic aims are c) to construct a simple, drug-based comorbidity index that predicts mortality in older persons and d) to evaluate the extent to which treatment decisions are clarified by inclusion of information from HCFA's Minimum Data Set. The proposed studies will utilize data from two large populations of persons aged 65 years or older: 1) over 400,000 residents of New Jersey who had prescription drug coverage through either Medicaid or that state's Pharmacy Assistance for the Aged or Disabled program during the years 1990-2000; and 2) all residents of British Columbia, including over 500,000 persons during the years 1995-2000, who received prescription benefits through that province's universal program of drug benefits for the elderly. Data sources for these populations include: prescription drug claims from these benefit programs; data on hospitalizations including discharge diagnoses, information on outpatient visits and diagnoses, and on mortality available from parallel databases; and detailed information on patient characteristics available for New Jersey residents in nursing homes available from HCFA's Minimum Data Set. The study populations have high death rates and contain large numbers of subgroups at particular risk for under-treatment including those aged 85 and above, nursing home residents, women and blacks. Clarification of the epidemiology of drug use, based on current longitudinal data, can lead to improved prescribing practices and thereby decrease morbidity and mortality in high-risk populations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: OCCLUDED ARTERY TRIAL DATA COORDINATING CENTER Principal Investigator & Institution: Knatterud, Genell L.; President; Maryland Medical Research Institute, Inc 600 Wyndhurst Ave Baltimore, Md 21210 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-AUG-2004 Summary: Current pharmacologic strategies fail to achieve effective reperfusion in 30 percent or more of acute myocardial infarction (MI) patients, and many patients with occluded infarct-related arteries (IRAs) do not meet current criteria for use of these agents. Early angioplasty, an effective reperfusion method, is available to a small proportion of potentially eligible acute MI patients in the U. S. Hence, a substantial number of acute MI patients pass the time when reperfusion therapy has well documented benefit (12-24 hours) with a persistently closed IRAs. Several lines of experimental and clinical evidence suggest that late reperfusion of these patients could provide clinically significant reductions in mortality and morbidity. Hypothesis. Opening an occluded IRA 3-21 days after an acute MI in high-risk asymptomatic patients (ejection fraction less than 50 percent or proximal occlusion of a large coronary artery) will reduce the composite end point of mortality, recurrent MI, and hospitalization for NYHA Class IV congestive heart failure (CHF) over an average 3year follow-up. Study aims. In the Open Artery Trial (OAT) 3,200 patients will be randomly allocated in equal proportions to the two treatments over two years. One treatment will consist of conventional medical management (including aspirin, beta blockers, ACE inhibitors, and risk factor modification). The experimental treatment will consist of conventional medical therapy plus percutaneous coronary intervention and coronary stenting. The primary specific aim is to compare the composite outcome of allcause mortality, non-fatal MI and hospitalization for Class IV CHF based on an average 3-year follow-up among patients assigned to the two treatments. Three secondary
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specific aims are to compare: 1) the individual components of the study composite primary end point in the two treatments; 2) the medical costs of the two treatments; and 3) health-related quality of life in the two treatments. Role of Data Coordinating Center. This application is made for support of a Data Coordinating Center (DCC) at the Maryland Medical Research Institute. The DCC is responsible for statistical design and power calculations, random treatment assignments, data management, support for the Mortality and Morbidity Classification Committee, rapid communication and generation of performance data for review with the Study Chair and Co-Chair of the Clinical Coordinating Center and data analysis to assess treatment effects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: OCCLUDED ARTERY TRIAL--CLINICAL COORDINATING CENTER Principal Investigator & Institution: Hochman, Judith S.; Professor of Medicine; St. Luke's-Roosevelt Inst for Hlth Scis Health Sciences New York, Ny 10019 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-AUG-2004 Summary: Background. The benefits of establishing early coronary reperfusion in acute myocardial infarction (MI) have now been unequivocally established. However, current pharmacological strategies fail to achieve effective reperfusion in 30% or more of patients, and many patients with occluded infarct arteries do not meet current criteria for use of these agents. Early angioplasty, an effective reperfusion method, is available to a small proportion of potentially eligible US acute MI patients. Hence, a substantial number of acute MI patients pass the time when reperfusion therapy has any documented benefit (12-24 hours) with a persistently closed infarct vessel. Several lines of experimental and clinical evidence suggest that late reperfusion of these patients could provide clinically significant reductions in mortality and morbidity. Hypothesis: The central hypothesis of the Open Artery Trial is that opening an occluded infarct artery 3-21 days after an acute MI in high-risk asymptomatic patients (ejection fraction less than 50% or proximal occlusion of a large coronary artery) will reduce the composite endpoint of mortality, recurrent MI, and hospitalization for NYHA class IV congestive hear failure (CHF) over an average three year follow-up. Specific aims. The study will be a prospective clinical trial with 3,200 patients randomly allocated in equal proportions to two tretments arms over two years. One treatment will consist of conventional medical management (including aspirin, beta blockers, ACE inhibitors, and risk factor modification). The experimental treatment will consist of conventional medical therapy plus percutaneous coronary intervention and coronary stenting. Clinical outcomes will be compared using an intention-to-treat analysis. We have one primary specific aim: 1) To compare the composite outcome of all-cause mortality, nonfetal MI and hospitalization of NYHA class IV CHF based on an average three year follow-up among patients assigned to the two treatments. We have three secondary specific aims: 1) To compare the individual components of the study composite primary endpoint in the two treatment arms. 2) To compare the medical costs of the two treatments and assess the cost effectiveness of percutaneous revascularization in the study population. 3) To compare health-related quality of life in the two treatment groups. Operations. The Luke's-Roosevelt Hospital in New York City. The Data Coordinating Center (DCC) is at the Maryland Medical Research Institute. The Economics and Quality of Life Coordinating Center is at Duke University. The Angiographic Core Laboratory is at the University of British Columbia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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•
Project Title: OXAZOLIDINES AS POTENTIAL PRODRUGS--STABILITY AND PHARMACOLOGICAL STUDIES Principal Investigator & Institution: Walker, Richard B.; University of Arkansas at Pine Bluff Box 4038, 1200 N University Pine Bluff, Ar 71601 Timing: Fiscal Year 2001 Summary: Oxazolidines have been described as potential pro-drugs having the aminoalcohol moiety. These would include many of the adrenergic agonists and beta blockers. These pro-drugs may enhance ocular, oral, dermal, nasal or pulmonary absorption of the parent drugs, as well as lessen first-pass raised about the formulation of these compounds, due to their instability in aqueous media. The purpose of the study is to investigate methods of stabilizing aqueous solutions of oxazolidines, which could perhaps lead to successful formulation procedures. Stabilization could either be accomplished by decreasing hydrolysis rate or shifting the equilibrium formed between oxazolidine, drug, and aldehyde to the left. The effects of pH and cyclodextrin (CD) analogs on hydrolysis rates and equilibria will be measured for ten oxazolidines using spectrophotometric and HPLC methods. An animal model will be used to identify conditions which lessen dosage requirements for pharmacological responses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: RCT TO REDUCE PRESCRIBING ERRORS IN HYPERTENSION Principal Investigator & Institution: Soumerai, Stephen B.; Harvard Pilgrim Health Care, Inc. 93 Worcester St Wellesley, Ma 02481 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-MAR-2004 Summary: (After the Application): Suboptimal choice of medications for primary care is a significant source of prescribing errors that can compromise patient safety. Prescribing calcium channel blockers for hypertension, for example, instead of firstline, evidencebased agents such as diuretics and beta blockers, is a prescribing error that can lead not only to higher costs of medical care but also to higher rates of morbidity and mortality. An educational intervention to reduce prescribing errors in hypertension could therefore result in improved patient outcomes and patient safety. In 1995, Harvard Community Health Plan (HCHP), a large HMO in New England, began an internallyfunded, pilot educational program that implemented three different strategies to reduce primary care physicians? errors in prescribing antihypertensive medications. These interventions, carried out as a randomized controlled trial in three managed care settings (2 different staff-model divisions of the HMO, and a group-model division of the HMO), were 1) mailed dissemination of educational materials (control); 2) mailed dissemination plus group academic detailing, and 3) mailed dissemination plus individual academic detailing. The study population comprised approximately 5,000 hypertensive patients who received care from 104 primary care physicians. For purposes of later evaluation, this program randomly assigned three comparable group practices, one in each of three HCHP divisions (nine total physician groups) to one of three experimental groups (control, group detailing, individual detailing). This application describes a comprehensive evaluation of the educational program by collecting, merging, validating, and analyzing data from ambulatory encounters, outpatient claims, and pharmacy dispensing databases from the three divisions of HCHP to measure the effects of the study interventions on reducing prescribing errors in hypertension. The principal analyses will examine the immediate and long-term effects of the educational interventions on 1) incident prescribing of sub-optimal agents; and 2) switching from sub-optimal agents to first-line agents. This study will also analyze the program costs
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and medication cost savings. Dissemination will capitalize on collaboration with AHRQ, and the HMO Research Network?s Center for Education and Research on Therapeutics (CERT). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: SYMPATHETIC CONTROL IN HEART FAILURE: A ROLE FOR STATINS Principal Investigator & Institution: Zucker, Irving H.; Theodore F. Hubbard Professor of Cardiov; Physiology and Biophysics; University of Nebraska Medical Center Omaha, Ne 681987835 Timing: Fiscal Year 2002; Project Start 01-JUL-1987; Project End 30-JUN-2007 Summary: (provided by applicant): Sympatho-excitation along with general neurohumoral activation is a universal finding in the setting of chronic heart failure (CHF). Interruption of sympathetic nerve activity using beta blockers has been a standard therapeutic regimen for CHF patients for many years. However, the mechanisms responsible for sympatho-excitation in the CHF state are still unclear. Recently, it has been shown that several substances which are either increased or decreased in the CHF state act as modulators of sympathetic outflow. These substances include nitric oxide (NO), angiotensin II (Ang II) and endothelin-1 (ET-1). Recent animal and human studies have shown that the class of compounds known as HMG CoA reductase inhibitors or statins possess a variety of biological effects other than their ability to lower plasma cholesterol. These so called pleiotropic effects include lowering of arterial pressure, increasing production of endothelial NO, reducing Ang II receptors, reducing the production of ET-1 and scavenging of oxygen derived free radicals. Because of these actions we hypothesize that statins participate in sympatho-inhibition in the CHF state by virtue of several of the above effects. Preliminary data suggest that administration of simvastatin to rabbits with experimental CHF reduces resting renal sympathetic nerve activity (RSNA) and enhances baroreflex function. We propose a series of experiments to extend these preliminary studies and investigate the role of statins in sympathetic regulation in conscious rabbits with and without pacing-induced CHF. Rabbits will be treated with either simvastatin or pravastatin. Hemodynamics and RSNA will be measured as well as arterial baroreflex function. The role of NO will be determined by repeating experiments following peripheral and central blockade of nNOS. Central alterations in Ang II receptors and in ET-1 will be determined. Finally, the involvement of the GTP binding proteins of the Rho family will be determined in order to assess the role of these substances in mediating the enhancement of NO production by statins. These experiments will shed new light on central mechanisms of sympatho-excitation in the CHF state. The data accrued will have applicability to our understanding of autonomic regulation and therapeutics in this disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 3
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text
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The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with beta blockers, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “beta blockers” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for beta blockers (hyperlinks lead to article summaries): •
A 7 year prospective comparative study of three topical beta blockers in the management of primary open angle glaucoma. Author(s): Watson PG, Barnett MF, Parker V, Haybittle J. Source: The British Journal of Ophthalmology. 2001 August; 85(8): 962-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11466256&dopt=Abstract
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A nonsteady-state agonist antagonist interaction model using plasma potassium concentrations to quantify the beta-2 selectivity of beta blockers. Author(s): Jonkers R, van Boxtel CJ, Koopmans RP, Oosterhuis B. Source: The Journal of Pharmacology and Experimental Therapeutics. 1989 April; 249(1): 297-302. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2565392&dopt=Abstract
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A pressor effect of noncardioselective beta blockers in mildly hypertensive patients during surgery under anesthesia. Author(s): Cleophas TJ, Asselt LM, Oudshoorn NH, Quadir SU. Source: Angiology. 1991 October; 42(10): 805-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1952269&dopt=Abstract
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A review of early intervention studies with beta blockers in patients with myocardial infarction. Author(s): Hjalmarson A. Source: European Heart Journal. 1986 July; 7 Suppl B: 35-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2875874&dopt=Abstract
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A review of ongoing trials of beta blockers in the secondary prevention of coronary heart disease. Author(s): Cutler JA. Source: Circulation. 1983 June; 67(6 Pt 2): I62-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6133645&dopt=Abstract
journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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A slow trickledown. Data on efficacy of beta blockers belatedly spur use. Author(s): Moore JD Jr. Source: Modern Healthcare. 1998 September 14; 28(37): 70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10183097&dopt=Abstract
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A strategy for the determination of beta blockers in plasma using solid-phase extraction in combination with high-performance liquid chromatography. Author(s): Musch G, Buelens Y, Massart DL. Source: Journal of Pharmaceutical and Biomedical Analysis. 1989; 7(4): 483-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2577451&dopt=Abstract
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ABC of heart failure. Management: digoxin and other inotropes, beta blockers, and antiarrhythmic and antithrombotic treatment. Author(s): Gibbs CR, Davies MK, Lip GY. Source: Bmj (Clinical Research Ed.). 2000 February 19; 320(7233): 495-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10678868&dopt=Abstract
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Abrupt and gradual change from clonidine to beta blockers in hypertension. Author(s): Lilja M, Jounela AJ, Juustila HJ, Paalzow L. Source: Acta Med Scand. 1982; 211(5): 375-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6126070&dopt=Abstract
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According to MIAMI and ISIS-I trials, can a general recommendation be given for beta blockers in acute myocardial infarction? Author(s): Kjekshus JK. Source: Cardiovascular Drugs and Therapy / Sponsored by the International Society of Cardiovascular Pharmacotherapy. 1988 May; 2(1): 113-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2908718&dopt=Abstract
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Acute and chronic hemodynamic effects of drugs with different actions on adrenergic receptors: a comparison between alpha blockers and different types of beta blockers with and without vasodilating effect. Author(s): Lund-Johansen P, Omvik P. Source: Cardiovascular Drugs and Therapy / Sponsored by the International Society of Cardiovascular Pharmacotherapy. 1991 June; 5(3): 605-15. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1678963&dopt=Abstract
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Advantages of beta blockers versus antiarrhythmic agents and calcium antagonists in secondary prevention after myocardial infarction. Author(s): Singh BN. Source: The American Journal of Cardiology. 1990 September 25; 66(9): 9C-20C. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1699400&dopt=Abstract
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Age-related changes in autonomic control: the use of beta blockers in the treatment of hypertension. Author(s): Collins KJ. Source: Cardiovascular Drugs and Therapy / Sponsored by the International Society of Cardiovascular Pharmacotherapy. 1991 January; 4 Suppl 6: 1257-62. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1672602&dopt=Abstract
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Alpha and beta blockers: effects on renin release. Author(s): McDonald RH Jr, Corder CN, Leenen FH. Source: Prog Brain Res. 1977; 47: 409-16. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=22094&dopt=Abstract
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Alpha blockers and vasodilating beta blockers--influence on factors involved in the pathogenesis of vascular disease in patients with hypertension. Author(s): Louis WJ, Drummer OH, Howes LG. Source: Clin Exp Hypertens A. 1989; 11(5-6): 1075-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2571433&dopt=Abstract
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Alpha blockers, diuretics and beta blockers for hypertension. Author(s): Coutts LC. Source: American Family Physician. 1997 May 15; 55(7): 2431-2, 2434. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9166141&dopt=Abstract
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Alternative medical treatment for patients with angina pectoris and adverse reactions to beta blockers. Usefulness of nifedipine. Author(s): Vetrovec GW, Parker VE. Source: The American Journal of Medicine. 1986 October 20; 81(4A): 20-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2876634&dopt=Abstract
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An update on beta blockers. Author(s): Richter MA. Source: J La State Med Soc. 1982 March-April; 134(2): 40-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6125550&dopt=Abstract
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Antihypertensive therapy with calcium-channel blockers: comparison with beta blockers. Author(s): Massie BM. Source: The American Journal of Cardiology. 1985 December 6; 56(16): 97H-100H. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2866709&dopt=Abstract
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Anxiolytics and beta blockers: evaluation of pharmacodynamics by quantitative EEG, psychometric and physiological variables. Author(s): Saletu B, Grunberger J, Linzmayer L, Flener R. Source: Agressologie. 1981 October; 22(C): 5-16. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6119922&dopt=Abstract
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Anxiolytics not acting at the benzodiazepine receptor: beta blockers. Author(s): Tyrer P. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 1992 January; 16(1): 17-26. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1348368&dopt=Abstract
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Are angiotensin converting enzyme inhibitors superior to beta blockers in retarding progressive renal function decline? Author(s): van Essen GG, Apperloo AJ, Rensma PL, Stegeman CA, Sluiter WJ, de Zeeuw D, de Jong PE. Source: Kidney International. Supplement. 1997 December; 63: S58-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9407423&dopt=Abstract
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Are beta blockers and nifedipine safe? Author(s): Stockley IH. Source: Bmj (Clinical Research Ed.). 1989 June 10; 298(6687): 1584. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2569337&dopt=Abstract
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Ask the Doctor. I know that there have been a lot of studies showing that beta blockers help patients with congestive heart failure live longer. I have heart failure, and last year my doctor prescribed a beta blocker. In a few days, I became so short of breath that he had me stop taking it. I am upset that I can't use this important therapy. Is there any way I might be able to do so? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2001 May; 11(9): 7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11410436&dopt=Abstract
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Ask the doctor. I read in your newsletter and elsewhere that beta blockers can help people with heart failure, but my doctor has been reluctant to try them on me. Why is he so nervous? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 1999 May; 9(9): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10198463&dopt=Abstract
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Ask the doctor. My father has severe heart failure. The doctors say his ejection fraction is only about 10%, and he gets short of breath during any physical activity. I've read that beta blockers are useful for heart failure, but his doctors say they're too risky for my father. I'm worried that he's missing out on a beneficial treatment. Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2001 October; 12(2): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11684495&dopt=Abstract
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Aspartame, headaches and beta blockers. Author(s): Watts RS. Source: Headache. 1991 March; 31(3): 181-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1676993&dopt=Abstract
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Asystole and bradycardia during dipyridamole stress testing in patients receiving beta blockers. Author(s): Roach PJ, Magee MA, Freedman SB. Source: International Journal of Cardiology. 1993 November; 42(1): 92-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7906680&dopt=Abstract
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Atherogenic effects of beta blockers on cells cultured from normal and atherosclerotic aorta. Author(s): Orekhov AN, Ruda MYa, Baldenkov GN, Tertov VV, Khashimov KA, Ryong LH, Lyakishev AA, Kozlov SG, Tkachuk VA, Smirnov VN. Source: The American Journal of Cardiology. 1988 May 1; 61(13): 1116-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2896453&dopt=Abstract
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Attenuation of exercise training effects in patients taking beta blockers during early cardiac rehabilitation. Author(s): Ciske PE, Dressendorfer RH, Gordon S, Timmis GC. Source: American Heart Journal. 1986 November; 112(5): 1016-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2877561&dopt=Abstract
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beta Blockade after myocardial infarction. Beta blockers have key role in reducing morbidity and mortality after infarction. Author(s): Nuttall SL, Toescu V, Kendall MJ. Source: Bmj (Clinical Research Ed.). 2000 February 26; 320(7234): 581. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10688573&dopt=Abstract
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Beta blockers 1984. Part 1. Author(s): Wing LM. Source: Aust Fam Physician. 1984 July; 13(7): 533-4, 536, 538. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6148926&dopt=Abstract
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Beta blockers 1984. Part 2. Author(s): Wing LM. Source: Aust Fam Physician. 1984 August; 13(8): 604, 606, 608. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6149740&dopt=Abstract
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Beta blockers after myocardial infarction: have trials changed practice? Author(s): Baber NS, Julian DG, Lewis JA, Rose G. Source: British Medical Journal (Clinical Research Ed.). 1984 November 24; 289(6456): 1431-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6149786&dopt=Abstract
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Beta blockers after myocardial infarction: have trials changed practice? Author(s): Colling A. Source: British Medical Journal (Clinical Research Ed.). 1985 January 26; 290(6464): 322. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2857105&dopt=Abstract
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Beta blockers and calcium channel blocking agents in acute myocardial infarction. Author(s): Pearle DL, Rackley CE. Source: Cardiovasc Clin. 1986; 16(3): 29-38. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2875793&dopt=Abstract
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Beta blockers and congestive heart failure. Author(s): Movahed A. Source: American Family Physician. 2000 December 1; 62(11): 2402-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11130228&dopt=Abstract
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Beta blockers and exercise: physiologic and biochemical definitions and new concepts. Author(s): Harrison DC. Source: The American Journal of Cardiology. 1985 April 26; 55(10): 29D-33D. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2859795&dopt=Abstract
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Beta blockers and fatigue. Author(s): Hall PE, Kendall MJ, Smith SR. Source: J Clin Hosp Pharm. 1984 December; 9(4): 283-91. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6151954&dopt=Abstract
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Beta blockers and infarct size. Author(s): Norris RM. Source: Journal of Molecular and Cellular Cardiology. 1986 October; 18 Suppl 4: 99-103. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2878085&dopt=Abstract
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Beta blockers and lactation: an update. Author(s): Shannon ME, Malecha SE, Cha AJ. Source: Journal of Human Lactation : Official Journal of International Lactation Consultant Association. 2000 August; 16(3): 240-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11153162&dopt=Abstract
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Beta blockers and lipoproteins: a review of current knowledge. Author(s): Northcote RJ, Todd IC, Ballantyne D. Source: Scott Med J. 1986 October; 31(4): 220-8. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2882600&dopt=Abstract
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Beta blockers and loss of hearing. Author(s): Faldt R, Liedholm H, Aursnes J. Source: British Medical Journal (Clinical Research Ed.). 1984 December 1; 289(6457): 1490-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6439285&dopt=Abstract
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Beta blockers and renal function: a reappraisal. Author(s): Epstein M, Oster JR. Source: J Clin Hypertens. 1985 March; 1(1): 85-99. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2873206&dopt=Abstract
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Beta blockers and the central nervous system. Author(s): Schoenen J. Source: Cephalalgia : an International Journal of Headache. 1986; 6 Suppl 5: 47-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2879632&dopt=Abstract
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Beta blockers and the neutrophil. Author(s): Tannous R. Source: The Journal of Laboratory and Clinical Medicine. 1987 February; 109(2): 109-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2879878&dopt=Abstract
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Beta blockers and verapamil: a cautionary tale. Author(s): McGourty JC, Silas JH. Source: British Medical Journal (Clinical Research Ed.). 1984 December 8; 289(6458): 1624. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6439350&dopt=Abstract
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Beta blockers and verapamil: a cautionary tale. Author(s): Findlay IN, McInnes GT, Dargie HJ. Source: British Medical Journal (Clinical Research Ed.). 1984 October 20; 289(6451): 1074. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6148994&dopt=Abstract
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Beta blockers and verapamil: a cautionary tale. Author(s): Hutchison SJ, Lorimer AR, Lakhdar A, McAlpine SG. Source: British Medical Journal (Clinical Research Ed.). 1984 September 15; 289(6446): 659-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6434029&dopt=Abstract
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Beta blockers as cardioprotective agents: Part II--Focus on prevention of sudden cardiac death. Author(s): Goldstein S. Source: Am J Manag Care. 2002 June; 8(9 Suppl): 18-24. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12099324&dopt=Abstract
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Beta blockers as cardioprotective agents: Part I--Insights into mechanisms of action. Author(s): Frishman WH. Source: Am J Manag Care. 2002 June; 8(9 Suppl): 13-7. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12099323&dopt=Abstract
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Beta blockers enhance early diastolic filling in ischaemic heart disease: a radionuclide assessment. Author(s): Moralidis E, McCurrach G, Martin W, Hutton I. Source: Heart (British Cardiac Society). 2001 October; 86(4): 457. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11559691&dopt=Abstract
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Beta blockers for CHF. Adrenergic blockade dramatically reduces morbidity and mortality. Author(s): Garg RK, Sorrentino MJ. Source: Postgraduate Medicine. 2001 March; 109(3): 49-56. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11265362&dopt=Abstract
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Beta blockers for congestive heart failure. Author(s): Gilbert EM. Source: Postgraduate Medicine. 1998 February; 103(2): 25-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9479305&dopt=Abstract
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Beta blockers for glaucoma and excess risk of airways obstruction: population based cohort study. Author(s): Kirwan JF, Nightingale JA, Bunce C, Wormald R. Source: Bmj (Clinical Research Ed.). 2002 December 14; 325(7377): 1396-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12480856&dopt=Abstract
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Beta blockers have important role in pulmonary oedema due to mitral stenosis. Author(s): Oakley CM. Source: Bmj (Clinical Research Ed.). 1996 February 10; 312(7027): 376. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8611845&dopt=Abstract
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Beta blockers in heart failure. Author(s): Dargie HJ. Source: Lancet. 2003 July 5; 362(9377): 2-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12853188&dopt=Abstract
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Beta blockers in heart failure: a comparison of a vasodilating beta blocker with metoprolol. Author(s): Sanderson JE, Chan SK, Yu CM, Yeung LY, Chan WM, Raymond K, Chan KW, Woo KS. Source: Heart (British Cardiac Society). 1998 January; 79(1): 86-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9505927&dopt=Abstract
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Beta blockers in older persons with heart failure: tolerability and impact on quality of life. Author(s): Baxter AJ, Spensley A, Hildreth A, Karimova G, O'Connell JE, Gray CS. Source: Heart (British Cardiac Society). 2002 December; 88(6): 611-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12433890&dopt=Abstract
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Beta blockers in pregnancy and their effect on regional Doppler ultrasound and fetal weight. Author(s): Crichton F. Source: Clin Exp Obstet Gynecol. 1996; 23(1): 15-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8653927&dopt=Abstract
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Beta blockers normalize QT hysteresis in long QT syndrome. Author(s): Cochrane Database Syst Rev. 2002;(4):CD002992 Source: American Heart Journal. 2002 March; 143(3): 528-34. /entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12519582
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Beta blockers prevent cardiac death following a myocardial infarction: so why are so many infarct survivors discharged without beta blockers? Author(s): Viskin S, Barron HV. Source: The American Journal of Cardiology. 1996 October 1; 78(7): 821-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8857489&dopt=Abstract
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beta Blockers protect brain during cardiac surgery. Author(s): Tanne JH. Source: Bmj (Clinical Research Ed.). 2002 June 22; 324(7352): 1475. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12077027&dopt=Abstract
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Beta blockers with intrinsic sympathomimetic activity. Author(s): White WB. Source: American Family Physician. 1985 January; 31(1): 115-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2857059&dopt=Abstract
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Beta blockers, hypertension, and blacks--is the answer really in? Author(s): Veiga RV, Taylor RE. Source: Journal of the National Medical Association. 1986 September; 78(9): 851-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2878086&dopt=Abstract
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Beta blockers: an important therapeutic modality for hypertensive diabetics. Author(s): Rehan N, Nasir K. Source: J Ayub Med Coll Abbottabad. 2002 April-June; 14(2): 31-4. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12238344&dopt=Abstract
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Beta blockers: are they difficult to use in heart failure patients. Author(s): Klibaner M. Source: Clin Cardiol. 1999 June; 22(6): A27, 438. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10376173&dopt=Abstract
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Beta blockers: are they difficult to use in heart failure patients? Author(s): Conti CR. Source: Clin Cardiol. 1999 April; 22(4): 255-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10198734&dopt=Abstract
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Beta blockers: evidence versus wishful thinking. Author(s): Andresen D, Ehlers HC, Wiedemann M, Bruggemann T. Source: The American Journal of Cardiology. 1999 March 11; 83(5B): 64D-67D. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10089842&dopt=Abstract
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Brimonidine.2% as a replacement for beta blockers in geriatric patients with glaucoma. Author(s): Noecker RJ; Study Group for the Efficacy of Brimonidine in Geriatric Patients. Source: Adv Ther. 2002 March-April; 19(2): 91-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12069372&dopt=Abstract
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Calcium antagonists and beta blockers in the control of mild to moderate systemic hypertension, with particular reference to verapamil and propranolol. Author(s): Singh BN, Rebanal P, Piontek M, Nademanee K. Source: The American Journal of Cardiology. 1986 February 26; 57(7): 99D-105D. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2869676&dopt=Abstract
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Calcium blockers and beta blockers: alone and in combination. Author(s): Raftery EB. Source: Acta Med Scand Suppl. 1985; 694: 188-96. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3890470&dopt=Abstract
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Calcium-channel blockers and beta blockers: advantages and disadvantages of combination therapy in chronic stable angina pectoris. Author(s): Krikler DM, Harris L, Rowland E. Source: American Heart Journal. 1982 September; 104(3): 702-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6126115&dopt=Abstract
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Can aggressive behavior in humans be modified by beta blockers? Author(s): Volavka J. Source: Postgraduate Medicine. 1988 February 29; Spec No: 163-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2894657&dopt=Abstract
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Can beta blockers be safely initiated at home in patients with heart failure? Author(s): Wald DS, More RS, Martin M, Hughes L, Reid CJ. Source: Qjm : Monthly Journal of the Association of Physicians. 2002 January; 95(1): 55-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11834774&dopt=Abstract
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Can beta blockers be safely used in patients with recent myocardial infarction who also have congestive heart failure? Author(s): Julian DG. Source: Circulation. 1983 June; 67(6 Pt 2): I91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6133652&dopt=Abstract
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Can patients with coronary artery disease receiving beta blockers obtain a training effect? Author(s): Froelicher V, Sullivan M, Myers J, Jensen D. Source: The American Journal of Cardiology. 1985 April 26; 55(10): 155D-161D. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2859792&dopt=Abstract
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Cardiac 123 I-MIBG imaging and clinical variables in risk stratification in patients with heart failure treated with beta blockers. Author(s): de Milliano PA, Tijssen JG, van Eck-Smit BL, Lie KI. Source: Nuclear Medicine Communications. 2002 June; 23(6): 513-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12029205&dopt=Abstract
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Cardiogenic shock associated with calcium-channel and beta blockers: reversal with intravenous calcium chloride. Author(s): Henry M, Kay MM, Viccellio P. Source: The American Journal of Emergency Medicine. 1985 July; 3(4): 334-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2860911&dopt=Abstract
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Cardiology update. Beta blockers in cardiology. Author(s): Bhagat K. Source: Nurs Stand. 1994 November 30-December 6; 9(10): 54. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7833246&dopt=Abstract
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Carvedilol for heart failure: renewed interest in beta blockers. Author(s): Young JB. Source: Cleve Clin J Med. 1997 September; 64(8): 415-22. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9308217&dopt=Abstract
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Carvedilol: the new role of beta blockers in congestive heart failure. Author(s): Vanderhoff BT, Ruppel HM, Amsterdam PB. Source: American Family Physician. 1998 November 1; 58(7): 1627-34, 1641-2. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9824960&dopt=Abstract
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Caution in use of beta blockers during pregnancy. Author(s): Cheng TO. Source: Catheterization and Cardiovascular Diagnosis. 1995 February; 34(2): 186. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7788700&dopt=Abstract
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Cautionary tales on using beta blockers. Author(s): Newbern VB. Source: Geriatric Nursing (New York, N.Y.). 1991 May-June; 12(3): 119-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1687318&dopt=Abstract
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Central haemodynamic effects of beta blockers in hypertension. A comparison between atenolol, metoprolol, timolol, penbutolol, alprenolol pindolol and bunitrolol. Author(s): Lund-Johansen P. Source: European Heart Journal. 1983 July; 4 Suppl D: 1-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6137366&dopt=Abstract
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Choice of beta blockers in hypertensive patients who smoke. Author(s): Miller LG. Source: Clin Pharm. 1987 December; 6(12): 924-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2892606&dopt=Abstract
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Choice of selective versus nonselective beta blockers: implications for exercise training. Author(s): Kelly JG. Source: The American Journal of Cardiology. 1985 April 26; 55(10): 162D-166D. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2859793&dopt=Abstract
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Circadian variation in portal pressure: appropriate use of non-selective beta blockers in the prevention of variceal bleed. Author(s): Mann NS, Leung JW. Source: Medical Hypotheses. 2001 October; 57(4): 423-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11601861&dopt=Abstract
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Clinical efficacy and quality of life with indapamide alone or in combination with beta blockers or angiotensin-converting enzyme inhibitors. Author(s): Athanassiadis DI, Dimopoulos CG, Tsakiris AK, Cokkinos DF, Tourkantonis AA, Toutouzas PK, Boutin B, Guez D. Source: The American Journal of Cardiology. 1990 May 2; 65(17): 62H-66H. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2184654&dopt=Abstract
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Clinical relevance of intrinsic sympathomimetic activity of beta blockers. Author(s): Kostis JB, DeFelice EA, Frishman W, Hosler M, Krieger SK, Aglitz N, Kuo PT. Source: Angiology. 1981 November; 32(11): 780-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6119937&dopt=Abstract
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Clinical relevance of pharmacokinetic differences between beta blockers. Author(s): Kendall MJ. Source: The American Journal of Cardiology. 1997 November 13; 80(9B): 15J-19J. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9375944&dopt=Abstract
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Clinical studies on beta blockers and heart failure preceding the MERIT-HF Trial. Metoprolol CR/XL Randomized Intervention Trial in Heart Failure. Author(s): Goldstein S. Source: The American Journal of Cardiology. 1997 November 13; 80(9B): 50J-53J. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9375951&dopt=Abstract
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Clinical usefulness of 123I meta-iodobenzylguanidine imaging in predicting the effectiveness of beta blockers for patients with idiopathic dilated cardiomyopathy before and soon after treatment. Author(s): Kakuchi H, Sasaki T, Ishida Y, Komamura K, Miyatake K. Source: Heart (British Cardiac Society). 1999 February; 81(2): 148-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9922349&dopt=Abstract
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Cognitive effects of beta blockers. Author(s): Dimsdale JE, Newton RP. Source: Journal of Psychosomatic Research. 1992 April; 36(3): 229-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1564675&dopt=Abstract
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Combination of calcium channel blockers and beta blockers for patients with exercise-induced angina pectoris: a double-blind parallel-group comparison of different classes of calcium channel blockers. The Netherlands Working Group on Cardiovascular Research (WCN). Author(s): van der Vring JA, Daniels MC, Holwerda NJ, Withagen PJ, Schelling A, Cleophas TJ, Hendriks MG. Source: Angiology. 1999 June; 50(6): 447-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10378820&dopt=Abstract
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Combination of oral diltiazem and beta blockers. Author(s): Cheng TO. Source: Clin Cardiol. 1991 September; 14(9): A29. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1683824&dopt=Abstract
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Combination of verapamil and beta blockers in systemic hypertension. Author(s): Dargie H, Cleland J, Findlay I, Murray G, McInnes G. Source: The American Journal of Cardiology. 1986 February 26; 57(7): 80D-82D. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3513518&dopt=Abstract
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Combination therapy with calcium-channel blockers and beta blockers for chronic stable angina pectoris. Author(s): Leon MB, Rosing DR, Bonow RO, Epstein SE. Source: The American Journal of Cardiology. 1985 January 25; 55(3): 69B-80B. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2857518&dopt=Abstract
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Comparative effects of three beta blockers (atenolol, metoprolol, and propranolol) on survival after acute myocardial infarction. Author(s): Gottlieb SS, McCarter RJ. Source: The American Journal of Cardiology. 2001 April 1; 87(7): 823-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11274934&dopt=Abstract
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Comparative efficacy and concomitant use of bepridil and beta blockers in the management of angina pectoris. Author(s): Frishman WH. Source: The American Journal of Cardiology. 1992 April 9; 69(11): 50D-55D. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1553892&dopt=Abstract
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Comparative efficacy of nifedipine gastrointestinal therapeutic system versus diltiazem when added to beta blockers in stable angina pectoris. Author(s): Siu SC, Jacoby RM, Phillips RT, Nesto RW. Source: The American Journal of Cardiology. 1993 April 15; 71(11): 887-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8096670&dopt=Abstract
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Comparative efficacy of orally and topically administered beta blockers for chronic simple glaucoma. Author(s): Williamson J, Young JD, Atta H, Muir G, Kadom H. Source: The British Journal of Ophthalmology. 1985 January; 69(1): 41-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2856893&dopt=Abstract
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Comparison of the effects of angiotensin converting-enzyme inhibitors and beta blockers on survival in elderly patients with reduced left ventricular function after myocardial infarction. Author(s): Shlipak MG, Browner WS, Noguchi H, Massie B, Frances CD, McClellan M. Source: The American Journal of Medicine. 2001 April 15; 110(6): 425-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11331052&dopt=Abstract
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Concomitant use of nitrates, calcium channel blockers, and beta blockers for optimal antianginal therapy. Author(s): Cohn PF. Source: Clin Cardiol. 1994 August; 17(8): 415-21. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7955587&dopt=Abstract
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Controlled trials with beta blockers in heart failure: metoprolol as the prototype. Author(s): Fowler MB. Source: The American Journal of Cardiology. 1993 March 25; 71(9): 45C-53C. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8096675&dopt=Abstract
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Co-prescribing of medications used to treat obstructive lung disease, congestive heart failure and depression among users of topical beta blockers: estimates from three US Veterans Affairs Medical Centers. Author(s): Valuck RJ, Perlman JI, Anderson C, Wortman GI. Source: Pharmacoepidemiology and Drug Safety. 2001 October-November; 10(6): 511-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11828833&dopt=Abstract
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Current concepts of pharmacotherapy in hypertension--ophthalmically administered beta blockers and their cardiopulmonary effects. Author(s): Ann Surg. 2001 Aug;234(2):263-5 Source: Journal of Clinical Hypertension (Greenwich, Conn.). 2001 May-June; 3(3): 175-8. Review. /entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11505074
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Current use of ophthalmic beta blockers. Author(s): Gross RL, Pineyro A. Source: Journal of Glaucoma. 1997 June; 6(3): 188-91. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9211143&dopt=Abstract
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Decreased heart rate variability and beta blockers after acute myocardial infarction. Author(s): Airaksinen KE, Ikaheimo MJ, Takkunen JT. Source: The American Journal of Cardiology. 1988 April 15; 61(11): 959. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2895578&dopt=Abstract
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Description of time- and frequency- domain-based measures of heart rate variability in individuals taking antiarrhythmics, beta blockers, calcium channel blockers, and/or antihypertensive drugs after sudden cardiac arrest. Author(s): Cowan MJ, Pike K, Burr RL, Cain KC, Narayanan SB. Source: Journal of Electrocardiology. 1993; 26 Suppl: 1-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7910623&dopt=Abstract
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Detection of some antihypertensive drugs and their metabolites in urine by thin-layer chromatography. Five commonly used beta blockers and hydralazine. Author(s): Jack DB, Dean S, Kendall MJ. Source: Journal of Chromatography. 1980 January 4; 187(1): 277-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6102096&dopt=Abstract
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Detection of some antihypertensive drugs and their metabolites in urine by thin-layer chromatography: II. A further five beta blockers and dihydralazine. Author(s): Jack DB, Dean S, Kendall MJ, Laugher S. Source: Journal of Chromatography. 1980 August 1; 196(1): 189-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6105163&dopt=Abstract
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Digoxin withdrawal in patients with dilated cardiomyopathy following normalization of ejection fraction with beta blockers. Author(s): Shammas NW, Harris ML, McKinney D, Hauber WJ. Source: Clin Cardiol. 2001 December; 24(12): 786-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11768743&dopt=Abstract
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Discontinuation of beta blockers before exercise radionuclide ventriculograms. Author(s): Ponto JA, Holmes KA. Source: Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine. 1982 May; 23(5): 456-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6122724&dopt=Abstract
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Disparate hemodynamic responses to mental challenge after antihypertensive therapy with beta blockers and calcium entry blockers. Author(s): Ferlinz J. Source: The American Journal of Medicine. 1987 April; 82(4): 868-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2882679&dopt=Abstract
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Disparate hemodynamic responses to mental challenge after antihypertensive therapy with beta blockers and calcium entry blockers. Author(s): Schmieder RE, Rueddel H, Neus H, Messerli FH, Von Eiff AW. Source: The American Journal of Medicine. 1987 January; 82(1): 11-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2879457&dopt=Abstract
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Do beta blockers cause arthropathy? Author(s): Silman AJ. Source: British Medical Journal (Clinical Research Ed.). 1986 January 18; 292(6514): 206. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2867804&dopt=Abstract
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Do beta blockers cause arthropathy? A case control study. Author(s): Waller PC, Ramsay LE. Source: British Medical Journal (Clinical Research Ed.). 1985 December 14; 291(6510): 1684. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2866808&dopt=Abstract
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Do beta blockers differ in their effects on hepatic microsomal enzymes and liver blood flow? Author(s): Parker G, Ene MD, Daneshmend TK, Roberts CJ. Source: Journal of Clinical Pharmacology. 1984 November-December; 24(11-12): 493-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6150945&dopt=Abstract
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Do beta blockers prevent pressor responses to mental stress and physical exercise? Author(s): Francois B, Cahen R, Gravejat MF, Estrade M. Source: European Heart Journal. 1984 May; 5(5): 348-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6145591&dopt=Abstract
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Dobutamine stress echocardiography for the detection of myocardial viability in patients with left ventricular dysfunction taking beta blockers: accuracy and optimal dose. Author(s): Zaglavara T, Haaverstad R, Cumberledge B, Irvine T, Karvounis H, Parharidis G, Louridas G, Kenny A. Source: Heart (British Cardiac Society). 2002 April; 87(4): 329-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11907003&dopt=Abstract
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Drug interactions and beta blockers. Author(s): Beeley L. Source: British Medical Journal (Clinical Research Ed.). 1984 November 17; 289(6455): 1330-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6149784&dopt=Abstract
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Drug treatment--antihypertensive drugs--the present role of beta blockers and alpha blockers. Author(s): Reid JL. Source: Clinical and Experimental Hypertension (New York, N.Y. : 1993). 1999 JulyAugust; 21(5-6): 815-21. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10423104&dopt=Abstract
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Drugs and the elderly; beta blockers and calcium channel blockers. Author(s): Todd B. Source: Geriatric Nursing (New York, N.Y.). 1982 July-August; 3(4): 228-32, 275. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6124487&dopt=Abstract
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Duration of action of beta blockers. Author(s): Johansson SR, McCall M, Wilhelmsson C, Vedin JA. Source: Clinical Pharmacology and Therapeutics. 1980 May; 27(5): 593-601. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6102896&dopt=Abstract
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Early-morning administration of short-acting beta blockers for treatment of winter depression. Author(s): Schlager DS. Source: The American Journal of Psychiatry. 1994 September; 151(9): 1383-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8067499&dopt=Abstract
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Economic consequences of postinfarction prophylaxis with beta blockers: cost effectiveness of metoprolol. Author(s): Olsson G, Levin LA, Rehnqvist N. Source: British Medical Journal (Clinical Research Ed.). 1987 February 7; 294(6568): 33942. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3101865&dopt=Abstract
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Effect of beta blockers after coronary artery bypass in postinfarct patients: what can we learn from available literature? Author(s): Geraci SA, Haan CK. Source: The Annals of Thoracic Surgery. 2002 November; 74(5): 1727-32. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12440651&dopt=Abstract
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Effect of beta blockers alone, of angiotensin-converting enzyme inhibitors alone, and of beta blockers plus angiotensin-converting enzyme inhibitors on new coronary events and on congestive heart failure in older persons with healed myocardial infarcts and asymptomatic left ventricular systolic dysfunction. Author(s): Aronow WS, Ahn C, Kronzon I. Source: The American Journal of Cardiology. 2001 December 1; 88(11): 1298-300. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11728359&dopt=Abstract
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Effect of beta blockers on blood lipid profile. Author(s): Lehtonen A. Source: American Heart Journal. 1985 May; 109(5 Pt 2): 1192-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2859784&dopt=Abstract
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Effect of beta blockers on expression of interleukin-6 and C-reactive protein in patients with unstable angina pectoris. Author(s): Doo YC, Kim DM, Oh DJ, Ryu KH, Rhim CY, Lee Y. Source: The American Journal of Cardiology. 2001 August 15; 88(4): 422-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11545768&dopt=Abstract
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Effect of beta blockers on incidence of new coronary events in older persons with prior myocardial infarction and diabetes mellitus. Author(s): Aronow WS, Ahn C. Source: The American Journal of Cardiology. 2001 March 15; 87(6): 780-1, A8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11249904&dopt=Abstract
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Effect of beta blockers on incidence of new coronary events in older persons with prior myocardial infarction and symptomatic peripheral arterial disease. Author(s): Aronow WS, Ahn C. Source: The American Journal of Cardiology. 2001 June 1; 87(11): 1284-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11377356&dopt=Abstract
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Effect of beta blockers on mortality and morbidity in persons treated for congestive heart failure. Author(s): Aronow WS. Source: Journal of the American Geriatrics Society. 2001 March; 49(3): 331-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11300246&dopt=Abstract
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Effect of beta blockers on new congestive heart failure in older persons with healed myocardial infarcts. Author(s): Lee YC. Source: The American Journal of Cardiology. 2002 July 1; 90(1): 86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12088792&dopt=Abstract
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Effect of beta blockers on the time to first syncope recurrence in patients after a positive isoproterenol tilt table test. Author(s): Sheldon R, Rose S, Flanagan P, Koshman ML, Killam S. Source: The American Journal of Cardiology. 1996 September 1; 78(5): 536-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8806338&dopt=Abstract
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Effect of beta blockers on vascular resistance in systemic hypertension. Author(s): Man in 't Veld AJ. Source: The American Journal of Cardiology. 1987 May 15; 59(13): 21F-25F. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2883873&dopt=Abstract
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Effect of low dose beta blockers on atrial and ventricular (B type) natriuretic factor in heart failure: a double blind, randomised comparison of metoprolol and a third generation vasodilating beta blocker. Author(s): Sanderson JE, Chan WW, Hung YT, Chan SK, Shum IO, Raymond K, Woo KS. Source: British Heart Journal. 1995 November; 74(5): 502-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8562234&dopt=Abstract
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Effect of partial agonist activity in beta blockers in severe angina pectoris: a double blind comparison of pindolol and atenolol. Author(s): Quyyumi AA, Wright C, Mockus L, Fox KM. Source: British Medical Journal (Clinical Research Ed.). 1984 October 13; 289(6450): 9513. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6148991&dopt=Abstract
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Effect of right atrial pacing, intravenous amiodarone and beta blockers for suppression of atrial fibrillation after coronary artery bypass surgery: a pilot study. Author(s): Cardona F, Seide H, Cox RA, Perez CM. Source: P R Health Sci J. 2003 June; 22(2): 119-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12866134&dopt=Abstract
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Effects of ACE inhibition supplementary to beta blockers and diuretics in early diabetic nephropathy. Author(s): Pedersen MM, Hansen KW, Schmitz A, Sorensen K, Christensen CK, Mogensen CE. Source: Kidney International. 1992 April; 41(4): 883-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1355149&dopt=Abstract
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Effects of beta blockers (atenolol or metoprolol) on heart rate variability after acute myocardial infarction. Author(s): Sandrone G, Mortara A, Torzillo D, La Rovere MT, Malliani A, Lombardi F. Source: The American Journal of Cardiology. 1994 August 15; 74(4): 340-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8059695&dopt=Abstract
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Effects of beta blockers and other antihypertensive drugs on cardiovascular risk. Author(s): Chobanian AV. Source: The American Journal of Cardiology. 1987 May 15; 59(13): 48F-52F. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2883879&dopt=Abstract
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Effects of beta blockers on symptoms and functional capacity in heart failure. Author(s): Fowler MB. Source: The American Journal of Cardiology. 1997 December 4; 80(11A): 55L-58L. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9412543&dopt=Abstract
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Effects of beta blockers on ventricular dysfunction after myocardial infarction: tolerability and survival effects. Author(s): Held P. Source: The American Journal of Cardiology. 1993 March 25; 71(9): 39C-44C. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8096674&dopt=Abstract
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Effects of cardioselective beta blockers on ventilation and gas exchange in patients with heart disease during ramp treadmill testing. Author(s): Foley KO, Brubaker PH, Matrazzo B, Berry MJ, Pribanich S, Miller HS. Source: The American Journal of Cardiology. 1997 November 1; 80(9): 1215-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9359554&dopt=Abstract
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Efficacy and safety of sustained-release diltiazem as replacement therapy for beta blockers and diuretics for stable angina pectoris and coexisting essential hypertension: a multicenter trial. Author(s): Kawanishi DT, Leman RB, Pratt CM, O'Rourke RA. Source: The American Journal of Cardiology. 1987 December 14; 60(17): 29I-35I. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2891291&dopt=Abstract
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Efficacy and tolerance of the new long-acting vasodilator RO 12-4713 in hypertensive patients not managed on beta blockers and diuretics. Author(s): Amann FW, Bolli P, Buhler FR. Source: Int J Clin Pharmacol Ther Toxicol. 1984 January; 22(1): 13-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6142004&dopt=Abstract
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Efficacy of beta blockers in idiopathic dilated cardiomyopathy and ischemic cardiomyopathy. Author(s): Waagstein F. Source: The American Journal of Cardiology. 1997 November 13; 80(9B): 45J-49J. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9375950&dopt=Abstract
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Efficacy of nifedipine gastrointestinal therapeutic system in combination with beta blockers in the management of exertional angina. A multicenter study of 54 patients. Author(s): Bittar N, Corder CN, Eich R, McGrew FA 3rd, Paulk EA, Zellner S. Source: The American Journal of Medicine. 1987 December 21; 83(6B): 30-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2902792&dopt=Abstract
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Electrophysiologic effects of beta blockers in ventricular arrhythmias. Author(s): Venditti FJ Jr, Garan H, Ruskin JN. Source: The American Journal of Cardiology. 1987 August 31; 60(6): 3D-9D. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2888298&dopt=Abstract
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Electrophysiology of beta blockers in supraventricular arrhythmias. Author(s): Kowey PR, Friehling TD, Marinchak RA. Source: The American Journal of Cardiology. 1987 August 31; 60(6): 32D-38D. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2888299&dopt=Abstract
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Enalapril and beta blockers in chronic renal failure. Author(s): Hazar DB, Tso L. Source: Bmj (Clinical Research Ed.). 1995 January 14; 310(6972): 129. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7833715&dopt=Abstract
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Evaluating effects of treatment in subgroups of patients within a clinical trial: the case of non-Q-wave myocardial infarction and beta blockers. Author(s): Yusuf S, Wittes J, Probstfield J. Source: The American Journal of Cardiology. 1990 July 15; 66(2): 220-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1973589&dopt=Abstract
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Experience with beta blockers in heart failure mortality trials. Author(s): Eichhorn EJ. Source: Clin Cardiol. 1999 October; 22 Suppl 5: V21-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10526700&dopt=Abstract
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From beta blockers to Ca2+ blockers in hypertension: a review. Author(s): Iaina A, Eliahou HE. Source: Isr J Med Sci. 1982 July; 18(7): 735-9. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6125488&dopt=Abstract
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Future/novel uses of beta blockers in clinical therapeutics. Author(s): Maclean D. Source: Angiology. 1986 March; 37(3 Pt 2): 218-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2871780&dopt=Abstract
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Genetic and environmental nature of the insulin resistance syndrome in IndoMauritian subjects with premature coronary heart disease: contribution of beta3adrenoreceptor gene polymorphism and beta blockers on triglyceride and HDL concentrations. Author(s): Manraj M, Francke S, Hebe A, Ramjuttun US, Froguel P. Source: Diabetologia. 2001 January; 44(1): 115-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11206402&dopt=Abstract
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Haemodynamic effects of different beta blockers in angina pectoris. Author(s): Astrom H, Jonsson B. Source: Scott Med J. 1977 January; 22(1): 64-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13496&dopt=Abstract
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Haemodynamic study as guideline for the use of beta blockers in acute theophylline poisoning. Author(s): Kempf J, Rusterholtz T, Ber C, Gayol S, Jaeger A. Source: Intensive Care Medicine. 1996 June; 22(6): 585-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8814476&dopt=Abstract
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Heart Failure: Treatment strategies for heart failure: beta blockers andantiarrhythmics. Author(s): Maggioni AP. Source: Heart (British Cardiac Society). 2001 January; 85(1): 97-103. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11119476&dopt=Abstract
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Hemodynamic and electrophysiologic interactions between antiarrhythmic drugs and beta blockers, with special reference to tocainide. Author(s): Ikram H. Source: American Heart Journal. 1980 December; 100(6 Pt 2): 1076-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6108707&dopt=Abstract
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How disturbing are side effects of beta blockers. Author(s): Besterman EM. Source: European Heart Journal. 1983 July; 4 Suppl D: 143-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6137374&dopt=Abstract
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How do the various beta blockers compare in type, frequency and severity of their adverse effects? Author(s): Friedman LM. Source: Circulation. 1983 June; 67(6 Pt 2): I89-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6133651&dopt=Abstract
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How well are the cardiovascular risk profiles modulated by current beta blockers in hypertension? Author(s): Hayduk K. Source: Cardiology. 1993; 82 Suppl 3: 3-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8106162&dopt=Abstract
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Hypertension in pregnancy: evaluation of two beta blockers atenolol and labetalol. Author(s): Lardoux H, Gerard J, Blazquez G, Chouty F, Flouvat B. Source: European Heart Journal. 1983 November; 4 Suppl G: 35-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6662119&dopt=Abstract
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Hypotensive mechanisms of beta blockers. Author(s): Conway J. Source: European Heart Journal. 1983 July; 4 Suppl D: 43-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6137382&dopt=Abstract
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Impact of beta 1 selectivity and intrinsic sympathomimetic activity on potential unwanted noncardiovascular effects of beta blockers. Author(s): Kendall MJ. Source: The American Journal of Cardiology. 1987 May 15; 59(13): 44F-47F. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2883878&dopt=Abstract
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Impact of clinical trials on the use of beta blockers after acute myocardial infarction and its relation to other risk indicators for death and 1-year mortality rate. Author(s): Karlson BW, Herlitz J, Hjalmarson A. Source: Clin Cardiol. 1994 June; 17(6): 311-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7915221&dopt=Abstract
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Impairment of physical performance after treatment with beta blockers and alpha blockers. Author(s): Bengtsson C. Source: British Medical Journal (Clinical Research Ed.). 1984 March 3; 288(6418): 671-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6141834&dopt=Abstract
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Importance of ancillary properties of beta blockers in angina: a study of celiprolol and atenolol. Author(s): McLenachan JM, Wilson JT, Dargie HJ. Source: British Heart Journal. 1988 June; 59(6): 685-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2899439&dopt=Abstract
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Incidence of new coronary events in older persons with prior myocardial infarction and systemic hypertension treated with beta blockers, angiotensin-converting enzyme inhibitors, diuretics, calcium antagonists, and alpha blockers. Author(s): Aronow WS, Ahn C. Source: The American Journal of Cardiology. 2002 May 15; 89(10): 1207-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12008178&dopt=Abstract
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Incidence of ocular side effects of topical beta blockers in the Netherlands. Author(s): van Beek LM, de Keizer RJ, Polak BC, Elzenaar PR, van Haeringen NJ, Kijlstra A. Source: The British Journal of Ophthalmology. 2000 August; 84(8): 856-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10906091&dopt=Abstract
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Influence of some beta blockers (pindolol, atenolol, timolol and metoprolol) on aggregation and arachidonic acid metabolism in human platelets. Author(s): Srivastava KC. Source: Prostaglandins Leukot Med. 1987 September; 29(1): 79-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2890173&dopt=Abstract
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Initial experience with beta blockers in dilated cardiomyopathy. Author(s): Swedberg K. Source: The American Journal of Cardiology. 1993 March 25; 71(9): 30C-38C. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8096673&dopt=Abstract
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Interaction between beta blockers and epinephrine on hemodynamics of spontaneously hypertensive rats. Author(s): Kim Y. Source: Res Commun Chem Pathol Pharmacol. 1993 April; 80(1): 3-19. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8488340&dopt=Abstract
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Interaction between two calcium antagonists and two beta blockers in conscious rabbits: hemodynamic consequences of differing cardiodepressant properties. Author(s): Hof RP. Source: The American Journal of Cardiology. 1987 January 30; 59(3): 43B-51B. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2880495&dopt=Abstract
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Interesting uses of beta blockers (2): propranolol in schizophrenia. Author(s): Chiu E. Source: Aust Fam Physician. 1981 May; 10(5): 376-9, 381-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7283843&dopt=Abstract
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Interesting uses of beta blockers (3): Beta blockers in anxiety. Author(s): Ogborne WL. Source: Aust Fam Physician. 1981 June; 10(6): 472-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6116486&dopt=Abstract
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Interesting uses of beta blockers. 1. Beta blockers in migraine prevention. Author(s): Anthony M. Source: Aust Fam Physician. 1981 April; 10(4): 258-9, 262. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6113825&dopt=Abstract
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Interesting uses of beta blockers: 5 Beta blockers in thyrotoxicosis. Author(s): Larkins RG, Heyma P. Source: Aust Fam Physician. 1981 October; 10(10): 833-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6118114&dopt=Abstract
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Interindividual pharmacokinetic and pharmacodynamic variability of different beta blockers. Author(s): Dayer P, Merier G, Perrenoud JJ, Marmy A, Leemann T. Source: Journal of Cardiovascular Pharmacology. 1986; 8 Suppl 6: S20-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2439813&dopt=Abstract
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Introducing new treatments in clinical practice: the Italian approach to beta blockers in heart failure. Author(s): Maggioni AP, Tavazzi L. Source: Heart (British Cardiac Society). 1999 May; 81(5): 453-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10212156&dopt=Abstract
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Ischaemic heart disease: how well are the risk profiles modulated by current beta blockers? Author(s): Leren P. Source: Cardiology. 1993; 82 Suppl 3: 8-12. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8106167&dopt=Abstract
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Key references. Beta blockers. Author(s): Nies AS. Source: Circulation. 1982 December; 66(6): 1342-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6128087&dopt=Abstract
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La practica quotidiana dello scompenso cardiaco: il caso del betablocco (Daily practice in heart failure: the case of adrenergic beta blockers). Author(s): Opasich C, Ferrari R. Source: Ital Heart J. 2000 August; 1(8 Suppl): 993-5. English, Italian. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10993004&dopt=Abstract
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Labetalol, beta blockers, and acute deterioration of chronic airway obstruction. Author(s): Adam WR, Meagher EJ, Barter CE. Source: Clin Exp Hypertens A. 1982; 4(8): 1419-28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6126285&dopt=Abstract
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Limitation of infarct size by beta blockers and its potential role for prognosis. Author(s): Hjalmarson A, Herlitz J. Source: Circulation. 1983 June; 67(6 Pt 2): I68-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6133646&dopt=Abstract
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Lipophilicity of beta blockers. Author(s): Sullman SA, Jackson EA. Source: Clin Pharm. 1983 November-December; 2(6): 510-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6140094&dopt=Abstract
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Lipophilicity, hydrophilicity, and the central nervous system side effects of beta blockers. Author(s): Drayer DE. Source: Pharmacotherapy. 1987; 7(4): 87-91. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2891122&dopt=Abstract
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Low density lipoprotein composition and oxidizability in coronary disease--apparent favourable effect of beta blockers. Author(s): Croft KD, Dimmitt SB, Moulton C, Beilin LJ. Source: Atherosclerosis. 1992 December; 97(2-3): 123-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1361323&dopt=Abstract
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Management of arrhythmias in ischemic heart disease. The role of beta blockers. Author(s): Morganroth J. Source: Postgraduate Medicine. 1988 February 29; Spec No: 113-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2894654&dopt=Abstract
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Management of hypertension. What is the role of beta blockers? Author(s): Gifford RW Jr. Source: Postgraduate Medicine. 1988 February 29; Spec No: 46-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2894661&dopt=Abstract
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Managing angina with beta blockers. Author(s): Segal BL, Kotler MN, Iskandrian AS. Source: Geriatrics. 1982 October; 37(10): 69-72, 76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6126421&dopt=Abstract
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Managing stable angina pectoris: nitroglycerin, beta blockers and risk factor reduction. Author(s): Wright C. Source: The Nurse Practitioner. 1984 February; 9(2): 54, 55, 57 Passim. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6143290&dopt=Abstract
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Medical management of angina: nitrates, beta blockers, calcium channel blockers. Author(s): Goosby E, Goldschlager N. Source: Postgraduate Medicine. 1982 September; 72(3): 50-2, 55-9, 62-3 Passim. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6126868&dopt=Abstract
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Medical management of mild-to-moderate heart failure before the advent of beta blockers. Author(s): Abraham WT, Wagoner LE. Source: The American Journal of Medicine. 2001 May 7; 110 Suppl 7A: 47S-62S. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11334776&dopt=Abstract
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Mode of action of beta blockers in angina pectoris. Author(s): Ablad B, Carlsson E, Ek L, Johnsson G. Source: Scott Med J. 1977 January; 22(1): 52-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13495&dopt=Abstract
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Mortality reduction by antiadrenergic modulation of arrhythmogenic substrate: significance of combining beta blockers and amiodarone. Author(s): Ogunyankin KO, Singh BN. Source: The American Journal of Cardiology. 1999 November 4; 84(9A): 76R-82R. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10568664&dopt=Abstract
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Nebulised salbutamol: an antidote for beta blockers. Author(s): Arora P, Kumar V, Dubey NK, Mahesh K. Source: Indian Pediatrics. 1999 June; 36(6): 591-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10736590&dopt=Abstract
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New drugs: beta blockers and sympathomimetics. Author(s): Feely J, Maclean D. Source: British Medical Journal (Clinical Research Ed.). 1983 June 18; 286(6382): 1972. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6407660&dopt=Abstract
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New drugs: beta blockers and sympathomimetics. Author(s): Kaye CM. Source: British Medical Journal (Clinical Research Ed.). 1983 April 30; 286(6375): 1439. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6404493&dopt=Abstract
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Newer beta blockers and the treatment of hypertension. Author(s): McAreavey D, Vermeulen R, Robertson JI. Source: Cardiovascular Drugs and Therapy / Sponsored by the International Society of Cardiovascular Pharmacotherapy. 1991 June; 5(3): 577-87. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1678961&dopt=Abstract
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Normalization of lipid metabolism after withdrawal from antihypertensive long-term therapy with beta blockers and diuretics. Author(s): Middeke M, Richter WO, Schwandt P, Beck B, Holzgreve H. Source: Arteriosclerosis. 1990 January-February; 10(1): 145-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2297344&dopt=Abstract
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Nutritional dose of magnesium in hypertensive patients on beta blockers lowers systolic blood pressure: a double-blind, cross-over study. Author(s): Wirell MP, Wester PO, Stegmayr BG. Source: Journal of Internal Medicine. 1994 August; 236(2): 189-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7913949&dopt=Abstract
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Obstacles to the initiation of beta blockers for heart failure in a specialised clinic within a district general hospital. Author(s): Mahmoudi M, McDonagh S, Poole-Wilson P, Dubrey SW. Source: Heart (British Cardiac Society). 2003 April; 89(4): 442-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12639877&dopt=Abstract
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Phantom limb pain: a case for beta blockers? Author(s): Marsland AR, Weekes JW, Atkinson RL, Leong MG. Source: Pain. 1982 March; 12(3): 295-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6123103&dopt=Abstract
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Pharmacodynamic models of various beta blockers: an explanation for the long duration of action of bopindolol. Author(s): Grevel J. Source: Journal of Cardiovascular Pharmacology. 1986; 8 Suppl 6: S16-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2439812&dopt=Abstract
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Pharmacologic characterization of beta blockers with special reference to the significance of nonspecific membrane effects. Author(s): Imai S. Source: The American Journal of Cardiology. 1991 April 22; 67(10): 8B-12B. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1673583&dopt=Abstract
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Pharmacologic differences between beta blockers. Author(s): Wood AJ. Source: American Heart Journal. 1984 October; 108(4 Pt 2): 1070-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6148865&dopt=Abstract
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Pharmacological and therapeutic basis for combined administration of beta blockers and calcium channel blockers in the treatment of stable chronic angina. Author(s): Spaulding C, Cabanes L, Weber S. Source: Br J Clin Pract Suppl. 1997 April; 88: 17-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9519503&dopt=Abstract
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Pharmacological characteristics of beta blockers and their role in clinical practice. Author(s): McDevitt DG. Source: Journal of Cardiovascular Pharmacology. 1986; 8 Suppl 6: S5-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2439820&dopt=Abstract
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Plasma levels of digoxin in patients with atrial fibrillation and indications to the association with beta blockers. Author(s): Melacini P, Cargnelli G, Roberti G, Schivazappa L, Ferrari M. Source: Pharmacol Res Commun. 1976 October; 8(5): 495-502. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1026971&dopt=Abstract
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Position of beta blockers in antihypertensive therapy. Author(s): Buhler FR, Brunner HR, Hansson L, Prichard BN, Vetter W, Zanchetti A. Source: Journal of Cardiovascular Pharmacology. 1986; 8 Suppl 6: S1-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2439809&dopt=Abstract
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Possible mechanisms of action in the positive effect of beta blockers in heart failure. Author(s): Kendall MJ. Source: Heart (British Cardiac Society). 1999 December; 82 Suppl 4: Iv5-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10574903&dopt=Abstract
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Possible regression of left ventricular hypertrophy during antihypertensive treatment with diuretics and/or beta blockers. Author(s): Cherchi A, Sau F, Seguro C. Source: J Clin Hypertens. 1987 June; 3(2): 216-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2886561&dopt=Abstract
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Postinfarction therapy with beta blockers: who should be treated? Author(s): Moss AJ. Source: International Journal of Cardiology. 1982; 1(5-6): 343-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6126440&dopt=Abstract
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Post-myocardial infarction trials: beta blockers, antiarrhythmics, thrombolytics. Author(s): Anderson JL. Source: Controlled Clinical Trials. 1996 June; 17(3 Suppl): 17S-27S. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8877264&dopt=Abstract
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Potential benefit of combination therapy with diuretics and beta blockers having intrinsic sympathomimetic activity. Author(s): Weinberger MH. Source: European Heart Journal. 1990 June; 11(6): 560-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1972064&dopt=Abstract
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Practolol and the safety of other beta blockers. Author(s): Sutherland DC, Wilson JD. Source: N Z Med J. 1976 October 13; 84(573): 282-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12491&dopt=Abstract
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Pressure responses of hypertensive patients treated with thiazides, beta blockers and clonidine during a psychological experimental stress situation. Author(s): Grosse A, Bianchi JM, Diaz Puertas de Grosse CS, Iglesias GE, Coviello A. Source: Medicina (B Aires). 1990; 50(2): 141-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1983221&dopt=Abstract
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Pre-treatment with beta blockers and the frequency of hypokalaemia in patients with acute chest pain. Author(s): Simpson E, Rodger JC, Raj SM, Wong C, Wilkie L, Robertson C. Source: British Heart Journal. 1987 November; 58(5): 499-504. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2890363&dopt=Abstract
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Prevalence of use of beta blockers and of calcium channel blockers in older patients with prior myocardial infarction at the time of admission to a nursing home. Author(s): Aronow WS. Source: Journal of the American Geriatrics Society. 1996 September; 44(9): 1075-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8790234&dopt=Abstract
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Prevention of epinephrine-induced hypokalemia by nonselective beta blockers. Author(s): Vincent HH, Man in't Veld AJ, Boomsma F, Schalekamp MA. Source: The American Journal of Cardiology. 1985 August 30; 56(6): 10D-14D. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2863970&dopt=Abstract
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Prevention of sudden cardiac death with beta blockers. Author(s): Hjalmarson A. Source: Clin Cardiol. 1999 October; 22 Suppl 5: V11-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10526698&dopt=Abstract
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Prevention of Syncope Trial (POST): a randomized clinical trial of beta blockers in the prevention of vasovagal syncope; rationale and study design. Author(s): Sheldon R, Rose S, Connolly S. Source: Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2003 January; 5(1): 71-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12504644&dopt=Abstract
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Psoriasis as a side effect of beta blockers. Author(s): Savola J, Vehvilainen O, Vaatainen N. Source: British Medical Journal (Clinical Research Ed.). 1987 September 12; 295(6599): 637. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2889504&dopt=Abstract
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Pulmonary hypertension, sleep-disordered breathing, and beta blockers in heart failure patients. Author(s): Blankfield RP. Source: Sleep & Breathing = Schlaf & Atmung. 2002 December; 6(4): 181-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12524571&dopt=Abstract
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QT dispersion in patients with chronic heart failure: beta blockers are associated with a reduction in QT dispersion. Author(s): Bonnar CE, Davie AP, Caruana L, Fenn L, Ogston SA, McMurray JJ, Struthers AD. Source: Heart (British Cardiac Society). 1999 March; 81(3): 297-302. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10026356&dopt=Abstract
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Randomised controlled trial of enalapril and beta blockers in non-diabetic chronic renal failure. Author(s): Hannedouche T, Landais P, Goldfarb B, el Esper N, Fournier A, Godin M, Durand D, Chanard J, Mignon F, Suo JM, et al. Source: Bmj (Clinical Research Ed.). 1994 October 1; 309(6958): 833-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7950612&dopt=Abstract
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Recent clinical data regarding the use of beta blockers in heart failure: focus on CIBIS II. Author(s): Dargie H. Source: Heart (British Cardiac Society). 1999 December; 82 Suppl 4: Iv2-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10574902&dopt=Abstract
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Recent studies on the effects of beta blockers on blood lipid levels. Author(s): Roberts WC. Source: American Heart Journal. 1989 March; 117(3): 709-14. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2563923&dopt=Abstract
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Regression of left ventricular hypertrophy in systemic hypertension with beta blockers (propranolol, atenolol, metoprolol, pindolol and celiprolol). Author(s): Vyssoulis GP, Karpanou EA, Pitsavos CE, Paleologos AA, Toutouzas PK. Source: The American Journal of Cardiology. 1992 November 1; 70(13): 1209-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1357954&dopt=Abstract
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Relative toxicity of beta blockers in overdose. Author(s): Reith DM, Dawson AH, Epid D, Whyte IM, Buckley NA, Sayer GP. Source: Journal of Toxicology. Clinical Toxicology. 1996; 34(3): 273-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8667464&dopt=Abstract
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Relevance of intrinsic sympathomimetic activity for beta blockers. Author(s): Jaillon P. Source: The American Journal of Cardiology. 1990 September 25; 66(9): 21C-23C. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1977302&dopt=Abstract
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Response to beta blockers in patients with neurocardiogenic syncope: how to predict beneficial effects. Author(s): Natale A, Newby KH, Dhala A, Akhtar M, Sra J. Source: Journal of Cardiovascular Electrophysiology. 1996 December; 7(12): 1154-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8985804&dopt=Abstract
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Restoring function in failing hearts: the effects of beta blockers. Author(s): Eichhorn EJ. Source: The American Journal of Medicine. 1998 February; 104(2): 163-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9528736&dopt=Abstract
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Risk indicators for death and prognosis among patients in whom acute myocardial infarction was not confirmed in relation to prescription of beta blockers at discharge. Author(s): Herlitz J, Karlson BW, Hjalmarson A. Source: Clin Cardiol. 1995 January; 18(1): 21-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7704981&dopt=Abstract
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Safer non-cardiac surgery for patients with coronary artery disease. beta blockers may be useful, but more evidence is needed. Author(s): Soar J, Howell SJ. Source: Bmj (Clinical Research Ed.). 1999 July 31; 319(7205): 320-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10484644&dopt=Abstract
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Safety of pyridostigmine in hypertensive patients receiving beta blockers. Author(s): Arad M, Roth A, Zelinger J, Zivner Z, Rabinowitz B, Atsmon J. Source: The American Journal of Cardiology. 1992 February 15; 69(5): 518-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1346558&dopt=Abstract
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Secondary prevention in acute myocardial infarction. Verapamil is alternative to beta blockers in patients without congestive heart failure. Author(s): Hansen JF. Source: Bmj (Clinical Research Ed.). 1998 October 24; 317(7166): 1153. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9841052&dopt=Abstract
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Secondary prevention in coronary heart disease. Effects of statins have been in addition to those of aspirin and beta blockers. Author(s): Morrell J. Source: Bmj (Clinical Research Ed.). 1999 May 22; 318(7195): 1419-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10334767&dopt=Abstract
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Serum lipoproteins during antihypertensive therapy with beta blockers and diuretics: a controlled long-term comparative trial. Author(s): Middeke M, Weisweiler P, Schwandt P, Holzgreve H. Source: Clin Cardiol. 1987 February; 10(2): 94-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3545579&dopt=Abstract
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Severe peripheral ischaemia during concomitant use of beta blockers and ergot alkaloids. Author(s): Venter CP, Joubert PH, Buys AC. Source: British Medical Journal (Clinical Research Ed.). 1984 August 4; 289(6440): 288-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6430442&dopt=Abstract
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Short-term effects of beta blockers atenolol, nadolol, pindolol, and propranolol on lipoprotein metabolism in normolipemic subjects. Author(s): Harvengt C, Heller FR, Martiat P, Van Nieuwenhuyze Y. Source: Journal of Clinical Pharmacology. 1987 July; 27(7): 475-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2888790&dopt=Abstract
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Should beta blockers be abandoned as initial monotherapy in chronic open angle glaucoma? The controversy. Author(s): Goldberg I. Source: The British Journal of Ophthalmology. 2002 June; 86(6): 691-2. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12034694&dopt=Abstract
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Should beta blockers be abandoned as initial monotherapy in chronic open angle glaucoma? View 1. Author(s): Anton A. Source: The British Journal of Ophthalmology. 2002 June; 86(6): 692-3; Discussion 695. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12075596&dopt=Abstract
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Should beta blockers be abandoned as initial monotherapy in chronic open angle glaucoma? View 2. Author(s): Skuta GL. Source: The British Journal of Ophthalmology. 2002 June; 86(6): 693-4; Discussion 695. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12075597&dopt=Abstract
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Should beta blockers be used in the treatment of hypertension in the elderly? Author(s): Prisant LM. Source: Journal of Clinical Hypertension (Greenwich, Conn.). 2002 July-August; 4(4): 286-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12147932&dopt=Abstract
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Should nitrates be used with beta blockers to prevent variceal bleeding? Author(s): Zalepuga R, Herrera JL. Source: The American Journal of Gastroenterology. 2000 October; 95(10): 2982-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11051383&dopt=Abstract
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Should patients with severe heart failure be treated with beta blockers? Author(s): Hobbs RE. Source: Cleve Clin J Med. 2001 May; 68(5): 469-70. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11352327&dopt=Abstract
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Should regional anesthesia and pharmacological agents such as beta blockers and opiates be utilized in modulating pain response? Author(s): Kehlet H. Source: The Journal of Trauma. 1984 September; 24(9 Suppl): S177-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6148428&dopt=Abstract
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Stage fright in musicians: a model illustrating the effect of beta blockers. Author(s): Neftel KA, Adler RH, Kappeli L, Rossi M, Dolder M, Kaser HE, Bruggesser HH, Vorkauf H. Source: Psychosomatic Medicine. 1982 November; 44(5): 461-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6129674&dopt=Abstract
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Stopping beta blockers in patients with angina. Author(s): Rangno RE. Source: Ration Drug Ther. 1981 September; 15(9): 1-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6127751&dopt=Abstract
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Successful implementation of guidelines for encouraging the use of beta blockers in patients after acute myocardial infarction. Author(s): Sarasin FP, Maschiangelo ML, Schaller MD, Heliot C, Mischler S, Gaspoz JM. Source: The American Journal of Medicine. 1999 May; 106(5): 499-505. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10335720&dopt=Abstract
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Suppressant effects of conventional beta blockers and sotalol on complex and repetitive ventricular premature complexes. Author(s): Deedwania PC. Source: The American Journal of Cardiology. 1990 January 2; 65(2): 43A-50A; Discussion 51A-52A. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1688482&dopt=Abstract
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Symptomatic bradycardia induced by the combination of oral diltiazem and beta blockers. Author(s): Sagie A, Strasberg B, Kusnieck J, Sclarovsky S. Source: Clin Cardiol. 1991 April; 14(4): 314-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1674455&dopt=Abstract
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Systematic review of the impact of beta blockers on mortality and hospital admissions in heart failure. Author(s): Shibata MC, Flather MD, Wang D. Source: European Journal of Heart Failure : Journal of the Working Group on Heart Failure of the European Society of Cardiology. 2001 June; 3(3): 351-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11378007&dopt=Abstract
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Systolic hypertension; alpha blockers and prostatism; are beta blockers still indicated; diabetes, obesity, and hypertension -- comments on the JCH contents. Author(s): Moser M. Source: Journal of Clinical Hypertension (Greenwich, Conn.). 2001 July-August; 3(4): 207-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11498650&dopt=Abstract
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The applied pharmacology of beta-adrenoceptor antagonists (beta blockers) in relation to clinical outcomes. Author(s): Fitzgerald JD. Source: Cardiovascular Drugs and Therapy / Sponsored by the International Society of Cardiovascular Pharmacotherapy. 1991 June; 5(3): 561-76. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1678960&dopt=Abstract
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The beta blockers: are they as protective in hypertension as in other cardiovascular conditions? Author(s): Hanes DS, Weir MR. Source: Journal of Clinical Hypertension (Greenwich, Conn.). 2001 July-August; 3(4): 236-43. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11498654&dopt=Abstract
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The cellular and physiologic effects of beta blockers in heart failure. Author(s): Sabbah HN. Source: Clin Cardiol. 1999 October; 22 Suppl 5: V16-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10526699&dopt=Abstract
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The clinical importance of lipid solubility in beta blockers. Author(s): Neil-Dwyer G. Source: Aviation, Space, and Environmental Medicine. 1981 November; 52(11 Pt 2): S1922. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6118118&dopt=Abstract
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The effect of beta blockers on retinal blood flow in diabetic patients. Author(s): Newsom RS, Rassam SM, Kohner EM. Source: Eur J Ophthalmol. 1991 July-September; 1(3): 131-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1841669&dopt=Abstract
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The effect of multiple doses of phenylpropanolamine on the blood pressure of patients whose hypertension was controlled with beta blockers. Author(s): O'Connell MB, Gross CR. Source: Pharmacotherapy. 1991; 11(5): 376-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1684039&dopt=Abstract
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The effect of nursing intervention on serum lipid level of patients taking beta blockers. Author(s): Miracle VA. Source: Ky Nurse. 1987 November-December; 35(6): 22-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2891878&dopt=Abstract
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The effect of oral treatment with beta blockers on the tear secretion. Author(s): Almog Y, Monselise M, Almog C, Barishak YR. Source: Metab Pediatr Syst Ophthalmol. 1982; 6(3-4): 343-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6135973&dopt=Abstract
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The effect of single-dose phenylpropanolamine on blood pressure in patients with hypertension controlled by beta blockers. Author(s): O'Connell MB, Gross CR. Source: Pharmacotherapy. 1990; 10(2): 85-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2349137&dopt=Abstract
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The effects of beta blockers on exercise capacity and on training response in elderly subjects. Author(s): Fagard R, Reybrouck T, Vanhees L, Cattaert A, Vanmeenen T, Grauwels R, Amery A. Source: European Heart Journal. 1984 November; 5 Suppl E: 117-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6526030&dopt=Abstract
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The effects of slow channel blockers and beta blockers on atrioventricular nodal conduction. Author(s): Prystowsky EN. Source: Journal of Clinical Pharmacology. 1988 January; 28(1): 6-21. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2450898&dopt=Abstract
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The evidence for beta blockers in heart failure. Author(s): Cleland JG, McGowan J, Clark A, Freemantle N. Source: Bmj (Clinical Research Ed.). 1999 March 27; 318(7187): 824-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10092240&dopt=Abstract
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The importance of beta blockers in the treatment of heart failure. Author(s): Chavey WE 2nd. Source: American Family Physician. 2000 December 1; 62(11): 2453-62. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11130231&dopt=Abstract
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The influence of beta blockers on cardiovascular reactivity and Type A behavior pattern in hypertensives. Author(s): Schmieder R, Friedrich G, Neus H, Rudel H, von Eiff AW. Source: Psychosomatic Medicine. 1983 October; 45(5): 417-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6635104&dopt=Abstract
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The role of beta blockers in alcohol withdrawal syndrome. Author(s): Gottlieb LD. Source: Postgraduate Medicine. 1988 February 29; Spec No: 169-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2894658&dopt=Abstract
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The role of beta blockers in open angle glaucoma. Author(s): Marmion VJ. Source: Indian J Ophthalmol. 1982 July; 30(4): 229-31. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6131867&dopt=Abstract
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The role of nitrates, beta blockers, and calcium antagonists in stable angina pectoris. Author(s): Chan PK, Heo JY, Garibian G, Askenase A, Segal BL, Iskandrian AS. Source: American Heart Journal. 1988 September; 116(3): 838-48. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2901214&dopt=Abstract
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The use of beta blockers following myocardial infarction--doubts. Author(s): Hampton JR. Source: European Heart Journal. 1983 July; 4 Suppl D: 151-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6137376&dopt=Abstract
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The use of electron impact and positive chemical ionization mass spectrometry in the screening of beta blockers and their metabolites in human urine. Author(s): Leloux MS, Maes RA. Source: Biomed Environ Mass Spectrom. 1990 March; 19(3): 137-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1970489&dopt=Abstract
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Thiazides, beta blockers and lipoproteins. Author(s): Ballantyne D, Ballantyne FC. Source: Postgraduate Medical Journal. 1983 August; 59(694): 483-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6137813&dopt=Abstract
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Topical beta blockers and atrioventricular block in the elderly. Author(s): Ruiz-Ruiz FJ, Perez-Calvo JI, Sanjuan-Cuartero R. Source: Journal of Postgraduate Medicine. 2002 October-December; 48(4): 327-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12571398&dopt=Abstract
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Topical beta blockers and serum lipoproteins. Author(s): Joyce PW, Raj PS. Source: The British Journal of Ophthalmology. 1991 August; 75(8): 510-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1873279&dopt=Abstract
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Topical ophthalmic beta blockers may cause release of histamine through cytotoxic effects on inflammatory cells. Author(s): van Beek LM, Mulder M, van Haeringen NJ, Kijlstra A. Source: The British Journal of Ophthalmology. 2000 September; 84(9): 1004-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10966954&dopt=Abstract
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Topical ophthalmic beta blockers: a comparative review. Author(s): Zimmerman TJ. Source: J Ocul Pharmacol. 1993 Winter; 9(4): 373-84. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7906296&dopt=Abstract
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Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Oral or intravenous beta blockers in acute myocardial infarction. Author(s): Jones S, Crawford I. Source: Emergency Medicine Journal : Emj. 2001 July; 18(4): 270-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11435360&dopt=Abstract
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Treating stage fright in musicians: the use of beta blockers. Author(s): Lehrer PM, Rosen RC, Kostis JB, Greenfield D. Source: N J Med. 1987 January; 84(1): 27-33. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2883619&dopt=Abstract
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Treatment of angina pectoris with pindolol: the significance of intrinsic sympathomimetic activity of beta blockers. Author(s): Kostis JB, Frishman W, Hosler MH, Thorsen NL, Gonasun L, Weinstein J. Source: American Heart Journal. 1982 August; 104(2 Pt 2): 496-504. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7102536&dopt=Abstract
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Treatment of cardiac myopathies with beta blockers. What do we know, where do we go from here? Author(s): Anderson JL. Source: Postgraduate Medicine. 1988 February 29; Spec No: 104-12. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2894653&dopt=Abstract
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Treatment of essential hypertension today. The role of beta blockers, calcium antagonists, and ACE inhibitors. Author(s): Lund-Johansen P. Source: The Medical Clinics of North America. 1987 September; 71(5): 947-57. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2887720&dopt=Abstract
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Trial is needed of ACE inhibitors plus beta blockers in survivors of myocardial infarction. Author(s): McAlister FA. Source: Bmj (Clinical Research Ed.). 1998 September 12; 317(7160): 751. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9732353&dopt=Abstract
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Underutilization of aspirin, beta blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering drugs and overutilization of calcium channel blockers in older persons with coronary artery disease in an academic nursing home. Author(s): Ghosh S, Ziesmer V, Aronow WS. Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2002 June; 57(6): M398-400. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12023270&dopt=Abstract
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Update on beta blockers. Author(s): Williams JR. Source: Aana Journal. 1989 February; 57(1): 29-36. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2564714&dopt=Abstract
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Use of beta blockers in congestive heart failure. Author(s): Morreale A, Warda J. Source: Clin Pharm. 1986 October; 5(10): 783, 787. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2877764&dopt=Abstract
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Use of beta blockers in postinfarct prophylaxis: aspects on quality of life. Author(s): Hjalmarson AC. Source: American Heart Journal. 1987 July; 114(1 Pt 2): 245-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2886038&dopt=Abstract
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Use of calcium blockers and beta blockers for treatment of coronary disease. Author(s): Horwitz LD. Source: Med Sect Proc. 1983; : 7-14. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6146976&dopt=Abstract
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Use of digoxin, diuretics, beta blockers, angiotensin-converting enzyme inhibitors, and calcium channel blockers in older patients in an academic hospital-based geriatrics practice. Author(s): Fishkind D, Paris BE, Aronow WS. Source: Journal of the American Geriatrics Society. 1997 July; 45(7): 809-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9215330&dopt=Abstract
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Using beta blockers after MI in the elderly. Author(s): Danforth J, Ports TA. Source: Geriatrics. 1985 May; 40(5): 75-7, 80, 85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2859233&dopt=Abstract
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Utility of immediate exercise treadmill testing in patients taking beta blockers or calcium channel blockers. Author(s): Diercks DB, Kirk JD, Turnipseed SD, Amsterdam EA. Source: The American Journal of Cardiology. 2002 October 15; 90(8): 882-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12372580&dopt=Abstract
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What to watch for with beta blockers. Author(s): Kirschenbaum HL, Rosenberg JM. Source: Rn. 1981 June; 44(6): 70-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6113680&dopt=Abstract
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Why aren't we using beta blockers after acute MI? Author(s): Weichel AS. Source: American Family Physician. 2000 October 15; 62(8): 1771-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11057834&dopt=Abstract
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Why beta blockers should be used in heart failure. Author(s): Bhagat K, Hakim JG. Source: Cent Afr J Med. 1999 July; 45(7): 187-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10695198&dopt=Abstract
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CHAPTER 2. BLOCKERS
ALTERNATIVE
MEDICINE
AND
BETA
Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to beta blockers. At the conclusion of this chapter, we will provide additional sources.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to beta blockers and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “beta blockers” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to beta blockers: •
“In vivo” and “in vitro” antitumoral action of Larrea divaricata Cav. Author(s): Anesini C, Genaro A, Cremaschi G, Zubillaga M, Boccio J, Sterin-Borda L, Borda E. Source: Acta Physiol Pharmacol Ther Latinoam. 1996; 46(1): 33-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8935489&dopt=Abstract
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Behavioral and physiological effects of a beta blocker and relaxation therapy on mild hypertensives. Author(s): Adsett CA, Bellissimo A, Mitchell A, Wilczynski N, Haynes RB. Source: Psychosomatic Medicine. 1989 September-October; 51(5): 523-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2678210&dopt=Abstract
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Formulation influence on conjunctival penetration of four beta blockers in the pigmented rabbit: a comparison with corneal penetration. Author(s): Ashton P, Podder SK, Lee VH. Source: Pharmaceutical Research. 1991 September; 8(9): 1166-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1788163&dopt=Abstract
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Influence of continuation of beta blockers during dobutamine stress echocardiography for the assessment of myocardial viability in patients with severe ischemic left ventricular dysfunction. Author(s): Poldermans D, Sozzi FB, Bax JJ, Boersma E, Duncker DJ, Vourvouri E, Elhendy A, Valkema R, Roelandt JR. Source: The American Journal of Cardiology. 2001 July 1; 88(1): A7, 68-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11423062&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.healthnotes.com/
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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine
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Open Directory Project: http://dmoz.org/Health/Alternative/
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HealthGate: http://www.tnp.com/
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WebMD®Health: http://my.webmd.com/drugs_and_herbs
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
The following is a specific Web list relating to beta blockers; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
General Overview Heart Attack Source: Healthnotes, Inc.; www.healthnotes.com
Alternative Medicine 75
High Cholesterol Source: Integrative Medicine Communications; www.drkoop.com Hypercholesterolemia Source: Integrative Medicine Communications; www.drkoop.com Migraine Headaches Source: Healthnotes, Inc.; www.healthnotes.com •
Herbs and Supplements Acebutolol Source: Healthnotes, Inc.; www.healthnotes.com Atenolol Source: Healthnotes, Inc.; www.healthnotes.com Beta-adrenergic Blockers Source: Healthnotes, Inc.; www.healthnotes.com Beta-blockers Source: Integrative Medicine Communications; www.drkoop.com Betaxolol Source: Healthnotes, Inc.; www.healthnotes.com Bisoprolol Source: Healthnotes, Inc.; www.healthnotes.com Hawthorn Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10035,00.html Metoprolol Source: Healthnotes, Inc.; www.healthnotes.com Propranolol Source: Healthnotes, Inc.; www.healthnotes.com Sotalol Source: Healthnotes, Inc.; www.healthnotes.com Timolol Source: Healthnotes, Inc.; www.healthnotes.com
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CHAPTER 3. PATENTS ON BETA BLOCKERS Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.4 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “beta blockers” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on beta blockers, we have not necessarily excluded non-medical patents in this bibliography.
Patents on Beta Blockers By performing a patent search focusing on beta blockers, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 4Adapted
from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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example of the type of information that you can expect to obtain from a patent search on beta blockers: •
Borderline active dosage forms of beta blockers Inventor(s): Liedtke; Rainer K. (Gruenwald, DE) Assignee(s): Pharmed Dr. Liedtke GmbH (Gruenwald, DE) Patent Number: 5,496,560 Date filed: October 13, 1994 Abstract: For short-term therapy of transient functional cardiovascular symptoms, borderline active dosage forms of beta blockers are used which produce in the body only the borderline active concentrations of active ingredient which produce no significant changes in the physiological values in the cardiovascular system under resting conditions for the respective specific beta blocker used and significantly reduce adrenergically induced transient stimulation effects. Oral, transdermal, or topical dosage forms are particularly advantageous. A differentiated therapy of functional symptoms which does not exist with the customary dosage forms of beta blockers designed for long-term therapies is possible. Both the quality of life and the risk-benefit ratio of the beta blockers are improved. The duration of the therapy also does not have to be extended beyond the symptomatically required scale since no rebound danger exists after withdrawal. As an additional and now indication, this also permits the short-term use for the primary therapy of sleep disturbances, within the framework of vegetative syndromes, in particular, within the framework of postmenopausal symptoms. Excerpt(s): The present invention concerns borderline active dosage forms of beta blockers for short-term therapy of transient functional cardiovascular symptoms. It is known that the chemical group of beta receptor blockers are part of the standard longterm therapy of manifest cardiovascular disorders such as hypertension and angina pectoris. The application spectrum of beta blockers also includes the following indications: hyperkinetic heart syndrome, migraines, tremors, glaucoma, anxiety syndromes, and withdrawal syndromes. See H. Lydtin & P. Trenkwalder, New Indications for Therapy with Beta-Receptor Blockers in: Beta-Receptor Blockers, G. Fischer, Stuttgart, 1991, pp. 58ff, incorporated herein by reference. Cardiovascular disorders can be subdivided diagnostically into those with pathological manifestations (e.g., angina pectoris based an a manifest coronary heart disorder), and into symptomatic types with only transient pathological-manifestations without a pronounced morphologic basis (e.g., situation-related reactive accelerations of the heart rate through exogenous or endogenous physical or psychological stressors). Also classified within this area, in a broader sense, are, for example, transient cardiac ischemias: so-called silent myocardial ischemic episodes which are not noticed by the patient but can be seen in the EKG. Transient manifestations of this type are also referred to as functional or vegetative symptoms and are based primarily on situationally inadequate reactions of the sympathetic nervous system or the adrenergic neurotransmitters released by it. Web site: http://www.delphion.com/details?pn=US05496560__
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•
Fluorinated propranolol and related methods Inventor(s): Aboul-Enein; Hassan Y. (Riyadh, SA), Mak; I. T. (Germantown, MD), Weglicki; William B. (Potomac, MD) Assignee(s): The George Washington University (Washington, DC) Patent Number: 5,776,985 Date filed: November 14, 1996 Abstract: Fluorinated beta blockers, such as propranolol, are presented with amplified antioxidant effects and various levels of beta blocking effects. Mixtures are also presented of fluorinated antioxidant drugs, such as propranolol, with fluorinated antioxidant non-beta blocking analogs of the same drugs. Methods of treatment of disease by the use of the fluorinated drugs and the mixtures are presented. Excerpt(s): This patent claims priority of U.S. Provisional Application No. 60/006,835, filed Nov. 16, 1995, and No. 60/008,790, filed Dec. 18, 1995. The field of this invention is pharmaceuticals which act as beta blockers and pharmaceuticals that act as antioxidants. Specifically, this invention relates to beta blockers with amplified and controlled antioxidant properties. Beta blockers such as various forms of propranolol are known. It is known that a variety of heart and hypertension problems can be treated with beta blockers. However, an excessive treatment of beta blockers can cause undesirable side effects in patients. Web site: http://www.delphion.com/details?pn=US05776985__
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Synergistic compositions of amiodarone and beta blockers Inventor(s): Baligadoo; Soorianarain (Center of Research Medicales, SSR, Univerisity de Maurice, Moka, MU) Assignee(s): none reported Patent Number: 5,455,269 Date filed: October 8, 1993 Abstract: There are disclosed pharmaceutical preparations and methods for the use thereof which have a cardioprotective action useful in coronary insufficiency, in the prevention of the constitution of an infarction or of sudden death. It consists in the utilization of amiodarone and a beta-blocker at certain diodes and in certain ratios whereby the gravity test is enhanced. Excerpt(s): There are disclosed pharmaceutical preparations and methods for the use thereof which have a cardioprotective action useful in coronary insufficiency, in the prevention of the constitution of an infarction or of sudden death. These methods comprise the utilization of amiodarone, a nitrate derivative and a beta-blocker. In coronary insufficiency, one observes a high frequency of sudden death particularly in acute coronary insufficiency which may culminate in the occurrence of myocardial infarction. Some cases of sudden death are related to arrhythmias consecutive to coronary insufficiency Itself. It would be desirable to contemporaneously decrease the consumption of oxygen, increase the myocardial irrigation and also exercise a preventive effect against arrhythmias. It has been observed that coronary thrombosis induces a phenomenon called stunned myocardial syndrome consecutive to the prolonged ischaemia of the heart. This phenomenon prevents the obtention of optimal benefits following reperfusion.
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Web site: http://www.delphion.com/details?pn=US05455269__ •
Use of beta blockers for the treatment of the progression of infantile axial myopia Inventor(s): Tiburtius; Heinfried (Breitenbachplatz 21, 1000 Berlin 33, DE) Assignee(s): none reported Patent Number: 4,942,161 Date filed: February 24, 1989 Abstract: The invention relates to the use of beta blockers for the treatment of the progression of infantile axial myopia. Excerpt(s): Myopia or shortsightedness is a disease of the eye in which parallel entering rays of light converge in front of the retina. It is possible for this disease to have two entirely different causes, namely either that the refraction of the rays in the eye is too strong, such as occasionally occurs in diabetics as well as during the onset of certain types of gray cataracts, which is then called curvature myopia, or because the eyeball is too long, resulting in so-called axial myopia, which is partially hereditary. The only therapy known up to now in the case of axial myopia is the use of concave spectacle lenses, which shift the focus back onto the retina, or of contact lenses, which are intended to slow the increase in length mechanically, by exerting pressure on the eye. Infantile axial myopia arises in most cases at school age between nine and eleven years of age, seldom earlier than that, and as a rule increases until approximately sixteen years of age. The causes of the disease are not definitely known, although an increase in shortsightedness has been noted. With the end of the period of growth of children, i.e. around the age of sixteen, the covers of the bulbus oculi, which were soft up to that time, have strengthened to a degree that further longitudinal increase of the eyeball, which would be equivalent to an increase in shortsightedness, is as a rule not expected. Web site: http://www.delphion.com/details?pn=US04942161__
Patent Applications on Beta Blockers As of December 2000, U.S. patent applications are open to public viewing.5 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to beta blockers: •
3-AMINO-PROPOXYPHENYL DERIVATIVES (I) Inventor(s): DRUMMER, OLAF HEINO; (VICTORIA, AU), IAKOVIDIS, DIMITRIOS; (VICTORIA, AU), JACKMAN, GRAHAM PAUL; (VICTORIA, AU), LOUIS, SIMON NICHOLAS STEWART; (VICTORIA, AU), LOUIS, WILLIAM JOHN; (VICTORIA, AU) Correspondence: SUGHRUE MION ZINN MACPEAK & SEAS; 2100 PENNSYLVANIA AVENUE NW; WASHINGTON; DC; 20037 Patent Application Number: 20030100616 Date filed: September 21, 1999
5
This has been a common practice outside the United States prior to December 2000.
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Abstract: Compounds of formula (Ia) as potent,.beta.sub.1-specific beta blockers with a short duration of action in the systemic circulation, wherein R is 3',4'-dimethoxyphenyl. R.sup.1 is hydrogen, and R.sup.2 is selected from methyl, ethyl, propyl, isobutyl and isopropyl; or R is 3',4'-dimethoxyphenyl, R.sup.1 is selected from fluorine, chlorine and bromine, and R.sup.2 is selected from methyl, ethyl, propyl, isopropyl, isobutyl and cyclopropylmethyl; of R is 4'-methoxyphenoxy, R.sup.1 is selected from hydrogen, fluorine, chlorine and bromine, and R.sup.2 is selected from methyl, ethyl, propyl, isopropyl, isobutyl and cyclopropylmethyl; or R is 3',4'-dimethoxyphenyl, R.sub.1 is cyano, and R.sup.2 is cyclopropylmethyl; or R is 4'-methoxyphenoxy, R.sup.1 is cyano, and R.sup.2 is isobutyl; and physiologically acceptable hydrolysable derivatives thereof having the hydroxy group in the 2-position of the 3-aminopropoxy side chain in esterified form, in their racemic and optically active forms, and their pharmaceutically acceptable acid addition salts. Excerpt(s): The present invention relates to potent,.beta.sub.1-specific beta adrenoreceptor blockers with a short duration of action and to a method for the treatment and/or prophylaxis of conditions for which potent,.beta.sub.1-specific beta adrenoreceptor blockers with a short duration of action in the systemic circulation would be particularly advantageous. The class of drugs known as.beta.-blockers are well known in the art for treatment of cardiac disorders and particular ophthalmological conditions. However, the optimum combination of properties of such agents depends critically on the condition being treated. Thus, in the long-term treatment of cardiovascular diseases such as hypertension and cardiac arrhythmias, the combination of.beta.sub.1-selectivity with high potency, good oral bioavailability and long plasma half-life and duration of action are usually considered optimal, since.beta.sub.1-selective compounds have a low incidence of side-effects associated with blockade of.beta.sub.2receptors, such as asthma, and the remaining properties permit treatment by oral administration usually on a once a day basis. In other conditions where.beta.sub.1selectivity is preferred, some of these properties are not optimal. In ocular administration for the treatment of glaucoma oral availability and long plasma half-life may lead to unwanted systemic side-effects. In the management of cardiac arrhythmias which may arise during induction of anaesthesia or in the care of critically ill patients, short systemic half-life permits rapid control of arrhythmias without the risk of inducing long acting beta blockade. Treatment of glaucoma requires a drug which is well absorbed into the eye. However rapid clearance from the systemic circulation by metabolism to inactive metabolites, after passing through the eye or being swallowed via the naso-lachrymal duct, ensures that treatment is limited to the eye and side-effects are minimised. For short-term systemic administration a combination of.beta.sub.1selectivity and short half-life is ideal. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Methods and materials for protecting against myocardial cell damage related to coronary intervention by regional beta blocker therapy Inventor(s): Uretsky, Barry F.; (Galveston, TX) Correspondence: Braman & Rogalskyj, LLP; P.O. Box 352; Canandaigua; NY; 144240352; US Patent Application Number: 20030045584 Date filed: July 22, 2002
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Abstract: Disclosed is method for reducing myocardial cell damage during and/or after percutaneous coronary intervention in a subject's coronary artery. The method includes instilling a beta blocker directly into the subject's coronary artery prior to percutaneous coronary intervention. A kit for carrying out percutaneous coronary intervention is also disclosed. The kit includes a catheter and a beta blocker. Excerpt(s): The present application claims the benefit of U.S. Provisional Patent Application Serial No. 60/306,761, filed Jul. 21, 2001, which is hereby incorporated by reference. The subject invention relates, generally, to methods and materials for protecting a subject against myocardial cell damage and, more particularly, for protecting a subject against myocardial cell damage resulting from coronary intervention. Percutaneous coronary intervention ("PCI") is an important treatment for coronary artery disease and other forms of atherosclerosis obstruction of the coronary arteries. However, myocardial necrosis (infarction) during PCI may occur in almost half of otherwise successful PCI (Klein et al., "Incidence and Clinical Significance of Transient Creatine Kinase Elevations and the Diagnosis of Non-Q Wave Myocardial Infarction Associated with Coronary Angioplasty," J. Am. Coll. Cardiol.,17:621-626 (1991) ("Klein"); Oh et al., "Creatine Kinase Release after Successful Percutaneous Transluminal Coronary Angioplasty," Am. Heart J., 109:1225-1231 (1985) ("Oh"); and Pauletto et al., "Changes in Myoglobin, Creatine Kinase, and Creatine Kinase-MB after Percutaneous Transluminal Coronary Angioplasty for Stable Angina Pectoris," Am. J. Cardiol., 59: 999-1000 (1987)) and is associated with an increased incidence of late adverse outcomes, particularly death, even with minor elevations in biochemical markers (Simoons et al., "Minimal myocardial damage during coronary intervention is associated with impaired outcome," Eur. Heart J., 20:1112-1119 (1999) ("Simoons"); Kong et al., "Prognostic implication of creatine kinase elevation following elective coronary artery interventions," JAMA, 277:461-466 (1997); Abdelmeguid et al., "Significance of Mild Transient Release of Creatine Kinase-MB Fraction after Percutaneous Coronary Interventions," Circulation, 94:1528-1536 (1996); and Akkerhuis et al., "Minor Myocardial Damage and Prognosis: Are Spontaneous and Percutaneous Coronary Intervention-Related Events Different?" Circulation, 105:554-556 (2002)). These biochemical markers include the enzyme creatine kinase ("CK"), the myocardial specific enzyme CKMB, and the myocardial cell protein troponin I and troponin T, and an increase in these markers after PCI is associated with a worsened prognosis. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with beta blockers, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “beta blockers” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on beta blockers. You can also use this procedure to view pending patent applications concerning beta blockers. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.
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CHAPTER 4. BOOKS ON BETA BLOCKERS Overview This chapter provides bibliographic book references relating to beta blockers. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on beta blockers include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “beta blockers” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on beta blockers: •
Mayo Clinic on High Blood Pressure Source: New York, NY: Kensington Publishing. 1999. 180 p. Contact: Available from Mayo Clinic. 200 First Street, S.W., Rochester, MN 55905. (800) 291-1128 or (507) 284-2511. Fax (507) 284-0161. Website: www.mayo.edu. PRICE: $14.95 plus shipping and handling. ISBN: 1893005011. Summary: This book focuses on what people who have high blood pressure can do to better manage their blood pressure and keep it at a safe level. The book begins with a chapter that explains the basics of blood pressure, how high blood pressure develops, and why it can be harmful. This is followed by a chapter that identifies unmodifiable and modifiable risk factors for high blood pressure. Unmodifiable risk factors include race, age, family history, and gender. Modifiable risk factors include obesity, inactivity, tobacco use, sodium sensitivity, low potassium, excessive alcohol consumption, stress, chronic illness, high cholesterol, diabetes, sleep apnea, and heart failure. Other topics
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addressed in this chapter include secondary high blood pressure and ways of preventing high blood pressure. The third chapter focuses on the diagnosis and treatment of high blood pressure. Topics include measuring blood pressure, receiving a diagnosis, getting a medical evaluation, and deciding on treatment with either medication or lifestyle changes. Subsequent chapters discuss determining a healthy weight, losing weight, becoming more physically active, and eating well using the Dietary Approaches to Stop Hypertension (DASH) plan. The following chapters detail the effects of sodium, tobacco, alcohol, caffeine, and stress on blood pressure. Another chapter focuses on the mode of action and side effects of various medications used in controlling high blood pressure, including diuretics, beta blockers, angiotensinconverting enzyme inhibitors, angiotensin II receptor blockers, calcium antagonists, alpha blockers, central acting agents, and direct vasodilators. Remaining chapters examine factors unique to women, management of high blood pressure among specific populations and groups, treatment of difficult-to-control high blood pressure, management of a hypertensive emergency, and home monitoring of blood pressure. The book also includes a week of menus based on the recommendations of the DASH eating plan. 17 figures. 2 tables.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print®). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “beta blockers” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “beta blockers” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “beta blockers” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •
Beta Blockers in Clinical Practice by J M Cruickshank, B N C Pritchard; ISBN: 0443039887; http://www.amazon.com/exec/obidos/ASIN/0443039887/icongroupinterna
•
Beta Blockers in the Treatment of Cardiovascular Disease by John B. Kostis (Editor), Eugene A. DeFelice (Editor); ISBN: 089004290X; http://www.amazon.com/exec/obidos/ASIN/089004290X/icongroupinterna
•
Beta blockers in the treatment of cardiovascular diseases; ISBN: 0881670081; http://www.amazon.com/exec/obidos/ASIN/0881670081/icongroupinterna
•
Drugs Looking for Diseases: Innovative Drug Research and the Development of the Beta Blockers and the Calcium Antagonists (Developments in Cardiovascular Medicine, 120) by Rein Vos (1991); ISBN: 0792309685; http://www.amazon.com/exec/obidos/ASIN/0792309685/icongroupinterna
•
The evaluation of beta blocker and calcium antagonist drugs : proceedings of the Symposium on How to Evaluate New Beta Blockers and Calcium Antagonist Drugs held in Philadelphia, PA, October 21-22, 1981; ISBN: 9024726425; http://www.amazon.com/exec/obidos/ASIN/9024726425/icongroupinterna
•
Understanding Clinical Trials: Beta Blockers by L. Hansson; ISBN: 1870026845; http://www.amazon.com/exec/obidos/ASIN/1870026845/icongroupinterna
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The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “beta blockers” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:6 •
Beta blockers Author: Lydtin, Helmut.; Year: 1980; Bern: Huber, c1980; ISBN: 3456809166
•
Medical therapy of ischemic heart disease: nitrates, beta blockers, and calcium antagonists Author: Abrams, Jonathan.; Year: 1992; Boston: Little, Brown, 1992; ISBN: 0316004715 http://www.amazon.com/exec/obidos/ASIN/0316004715/icongroupinterna
•
Position of beta blockers in antihypertensive therapy Author: Bühler, Fritz R.; Year: 1986; New York: Raven Press, c1986
Chapters on Beta Blockers In order to find chapters that specifically relate to beta blockers, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and beta blockers using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “beta blockers” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on beta blockers: •
Coronary Artery Disease in Diabetes Source: in Johnstone, M.T. and Veves, A. Diabetes and Cardiovascular Disease. Totowa, NJ: The Humana Press, Inc. 2001. p. 247-279. Contact: Humana Press, Inc. 999 Riverview Dr., Suite 208 Totowa, NJ 07512. (973) 2561699. Fax (973) 256-8341. E-mail:
[email protected] PRICE: $125.00, plus shipping and handling. ISBN: 089603755X. Summary: Both type 1 and type 2 diabetes are powerful and independent risk factors for coronary artery disease (CAD), stroke (cerebrovascular accident), and peripheral artery disease. Furthermore, when patients with diabetes develop clinical events, they sustain a worse prognosis compared with nondiabetics. Ultimately, atherosclerosis (hardening and narrowing of the arteries) accounts for 65 to 80 percent of all deaths among North
6
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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American diabetes patients. This chapter on CAD in diabetes is from a textbook that offers physicians practical knowledge about cardiovascular disease and diabetes. The authors discuss epidemiology, the mechanism of atherosclerosis, clinical features, management of risk factors, medical therapy, revascularization procedures, and cardiovascular autonomic neuropathy (nerve disease). Clinical interventions include cholesterol reduction, treatment of hypertension, glycemic control, and screening for the presence of CAD; medical therapy can include aspirin, beta blockers, ACE inhibitors, glycoprotein IIB or IIIa antagonists, and thrombolytic therapy (to reduce clotting). 2 figures. 4 tables. 252 references. •
Summary of Cardiovascular Disease Reduction in Diabetes Source: in Moser, M. and Sowers, J.R. Clinical Management of Cardiovascular Risk Factors in Diabetes. Caddo, OK: Professional Communications, Inc. 2002. p.209-216. Contact: Available from Professional Communications, Inc., Fulfillment Center, PO Box 10, Caddo, OK 74729-0010. (800)337-9838. Fax (580)367-9989. E-mail:
[email protected]. ISBN: 1884735665. PRICE: $21.95, plus shipping and handling. Summary: Cardiovascular disease (CVD) accounts for up to 80 percent of mortal events in persons with diabetes. Thus, all strategies to reduce this risk should be optimized in these patients. This concluding chapter is from a handbook that offers a concise overview of the clinical management of cardiovascular risk factors in diabetes. The authors summarize the strategies for cardiovascular disease reduction in people with diabetes. The authors review the recommendations for aspirin therapy, optimal glycemic control, use of ACE inhibitors or beta blockers, the control of elevated blood pressure and lipid (fats) abnormalities, and the elimination of smoking habits. The authors conclude that it is important that the management of the patient with diabetes be extended beyond nutritional intervention and glycemic control. One detailed chart summarizes CVD prevention strategies for patients with diabetes. 1 table. 1 reference.
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Vascular Disease In Diabetes: The Head, The Heart and the Feet Source: in Jagger, P.I. Endocrine Society 43rd Postgraduate Assembly Syllabus, San Diego, California, October 9-13, 1991. Bethesda, MD: The Endocrine Society Press. 1991. p. 460-467. Contact: Available from Endocrine Society Press. 9650 Rockville Pike, Bethesda, MD 20814-3998. (301) 571-1802. PRICE: $41. ISBN: 1879225034. Summary: This article comprises a chapter from the proceedings of the Endocrine Society's conference in October 1991. After presenting three case studies of vascular disease in diabetes, the author discusses the risk factors for vascular disease and the therapy for hypertension and hyperlipidemia and its complications in patients with diabetes. Specific topics include cholesterol levels, diabetic nephropathy, the use of thiazide diuretics and beta blockers, the benefits of diet therapy, and the potential dangers of recurring hypoglycemia in the diabetes population with vascular disease. 3 tables. 21 references.
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Effect of Medications on Diabetes Source: in Carlisle, B.A.; Kroon, L.A.; Koda-Kimble, M.A. 101 Medication Tips for People with Diabetes. Alexandria, VA: American Diabetes Association. 1999. p. 76-83.
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Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $14.95 plus shipping and handling. ISBN: 1580400329. Order number 483301. Summary: This chapter answers questions about the effects of common medications, alcohol, birth control pills, estrogen therapy, beta blockers, hydrochlorothiazide, and niacin on blood glucose levels. Common medications that can increase blood glucose include glucocorticoids, niacin, and protease inhibitors. Glucocorticoids taken as pills or by injection are likely to increase blood glucose levels if they are taken in large doses. If they are inhaled or applied to the skin, they are unlikely to increase blood glucose. The effect of alcohol on blood glucose depends on how much a person drinks during a particular timespan. Birth control pills will not generally make diabetes worse, and estrogen replacement therapy is safe for most women with diabetes. The benefits of beta blockers for people who have diabetes and who have had a heart attack far exceed the risks; currently prescribed doses of hydrochlorothiazide used to control blood pressure have minimal effects on blood glucose level. The amount of niacin in multivitamins is not high enough to increase blood glucose levels. •
Hypertension and Medical Nutrition Therapy Source: in Franz, M.J. and Bantle, J.P., eds. American Diabetes Association Guide to Medical Nutrition Therapy for Diabetes. Alexandria, VA: American Diabetes Association. 1999. p. 295-311. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $39.95 for members; $49.95 for nonmembers; plus shipping and handling. ISBN: 158040006X. Order number 561601. Summary: This chapter focuses on the use of medical nutrition therapy (MNT) in treating hypertension in people with diabetes and presents the recommendations issued by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Numerous randomized, controlled clinical trials have provided strong evidence that lowering blood pressure reduces renal and other complications of diabetes. In the United Kingdom Prospective Diabetes Study, angiotensin converting enzyme (ACE) inhibitors and beta blockers were equally effective and beneficial in treating hypertension. ACE inhibitors may be preferable if albuminuria is present because they are renoprotective and because recent evidence suggests that they may also be cardioprotective. The final results of the Appropriate Blood Pressure Control in Diabetes Trial will provide evidence to judge the best medical treatment approach for individuals who have diabetes and hypertension. Extrapolating from more general studies, weight reduction appears to be the preferable treatment for hypertension in people who have diabetes. Although sodium restriction appears to be effective in lowering blood pressure in sodium sensitive people, severe sodium restriction can worsen lipids and insulin resistance, and present a possible cardiovascular risk. There is no evidence to support the supplemental use of fish oils, potassium, or calcium. The Dietary Approaches To Stop Hypertension Trial demonstrated that a diet high in fruits and vegetables, low in total and saturated fats and cholesterol, and high in whole grains, as well as being moderately low in sodium lowered blood pressure. 5 tables. 36 references.
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•
Cardiovascular Risk Reduction in Hypertensive Diabetics Source: in Moser, M. and Sowers, J.R. Clinical Management of Cardiovascular Risk Factors in Diabetes. Caddo, OK: Professional Communications, Inc. 2002. p.119-149. Contact: Available from Professional Communications, Inc., Fulfillment Center, PO Box 10, Caddo, OK 74729-0010. (800)337-9838. Fax (580)367-9989. E-mail:
[email protected]. ISBN: 1884735665. PRICE: $21.95, plus shipping and handling. Summary: This chapter on cardiovascular risk reduction in patients with hypertension and diabetes is from a handbook that offers a concise overview of the clinical management of cardiovascular risk factors in diabetes. The authors first review the unique challenges in adequately treating hypertension in this population, including obesity, and getting accurate blood pressure readings. The authors then discuss nonpharmacologic treatment options; and pharmacologic treatment, including with ACE inhibitors, ARBs (angiotensin receptor blockers), diuretics, beta blockers, calcium channel blockers, and combination therapy. The chapter concludes with a specific treatment plan and case presentation. 3 figures. 11 tables. 8 references.
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High Blood Pressure Source: in Gilroy, D.K., ed. Guide to a Man's Life. Emmaus, PA: Rodale Press. 1995. p. 11-13. Contact: Available from Rodale Press. 14 East Minor Street, Emmaus, PA 18098. (610) 967-8620. PRICE: Single copy free. Summary: This chapter on high blood pressure is from a booklet that presents the latest medical breakthroughs on common health risks that target men. The chapter presents a brief discussion of the problems caused by hypertension and then considers two recent advances in the treatment of hypertension: the use of beta blockers and the addition of high-potassium foods to the diet. The chapter then lists recommendations for lifestyle changes that can have a positive impact on the problem of hypertension. Suggestions cover topics including weight loss; sodium restrictions; alcohol consumptions; the role of calcium; avoiding isometrics; aerobic exercise; dietary changes, including the role of vegetarianism; monitoring blood pressure at home; psychological factors; and communication. The booklet is written in an informal, friendly style, with medical terms defined for the layperson.
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Portal Hypertension and Gastrointestinal Bleeding Source: in Friedman, L.S. and Keeffe, E.B., eds. Handbook of Liver Disease. Philadelphia, PA: Churchill-Livingstone. 1998. p. 139-149. Contact: Available from W.B. Saunders Company. Book Order Fulfillment Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522. Fax (800) 874-6418. Email:
[email protected]. PRICE: $73.00 plus shipping and handling. ISBN: 0443055203. Summary: This chapter on portal hypertension and gastrointestinal bleeding is from a comprehensive handbook in outline format that offers easy access to information on the full range of liver disorders and covers symptoms, signs, differential diagnoses, and treatments. Patients with cirrhosis (liver scarring) who develop large esophageal varices (dilated veins) as a consequence of portal hypertension have a 25 to 35 percent risk of a variceal hemorrhage and a 30 to 50 percent mortality rate associated with the bleeding
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episode. Mortality depends on the clinical status of the patient and the severity of the bleeding episodes. Nonselective beta adrenergic blockers are the only proven therapy for preventing the first variceal hemorrhage in patients with cirrhosis. Both endoscopic therapy (sclerotherapy, variceal ligation) and drug therapy (vasopressin plus nitroglycerin, somatostatin, Glypressin) are effective in controlling the acute bleeding episode. The combination of endoscopic and pharmacologic therapy offers advantages over the use of either therapy alone. Endoscopic variceal ligation is the endoscopic treatment of choice for preventing recurrent variceal bleeding. Nonselective beta adrenergic blockers or combinations of beta blockers and long acting nitrates are effective in preventing recurrent variceal bleeding. Serial measurement of portal pressure is helpful in assessing the effectiveness of therapy and making appropriate changes when indicated. For patients failing medical therapy to prevent recurrent variceal hemorrhage, options include transjugular intrahepatic portosystemic stent shunts, surgical shunts, or liver transplantation. Selection of the appropriate rescue procedure is dictated by the clinical status of the patient, the availability of expertise in the procedure and, in the case of liver transplantation, appropriateness of the condition and availability of a donor organ. 2 tables. 9 references. (AA-M). •
What You Need to Know About Hypertension Source: in Hirsch, I.B. 12 Things You Must Know About Diabetes Care Right Now!. Alexandria, VA: American Diabetes Association. 2000. p. 101-114. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $14.95 plus shipping and handling. ISBN: 1580400612. Summary: This chapter provides information on hypertension. Although hypertension itself usually does not have symptoms as dramatic as those of eye or kidney disease, it is a serious problem that increases the risk of heart attack, eye problems, and kidney disease. Normal blood pressure is 120/80 mmHg. Hypertension results when blood pressure levels are consistently at 140/90 mmHg or above. Factors that influence whether a person will have hypertension include gender, race, age, how long a person has had diabetes, and whether protein is present in the urine. People who have type 2 diabetes are more likely to have hypertension than people who have type 1 diabetes. The United Kingdom Prospective Diabetes Study showed that improving hypertension control would reduce the risk of diabetes related complications. The diagnosis of hypertension should be based on blood pressure measurements obtained on at least three different occasions. The American Diabetes Association recommends that the goal of blood pressure therapy for people older than 18 who have diabetes is to keep blood pressure below 130/85 mmHg. Mild to moderate hypertension may be treated with lifestyle changes before beginning drug therapy. These changes include losing weight, restricting sodium, quitting smoking, limiting daily alcohol intake to less than 2 ounces, and doing regular aerobic exercise. Drugs available to treat hypertension include thiazide diuretics, beta blockers, angiotensin converting enzyme inhibitors, calcium channel blockers, and alpha blockers. The chapter discusses the effects of these drugs and highlights factors that people need to consider about these drugs. In addition, the chapter includes a list of questions a patient may ask a doctor and questions a doctor may ask a patient. 3 tables.
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Treatment of Non-Cognitive Features of Dementia Source: in Levy, R.; Howard, R.; Burns, A.; eds. Treatment and Care in Old Age Psychiatry. Petersfield, Hampshire, UK: Wrightson Biomedical Publishing Ltd. 1993. p. 47-57. Contact: Available from Taylor and Francis. 1900 Frost Road, Suite 101, Bristol, PA 19007-1598. (800) 821-8312 or (215) 785-5515 (FAX). PRICE: $85.00. Summary: This chapter, in a text concerning recent advances in the psychiatry of the aged, describes the psychiatric symptoms and behavioral disturbances that occur in patients with dementia, outlines their importance, and discusses their treatment. Noncognitive features, including delusions, hallucinations, mood changes, sleep disturbances, appetite changes, sexual changes, psychomotor changes, and personality changes, may have diagnostic value and may help to indicate subgroups of Alzheimer's disease. The chapter focuses on pharmacological treatment of these symptoms, with discussion of neuroleptic agents in general and specific discussion of non-neuroleptics. The latter include antidepressants, anticonvulsants, beta blockers, benzodiazepines, and psychostimulants. General recommendations for drug treatment are given, along with discussions of the drug and behavioral treatment of specific behaviors, including depression, delusions, anxiety, insomnia, aggression, shouting, wandering, and agitation. 27 references.
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CHAPTER 5. MULTIMEDIA ON BETA BLOCKERS Overview In this chapter, we show you how to keep current on multimedia sources of information on beta blockers. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.
Bibliography: Multimedia on Beta Blockers The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in beta blockers (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on beta blockers: •
Beta blockers [videorecording] Source: [presented by] Marshfield Clinic and St. Joseph's Hospital; Year: 1983; Format: Videorecording; Marshfield, WI: Marshfield Regional Video Network, 1983
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Beta blockers after myocardial infarction [videorecording] Source: presented by Department of Medicine, Emory University, School of Medicine; Year: 1982; Format: Videorecording; Atlanta, Ga.: Emory Medical Television Network, 1982
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Furosemide and beta blockers in diabetes [videorecording] Source: Emory University School of Medicine; Year: 1973; Format: Videorecording; Atlanta: Georgia Regional Medical Television Network: [for loan or sale by A. W. Calhoun Medical Library, 1973]
•
Protection of ischemic myocardium with pre-conditioning and short-acting beta blockers [videorecording] Source: Marshfield Clinic, Saint Joseph's Hospital; a presentation of the Marshfield Video Network; Year: 1994; Format: Videorecording; Marshfield, WI: The Clinic, [1994]
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The Beta blockers [videorecording] Source: produced by the Health Communications Network, Division of Continuing Education, Medical University of South Carolina; Year: 1985; Format: Videorecording; Charleston, S.C.: The Network, 1985
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CHAPTER 6. PERIODICALS AND NEWS ON BETA BLOCKERS Overview In this chapter, we suggest a number of news sources and present various periodicals that cover beta blockers.
News Services and Press Releases One of the simplest ways of tracking press releases on beta blockers is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “beta blockers” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to beta blockers. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “beta blockers” (or synonyms). The following was recently listed in this archive for beta blockers: •
Risk from beta blockers minimal, study says Source: Reuters Health eLine Date: February 12, 2003
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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “beta blockers” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “beta blockers” (or synonyms). If you know the name of a company that is relevant to beta blockers, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “beta blockers” (or synonyms).
Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly
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to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “beta blockers” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on beta blockers: •
Diabetes and Heart Disease: New Strategies Emerge Source: Harvard Heart Letter. 10(11): 1-4. July 2000. Contact: Available from Harvard Medical School Health Publications Group. Harvard Heart Letter, P.O. Box 420300, Palm Coast, FL 32142-0300. (800) 829-9045. E-mail:
[email protected]. Website: www.health.harvard.edu. Summary: This article explores the relationship between diabetes and cardiovascular disease. Diabetes is a risk factor for atherosclerosis in the blood vessels of the heart and throughout the body. In addition, other risk factors for heart disease are closely associated with diabetes, including obesity, hypertension, and lipid abnormalities. Although the death rates due to coronary heart disease have been steadily declining over the last few decades, this has not been the case for people who have diabetes. Middle aged women with diabetes have the same increased risk for heart disease as do men. In addition, people who have diabetes and have had heart attacks have a less favorable prognosis than heart attack victims without diabetes. Therefore, most experts recommend that physicians regard all people who have diabetes as heart disease patients, even if they show no signs of cardiovascular problems. Studies have shown that beta blockers such as atenolol, metoprolol, nadolol, and propranolol are among the best drugs to treat coronary artery disease. Doctors traditionally have avoided prescribing beta blockers for people who have diabetes because they can mask the warning signs of low blood glucose and can worsen some problems common in people who have diabetes such as impotence and fatigue. However, research suggests that people who have diabetes may derive even greater benefits from beta blockers when compared with people who do not have diabetes. In addition, research suggests that tight diabetes control can reduce the risk of other diabetes complications. Other studies have investigated the outcomes between people with and without diabetes following balloon angioplasty. Results suggest that angioplasty in people who have diabetes leaves more heart muscle in danger than does bypass surgery. Thus, most physicians create treatment plans under the assumption that bypass surgery is the best form of treatment for people who have diabetes and severe symptoms of coronary disease that has not responded to drug treatment.
•
Xerostomia: Absence Makes the Mouth Get Drier Source: Harvard Health Letter. 25(7): 7. May 2000. Contact: Available from Harvard Health Letter. P.O. Box 420300, Palm Coast, FL 321420300. (800) 829-9045. E-mail:
[email protected]. Summary: This brief health newsletter article describes xerostomia, or dry mouth, and the impact of xerostomia on one's oral health. Xerostomia can range from a minor discomfort, to causing serious problems including burning mouth, swallowing difficulties, and serious dental problems. The article notes that the treatment of dry mouth depends on its cause. The vast majority of xerostomia cases is a side effect of the many medications older people take, rather than aging itself. When the prescription can be changed, that is the first approach to take, but many of the drugs that cause
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xerostomia are some of the most popular and effective medicines available: beta blockers to control high blood pressure, tricyclic antidepressants for depression and for pain relief, and the first generation antihistamines used to control the symptoms of hay fever. The author offers recommendations for coping with xerostomia, including frequent sipping of water, the use of sugar free lozenges, saliva substitutes, and the use of pilocarpine mouthwashes and tablets. 1 figure. •
Hypertension Drugs: They Can Treat More Than High Blood Pressure Source: Mayo Clinic Health Letter. 17(11): 5. November 1999. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465. Summary: This health newsletter article reviews the drugs used to treat hypertension (high blood pressure). The author focuses on the additional benefits of these drugs. Not only do hypertension drugs help control elevated blood pressure, but some actually offer additional health benefits. These can include treating heart failure, diabetes, or symptoms resulting from an enlarged prostate. There are several types of hypertension drugs, and each type helps control elevated blood pressure in a different way. These include diuretics, beta blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, calcium channel blockers, alpha blockers, and central acting agents (central adrenergic inhibitors). In choosing drug therapy to treat a specific patient's hypertension, the physician will consider age, overall health, other medications already being taken, and cost considerations. One table outlines the possible additional health benefits these drugs have beyond treating elevated blood pressure. 1 table.
•
Medications and Their Effects on the Voice Source: Voice Foundation Newsletter. 5(1): 1, 5-6. January 1999. Contact: Available from Voice Foundation. 1721 Pine Street, Philadelphia, PA 19103. (215) 735-7999. Fax (215) 735-9293. E-mail:
[email protected]. Summary: This newsletter article is the second in a series of three articles that summarize vocal consequences of many types of medications. The article discusses gastroenterologic agents, vitamin C, sleeping pills, analgesics (including aspirin), hormones, bronchoactive medications, beta blockers, and psychoactive medications. The longest section of the article is the latter, and the author outlines the indications for psychoactive medication, the use of tricyclic and tetracyclic antidepressants, and side effects including those on the autonomic system, the central nervous system, the immunologic system (allergic symptoms), and the voice. For each class of drugs, the author briefly notes the potential impact of the drug on the voice and offers management strategies.
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Understanding Headaches Source: Fibromyalgia Frontiers. 7(5): 5-7. September-October 1999. Contact: Available from National Fibromyalgia Partnership. 140 Zinn Way, Linden, VA 22642-5609. Toll-free phone (866) 725-4404. Fax (540) 622-2998. E-mail:
[email protected]. Website: www.fmpartnership.org. Summary: This newsletter article provides people who have fibromyalgia (FM) with information on the treatment of primary headache disorders. These uncomfortable disorders are usually benign. Although each headache syndrome has its own distinctive
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pain patterns, vascular headaches and tension headaches have overlaps in treatment. The mainstays of preventive medication in the treatment of vascular headaches and tension headaches are the tricyclics and beta blockers. Selective serotonin uptake inhibitors, which are sometimes helpful in FM, probably help tension headaches more than vascular headaches. The physical approach to the management of vascular headaches is also helpful in treating the patient with FM. Although tension like headaches are believed to be caused by muscle contraction, in patients with FM they may also be related to neurally mediated hypotension. Temporomandibular joint dysfunction (TMD) is very common in these patients, and treatment is similar to that given to others who have TMD. Atypical facial pain syndromes may be more common in patients with FM than in the general population. Other head pain syndromes such as cluster headache and trigeminal neuralgia are no more common in patients with FM than in the general population, so treatments are specific to the particular disorder. People who experience headaches, particularly those who have FM, need to avoid narcotics and other drugs that can cause rebound headaches. •
PKD Pharmacology Source: PKD Progress. 17(4): 11-13. Winter 2002. Contact: Available from PKD Foundation. 4901 Main Street, Suite 200, Kansas City, MO 64112-2634. (800) 753-2873. E-mail:
[email protected]. Summary: Throughout the course of polycystic kidney disease (PKD), patients face a host of physical and biological challenges. This article describes three common problems associated with PKD and the medications used to treat them. The problems are hypertension (high blood pressure), anemia, and calcium and phosphorus issues. Drugs discussed include ACE inhibitors, beta blockers, calcium channel blockers, darbepoetin (a new form of erythropoietin), calcium carbonate, calcium acetate, sevelamer hydrochloride, and vitamin D.
Academic Periodicals covering Beta Blockers Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to beta blockers. In addition to these sources, you can search for articles covering beta blockers that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”
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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.
NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute7: •
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25
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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm
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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375
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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/
7
These publications are typically written by one or more of the various NIH Institutes.
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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm
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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm
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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/
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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm
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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html
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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/
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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp
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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html
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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.8 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:9 •
Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
8
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 9 See http://www.nlm.nih.gov/databases/databases.html.
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
The NLM Gateway10 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.11 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “beta blockers” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total
Items Found 65844 328 883 48 13 67116
HSTAT12 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.13 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.14 Simply search by “beta blockers” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
10
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
11
The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 12 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 13 14
The HSTAT URL is http://hstat.nlm.nih.gov/.
Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.
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Coffee Break: Tutorials for Biologists15 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.16 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.17 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
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Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
15 Adapted 16
from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.
The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 17 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on beta blockers can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to beta blockers. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to beta blockers. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “beta blockers”:
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•
Other guides Anabolic Steroids http://www.nlm.nih.gov/medlineplus/anabolicsteroids.html Arrhythmia http://www.nlm.nih.gov/medlineplus/arrhythmia.html Asthma http://www.nlm.nih.gov/medlineplus/asthma.html Bipolar Disorder http://www.nlm.nih.gov/medlineplus/bipolardisorder.html Coronary Disease http://www.nlm.nih.gov/medlineplus/coronarydisease.html Drug and Medical Device Safety http://www.nlm.nih.gov/medlineplus/drugandmedicaldevicesafety.html Heart Attack http://www.nlm.nih.gov/medlineplus/heartattack.html Heart Failure http://www.nlm.nih.gov/medlineplus/heartfailure.html Lupus http://www.nlm.nih.gov/medlineplus/lupus.html Migraine http://www.nlm.nih.gov/medlineplus/migraine.html Preeclampsia http://www.nlm.nih.gov/medlineplus/preeclampsia.html Sports Fitness http://www.nlm.nih.gov/medlineplus/sportsfitness.html Stroke http://www.nlm.nih.gov/medlineplus/stroke.html Thyroid Diseases http://www.nlm.nih.gov/medlineplus/thyroiddiseases.html Tremor http://www.nlm.nih.gov/medlineplus/tremor.html
You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
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The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on beta blockers. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •
Marfan Syndrome Fact Sheet Source: Port Washington, NY: National Marfan Foundation. 1997. [4 p.]. Contact: Available from National Marfan Foundation. 382 Main Street, Port Washington, NY 11050. (800) 862-7326 or (516) 883-8712. Fax (516) 883-8040. E-mail:
[email protected]. Website: www.marfan.org. PRICE: Single copy free. Summary: Marfan syndrome is a medical condition that is classified as a heritable disorder of connective tissue. Connective tissue is the glue and scaffolding of the body, and is also important in development before birth, growth after birth, cushioning of joints, and enabling passage of light through the eye. All organs contain connective tissues and the manifestations of the Marfan syndrome appear in many parts of the body. Early diagnosis and management of the Marfan syndrome can save lives. This brochure familiarizes readers with the basic facts about Marfan syndrome, including the causes of Marfan (genetic), diagnostic tests, diagnostic criteria for Marfan syndrome, and treatment options (annual screening tests, beta blockers for high blood pressure, antibiotics prior to dental care, and lifestyle adaptations). The brochure concludes with a description of the National Marfan Foundation (NMF), a nonprofit voluntary health organization dedicated to saving lives and improving the quality of life for people and families affected by the Marfan syndrome and related disorders. The brochure explains the activities of the NMF in legislation, local chapters and support groups, and research activities. A form is included for readers to request additional information, to donate to NMF, or to become a member of the Foundation. 1 figure.
•
Diabetes and Your Heart Source: New York, NY: Juvenile Diabetes Foundation International. 199x. [4 p.]. Contact: Available from Juvenile Diabetes Foundation International. 120 Wall Street, New York, NY 10005-4001. (800) 533-2873 or (212) 785-9500. Website: www.jdfcure.com. PRICE: Single copy free; bulk copies available. Summary: This brochure discusses the effects of diabetes on the heart. Although diabetes is one of the four major risk factors for developing heart disease, people with diabetes can effectively improve their cardiovascular risk profile. The most common types of cardiovascular disease are hypertension and coronary artery disease. The brochure explains symptoms and identifies the factors that contribute to these diseases in people who have diabetes. Measures that can help prevent heart problems and enhance diabetes control, including weight loss, exercise, and good nutrition, are outlined. In addition, the brochure describes some of the medications used to lower blood pressure and cholesterol levels, including angiotensin-converting enzyme inhibitors, diuretics, vasodilators, beta blockers, and cholesterol lowering agents.
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•
High Blood Pressure and Diabetes: A Dangerous Combination Source: Clinical Diabetes. 14(4): 95. July-August 1996. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Reproducible. Summary: This fact sheet provides information about high blood pressure and diabetes. Topics include determining if high blood pressure is present; steps to take to lower hypertension without medication; the use of antihypertensive medications, including diuretics, beta blockers, vasodilators, alpha blockers, ACE inhibitors, and calcium channel blockers; and the side effects of some hypertensive medications. One chart lists the ranges of blood pressure readings from high normal to very severe hypertension. The fact sheet includes the toll-free number of the American Diabetes Association (800342-2383).
•
Glaucoma: A Guide for Patients Source: San Ramon, CA: Health InfoNet, Inc. 1999. 33 p. Contact: Available from Health InfoNet, Inc. 231 Market Place, No. 331, San Ramon, CA 94583. (800) HIN-1947. Fax (925) 358-4377. Website: www.hinbooks.com. PRICE: $2.95 per copy; discounts for professionals; bulk quantities available. Summary: This illustrated booklet helps people who have glaucoma learn about this eye problem. Glaucoma refers to several eye conditions that cause damage to the optic nerve. The booklet explains how the eye works; describes the open angle, chronic open angle, chronic and acute angle closure, and neovascular forms of glaucoma; and discusses the diagnosis of glaucoma using various tests such as visual field tests, gonioscopy, measurement of eye pressure, and stereo photographs of the optic nerves. The booklet discusses the treatment of glaucoma with eye drops, including beta blockers, epinephrine, miotics, carbonic anhydrase inhibitor, prostaglandins, and alpha stimulators; laser therapy; medications such as carbonic anhydrase inhibitors; and surgical procedures such as trabeculectomy, draining device surgery, and cyclodestructive surgery. Other topics include glaucoma in children, the impact of glaucoma on other health issues, and glaucoma research. In addition, the booklet provides a glossary of terms and lists sources of additional information. The NIH Search Utility
The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to beta blockers. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
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Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
•
Family Village: http://www.familyvillage.wisc.edu/specific.htm
•
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
•
Med Help International: http://www.medhelp.org/HealthTopics/A.html
•
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
•
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
•
WebMD®Health: http://my.webmd.com/health_topics
Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to beta blockers. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with beta blockers. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about beta blockers. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “beta blockers” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received
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your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “beta blockers”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “beta blockers” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “beta blockers” (or a synonym) into the search box, and click “Submit Query.”
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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.18
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of
18
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)19: •
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
•
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
•
California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/
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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/
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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html
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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
•
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
19
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
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•
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml
•
Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/
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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html
•
Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/
•
Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm
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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/
•
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/
•
Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/
•
Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html
•
Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/
•
Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/
•
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10
•
Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/
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•
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
•
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
•
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
•
Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
•
Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
•
Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
•
Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
•
Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
•
Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
•
Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
•
Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
•
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
•
National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
•
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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•
Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
•
New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
•
New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
•
New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
•
New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
•
New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
•
New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
•
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
•
Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
•
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
•
Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
•
Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
•
Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
•
Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
•
Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
•
Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
•
Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
•
Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
•
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
•
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
•
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
•
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
•
On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
•
Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
•
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on beta blockers: •
Basic Guidelines for Beta Blockers Beta blockers overdose Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002578.htm
•
Signs & Symptoms for Beta Blockers Blurred vision Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003029.htm Coma Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Confusion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003205.htm Convulsions Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003200.htm
120 Beta Blockers
Difficulty breathing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm Double vision Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003029.htm Emesis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Excessive sweating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003218.htm Irregular heartbeat Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003081.htm Lightheadedness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003092.htm Low blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003083.htm Rapid heartbeat Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003081.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm Wheezing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003070.htm •
Diagnostics and Tests for Beta Blockers Blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003398.htm EKG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003868.htm Pulse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003399.htm Slow heartbeat Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003399.htm
•
Background Topics for Beta Blockers Respiratory Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002290.htm
Online Glossaries 121
Shock Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000039.htm Stop breathing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000007.htm Vital signs Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002341.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
•
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
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BETA BLOCKERS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Accommodation: Adjustment, especially that of the eye for various distances. [EU] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Actin: Essential component of the cell skeleton. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenaline: A hormone. Also called epinephrine. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adrenergic Agonists: Drugs that bind to and activate adrenergic receptors. [NIH] Adrenergic Antagonists: Drugs that bind to but do not activate adrenergic receptors. Adrenergic antagonists block the actions of the endogenous adrenergic transmitters epinephrine and norepinephrine. [NIH] Adrenergic beta-Antagonists: Drugs that bind to but do not activate beta-adrenergic
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receptors thereby blocking the actions of beta-adrenergic agonists. Adrenergic betaantagonists are used for treatment of hypertension, cardiac arrythmias, angina pectoris, glaucoma, migraine headaches, and anxiety. [NIH] Adrenergic Uptake Inhibitors: Drugs that block the transport of adrenergic transmitters into axon terminals or into storage vesicles within terminals. The tricyclic antidepressants (antidepressive agents, tricyclic) and amphetamines are among the therapeutically important drugs that may act via inhibition of adrenergic transport. Many of these drugs also block transport of serotonin. [NIH] Adrenoreceptor: Receptors specifically sensitive to and operated by adrenaline and/or noradrenaline and related sympathomimetic drugs. Adrenoreceptor is an alternative name. [NIH]
Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerobic Exercise: A type of physical activity that includes walking, jogging, running, and dancing. Aerobic training improves the efficiency of the aerobic energy-producing systems that can improve cardiorespiratory endurance. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Airway Obstruction: Any hindrance to the passage of air into and out of the lungs. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Albuminuria: More than normal amounts of a protein called albumin in the urine. Albuminuria may be a sign of kidney disease. [NIH] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH]
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Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alprenolol: 1-((1-Methylethyl)amino)-3-(2-(2-propenyl)phenoxy)-2-propanol. Adrenergic beta-blocker used as an antihypertensive, anti-anginal, and anti-arrhythmic agent. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amiodarone: An antianginal and antiarrhythmic drug. It increases the duration of ventricular and atrial muscle action by inhibiting Na,K-activated myocardial adenosine triphosphatase. There is a resulting decrease in heart rate and in vascular resistance. [NIH] Amlodipine: 2-((2-Aminoethoxy)methyl)-4-(2-chlorophenyl)-1,4-dihydro-6-methyl-3,5pyridinedicarboxylic acid 3-ethyl 5-methyl ester. A long-acting dihydropyridine calcium channel blocker. It is effective in the treatment of angina pectoris and hypertension. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [EU] Anabolic Steroids: Chemical derivatives of testosterone that are used for anabolic promotion of growth and repair of body tissues and the development of male sexual characteristics. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesics: Compounds capable of relieving pain without the loss of consciousness or without producing anesthesia. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast
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cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Androgenic: Producing masculine characteristics. [EU] Androstenedione: A steroid with androgenic properties that is produced in the testis, ovary, and adrenal cortex. It is a precursor to testosterone and other androgenic hormones. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Anginal: Pertaining to or characteristic of angina. [EU] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Angiotensin converting enzyme inhibitor: A drug used to decrease pressure inside blood vessels. [NIH] Angiotensin-Converting Enzyme Inhibitors: A class of drugs whose main indications are the treatment of hypertension and heart failure. They exert their hemodynamic effect mainly by inhibiting the renin-angiotensin system. They also modulate sympathetic nervous system activity and increase prostaglandin synthesis. They cause mainly vasodilation and mild natriuresis without affecting heart rate and contractility. [NIH] Angiotensinogen: An alpha-globulin of which a fragment of 14 amino acids is converted by renin to angiotensin I, the inactive precursor of angiotensin II. It is a member of the serpin superfamily. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH]
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Anterior chamber: The space in front of the iris and behind the cornea. [NIH] Antianginal: Counteracting angina or anginal conditions. [EU] Antiarrhythmic: An agent that prevents or alleviates cardiac arrhythmia. [EU] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]
Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidote: A remedy for counteracting a poison. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antihypertensive: An agent that reduces high blood pressure. [EU] Antihypertensive Agents: Drugs used in the treatment of acute or chronic hypertension regardless of pharmacological mechanism. Among the antihypertensive agents are diuretics (especially diuretics, thiazide), adrenergic beta-antagonists, adrenergic alpha-antagonists, angiotensin-converting enzyme inhibitors, calcium channel blockers, ganglionic blockers, and vasodilator agents. [NIH] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antilipemic Agents: Substances used to treat hyperlipidemia. [NIH] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic
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and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Antithrombotic: Preventing or interfering with the formation of thrombi; an agent that so acts. [EU] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiety Disorders: Disorders in which anxiety (persistent feelings of apprehension, tension, or uneasiness) is the predominant disturbance. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Apathy: Lack of feeling or emotion; indifference. [EU] Apnea: A transient absence of spontaneous respiration. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arrhythmia: Any variation from the normal rhythm or rate of the heart beat. [NIH] Arrhythmogenic: Producing or promoting arrhythmia. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriography: A procedure to x-ray arteries. The arteries can be seen because of an injection of a dye that outlines the vessels on an x-ray. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arthropathy: Any joint disease. [EU] Ascites: Accumulation or retention of free fluid within the peritoneal cavity. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Astigmatism: A condition in which the surface of the cornea is not spherical; causes a blurred image to be received at the retina. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [NIH] Atherogenic: Causing the formation of plaque in the lining of the arteries. [NIH] Atrial: Pertaining to an atrium. [EU]
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Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrioventricular: Pertaining to an atrium of the heart and to a ventricle. [EU] Atrioventricular Node: A small nodular mass of specialized muscle fibers located in the interatrial septum near the opening of the coronary sinus. It gives rise to the atrioventricular bundle of the conduction system of the heart. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Aura: A subjective sensation or motor phenomenon that precedes and marks the of a paroxysmal attack, such as an epileptic attack on set. [EU] Auscultation: Act of listening for sounds within the body. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Autonomic Neuropathy: A disease of the nerves affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. These nerves are not under a person's conscious control and function automatically. Also called visceral neuropathy. [NIH] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]
Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH] Baroreflex: A negative feedback system which buffers short-term changes in blood pressure. Increased pressure stretches blood vessels which activates pressoreceptors (baroreceptors) in the vessel walls. The net response of the central nervous system is a reduction of central sympathetic outflow. This reduces blood pressure both by decreasing peripheral vascular resistance and by lowering cardiac output. Because the baroreceptors are tonically active, the baroreflex can compensate rapidly for both increases and decreases in blood pressure. [NIH]
Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of
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donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]
Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Benzodiazepines: A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any Hisomer. [NIH] Beta blocker: A drug used to slow the heart rate and reduce pressure inside blood vessels. It also can regulate heart rhythm. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example,
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in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bradycardia: Excessive slowness in the action of the heart, usually with a heart rate below 60 beats per minute. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]
Breakdown: A physical, metal, or nervous collapse. [NIH] Bromine: A halogen with the atomic symbol Br, atomic number 36, and atomic weight 79.904. It is a volatile reddish-brown liquid that gives off suffocating vapors, is corrosive to the skin, and may cause severe gastroenteritis if ingested. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchodilator: A drug that relaxes the smooth muscles in the constricted airway. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Buffers: A chemical system that functions to control the levels of specific ions in solution. When the level of hydrogen ion in solution is controlled the system is called a pH buffer. [NIH]
Bulimia: Episodic binge eating. The episodes may be associated with the fear of not being able to stop eating, depressed mood, or self-deprecating thoughts (binge-eating disorder) and may frequently be terminated by self-induced vomiting (bulimia nervosa). [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been
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observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium blocker: A drug used to relax the blood vessel and heart muscle, causing pressure inside blood vessels to drop. It also can regulate heart rhythm. [NIH] Calcium Carbonate: Carbonic acid calcium salt (CaCO3). An odorless, tasteless powder or crystal that occurs in nature. It is used therapeutically as a phosphate buffer in hemodialysis patients and as a calcium supplement. [NIH] Calcium channel blocker: A drug used to relax the blood vessel and heart muscle, causing pressure inside blood vessels to drop. It also can regulate heart rhythm. [NIH] Calcium Channel Blockers: A class of drugs that act by selective inhibition of calcium influx through cell membranes or on the release and binding of calcium in intracellular pools. Since they are inducers of vascular and other smooth muscle relaxation, they are used in the drug therapy of hypertension and cerebrovascular spasms, as myocardial protective agents, and in the relaxation of uterine spasms. [NIH] Calcium Chloride: A salt used to replenish calcium levels, as an acid-producing diuretic, and as an antidote for magnesium poisoning. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [NIH] Carbamazepine: An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but some of its actions resemble those of phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carbonate Dehydratase: A zinc-containing enzyme of erythrocytes with molecular weight of 30 kD. It is among the most active of known enzymes and catalyzes the reversible hydration of carbon dioxide, which is significant in the transport of CO2 from the tissues to the lungs. The enzyme is inhibited by acetazolamide. EC 4.2.1.1. [NIH]
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Carbonic Anhydrase Inhibitors: A class of compounds that reduces the secretion of H+ ions by the proximal kidney tubule through inhibition of carbonic anhydrase (carbonate dehydratase). [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiac arrest: A sudden stop of heart function. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiology: The study of the heart, its physiology, and its functions. [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardioselective: Having greater activity on heart tissue than on other tissue. [EU] Cardiotonic: 1. Having a tonic effect on the heart. 2. An agent that has a tonic effect on the heart. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular Agents: Agents that affect the rate or intensity of cardiac contraction, blood vessel diameter, or blood volume. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Cataracts: In medicine, an opacity of the crystalline lens of the eye obstructing partially or totally its transmission of light. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be
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analyzed from an epidemiologic viewpoint. [NIH] Celiprolol: A cardioselective beta-1-adrenergic antagonist that may act as a partial agonist at some adrenergic sites. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Cycle: The complex series of phenomena, occurring between the end of one cell division and the end of the next, by which cellular material is divided between daughter cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebellar Diseases: Diseases that affect the structure or function of the cerebellum. Cardinal manifestations of cerebellar dysfunction include dysmetria, gait ataxia, and muscle hypotonia. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing,
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as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of
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the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compulsive Behavior: The behavior of performing an act persistently and repetitively without it leading to reward or pleasure. The act is usually a small, circumscribed behavior, almost ritualistic, yet not pathologically disturbing. Examples of compulsive behavior include twirling of hair, checking something constantly, not wanting pennies in change,
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straightening tilted pictures, etc. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Concentric: Having a common center of curvature or symmetry. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constriction: The act of constricting. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Cor: The muscular organ that maintains the circulation of the blood. c. adiposum a heart that has undergone fatty degeneration or that has an accumulation of fat around it; called also fat or fatty, heart. c. arteriosum the left side of the heart, so called because it contains oxygenated (arterial) blood. c. biloculare a congenital anomaly characterized by failure of formation of the atrial and ventricular septums, the heart having only two chambers, a single atrium and a single ventricle, and a common atrioventricular valve. c. bovinum (L. 'ox heart') a greatly enlarged heart due to a hypertrophied left ventricle; called also c. taurinum and bucardia. c. dextrum (L. 'right heart') the right atrium and ventricle. c. hirsutum, c.
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villosum. c. mobile (obs.) an abnormally movable heart. c. pendulum a heart so movable that it seems to be hanging by the great blood vessels. c. pseudotriloculare biatriatum a congenital cardiac anomaly in which the heart functions as a three-chambered heart because of tricuspid atresia, the right ventricle being extremely small or rudimentary and the right atrium greatly dilated. Blood passes from the right to the left atrium and thence disease due to pulmonary hypertension secondary to disease of the lung, or its blood vessels, with hypertrophy of the right ventricle. [EU] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. [NIH] Coronary Circulation: The circulation of blood through the coronary vessels of the heart. [NIH]
Coronary Disease: Disorder of cardiac function due to an imbalance between myocardial function and the capacity of the coronary vessels to supply sufficient flow for normal function. It is a form of myocardial ischemia (insufficient blood supply to the heart muscle) caused by a decreased capacity of the coronary vessels. [NIH] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Coronary Vessels: The veins and arteries of the heart. [NIH] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] C-Reactive Protein: A plasma protein that circulates in increased amounts during inflammation and after tissue damage. [NIH] Creatine: An amino acid that occurs in vertebrate tissues and in urine. In muscle tissue, creatine generally occurs as phosphocreatine. Creatine is excreted as creatinine in the urine. [NIH]
Creatine Kinase: A transferase that catalyzes formation of phosphocreatine from ATP + creatine. The reaction stores ATP energy as phosphocreatine. Three cytoplasmic isoenzymes
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have been identified in human tissues: MM from skeletal muscle, MB from myocardial tissue, and BB from nervous tissue as well as a mitochondrial isoenzyme. Macro-creatine kinase refers to creatine kinase complexed with other serum proteins. EC 2.7.3.2. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cytogenetics: A branch of genetics which deals with the cytological and molecular behavior of genes and chromosomes during cell division. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytotoxic: Cell-killing. [NIH] Dairy Products: Raw and processed or manufactured milk and milk-derived products. These are usually from cows (bovine) but are also from goats, sheep, reindeer, and water buffalo. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydroepiandrosterone: DHEA. A substance that is being studied as a cancer prevention drug. It belongs to the family of drugs called steroids. [NIH] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids
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produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]
Dental Hygienists: Persons trained in an accredited school or dental college and licensed by the state in which they reside to provide dental prophylaxis under the direction of a licensed dentist. [NIH] Depersonalization: Alteration in the perception of the self so that the usual sense of one's own reality is lost, manifested in a sense of unreality or self-estrangement, in changes of body image, or in a feeling that one does not control his own actions and speech; seen in depersonalization disorder, schizophrenic disorders, and schizotypal personality disorder. Some do not draw a distinction between depersonalization and derealization, using depersonalization to include both. [EU] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Derealization: Is characterized by the loss of the sense of reality concerning one's surroundings. [NIH] Dermal: Pertaining to or coming from the skin. [NIH] Detergents: Purifying or cleansing agents, usually salts of long-chain aliphatic bases or acids, that exert cleansing (oil-dissolving) and antimicrobial effects through a surface action that depends on possessing both hydrophilic and hydrophobic properties. [NIH] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Diabetes Insipidus: A metabolic disorder due to disorders in the production or release of vasopressin. It is characterized by the chronic excretion of large amounts of low specific gravity urine and great thirst. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diastolic blood pressure: The minimum pressure that remains within the artery when the heart is at rest. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilatation: The act of dilating. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilated cardiomyopathy: Heart muscle disease that leads to enlargement of the heart's chambers, robbing the heart of its pumping ability. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH]
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Dilator: A device used to stretch or enlarge an opening. [NIH] Diltiazem: A benzothiazepine derivative with vasodilating action due to its antagonism of the actions of the calcium ion in membrane functions. It is also teratogenic. [NIH] Dipyridamole: A drug that prevents blood cell clumping and enhances the effectiveness of fluorouracil and other chemotherapeutic agents. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Diuretic: A drug that increases the production of urine. [NIH] Diuretics, Thiazide: Diuretics characterized as analogs of 1,2,4-benzothiadiazine-1,1dioxide. All have a common mechanism of action and differ primarily in the dose required to produce a given effect. They act directly on the kidney to increase the excretion of sodium chloride and water and also increase excretion of potassium ions. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dobutamine: A beta-2 agonist catecholamine that has cardiac stimulant action without evoking vasoconstriction or tachycardia. It is proposed as a cardiotonic after myocardial infarction or open heart surgery. [NIH] Doping: The action of administering a drug to someone before a sports event (originally to a horse before a race); the substance thus administered. [EU] Dosage Forms: Completed forms of the pharmaceutical preparation in which prescribed doses of medication are included. They are designed to resist action by gastric fluids, prevent vomiting and nausea, reduce or alleviate the undesirable taste and smells associated with oral administration, achieve a high concentration of drug at target site, or produce a delayed or long-acting drug effect. They include capsules, liniments, ointments, pharmaceutical solutions, powders, tablets, etc. [NIH] Doxazosin: A selective alpha-1-adrenergic blocker that lowers serum cholesterol. It is also effective in the treatment of hypertension. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated
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from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyslipidemia: Disorders in the lipoprotein metabolism; classified as hypercholesterolemia, hypertriglyceridemia, combined hyperlipidemia, and low levels of high-density lipoprotein (HDL) cholesterol. All of the dyslipidemias can be primary or secondary. Both elevated levels of low-density lipoprotein (LDL) cholesterol and low levels of HDL cholesterol predispose to premature atherosclerosis. [NIH] Dyspareunia: Painful sexual intercourse. [NIH] Dyspepsia: Impaired digestion, especially after eating. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Eclampsia: Onset of convulsions or coma in a previously diagnosed pre-eclamptic patient. [NIH]
Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Ejection fraction: A measure of ventricular contractility, equal to normally 65 8 per cent; lower values indicate ventricular dysfunction. [EU] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH]
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Emergency Medicine: A branch of medicine concerned with an individual's resuscitation, transportation and care from the point of injury or beginning of illness through the hospital or other emergency treatment facility. [NIH] Emergency Treatment: First aid or other immediate intervention for accidents or medical conditions requiring immediate care and treatment before definitive medical and surgical management can be procured. [NIH] Enalapril: An angiotensin-converting enzyme inhibitor that is used to treat hypertension. [NIH]
Encephalopathy: A disorder of the brain that can be caused by disease, injury, drugs, or chemicals. [NIH] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endopeptidases: A subclass of peptide hydrolases. They are classified primarily by their catalytic mechanism. Specificity is used only for identification of individual enzymes. They comprise the serine endopeptidases, EC 3.4.21; cysteine endopeptidases, EC 3.4.22; aspartic endopeptidases, EC 3.4.23, metalloendopeptidases, EC 3.4.24; and a group of enzymes yet to be assigned to any of the above sub-classes, EC 3.4.99. EC 3.4.-. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxic: Of, relating to, or acting as an endotoxin (= a heat-stable toxin, associated with the outer membranes of certain gram-negative bacteria. Endotoxins are not secreted and are released only when the cells are disrupted). [EU] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]
Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH]
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Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [NIH] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Ergot: Cataract due to ergot poisoning caused by eating of rye cereals contaminated by a fungus. [NIH] Ergot Alkaloids: Alkaloids isolated from the ergot fungus Claviceps purpurea (Hypocreaceae). The ergot alkaloids were the first alpha-adrenergic antagonists discovered, but side effects generally prevent their administration in doses that would produce more than a minimal blockade in humans. Their smooth muscle-stimulating activities may be attributed to alpha-agonistic properties, thus characterizing these alkaloids as a series of partial agonists. They have many clinical applications, notably in obstetrics and the treatment of migraine. (From Martindale, The Extra Pharmacopoeia, 28th ed, p662). [NIH] Erythrocyte Volume: Volume of circulating erythrocytes. It is usually measured by radioisotope dilution technique. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Varices: Stretched veins in the esophagus that occur when the liver is not working properly. If the veins burst, the bleeding can cause death. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
Estrogen: One of the two female sex hormones. [NIH] Estrogen Replacement Therapy: The use of hormonal agents with estrogen-like activity in postmenopausal or other estrogen-deficient women to alleviate effects of hormone deficiency, such as vasomotor symptoms, dyspareunia, and progressive development of osteoporosis. This may also include the use of progestational agents in combination therapy. [NIH]
Ethnic Groups: A group of people with a common cultural heritage that sets them apart
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from others in a variety of social relationships. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Facial: Of or pertaining to the face. [EU] Facial Pain: Pain in the facial region including orofacial pain and craniofacial pain. Associated conditions include local inflammatory and neoplastic disorders and neuralgic syndromes involving the trigeminal, facial, and glossopharyngeal nerves. Conditions which feature recurrent or persistent facial pain as the primary manifestation of disease are referred to as facial pain syndromes. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]
Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fetal Weight: The weight of the fetus in utero, which is usually estimated by various formulas based on measurements made during prenatal ultrasonography. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrinolytic: Pertaining to, characterized by, or causing the dissolution of fibrin by enzymatic action [EU] Fibrinolytic Agents: Fibrinolysin or agents that convert plasminogen to fibrinolysin (plasmin). [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibromuscular Dysplasia: An idiopathic, segmental, nonatheromatous disease of the musculature of arterial walls, leading to stenosis of small and medium-sized arteries. Most commonly affected are the renal arteries; involvement of the axillary, iliac, basilar, carotid, hepatic and intracranial arteries have been reported. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Fish Oils: Oils high in unsaturated fats extracted from the bodies of fish or fish parts, especially the livers. Those from the liver are usually high in vitamin A. The oils are used as dietary supplements, in soaps and detergents, as protective coatings, and as a base for other food products such as vegetable shortenings. [NIH]
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Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flatus: Gas passed through the rectum. [NIH] Fluorine: A nonmetallic, diatomic gas that is a trace element and member of the halogen family. It is used in dentistry as flouride to prevent dental caries. [NIH] Fluorouracil: A pyrimidine analog that acts as an antineoplastic antimetabolite and also has immunosuppressant. It interferes with DNA synthesis by blocking the thymidylate synthetase conversion of deoxyuridylic acid to thymidylic acid. [NIH] Foot Care: Taking special steps to avoid foot problems such as sores, cuts, bunions, and calluses. Good care includes daily examination of the feet, toes, and toenails and choosing shoes and socks or stockings that fit well. People with diabetes have to take special care of their feet because nerve damage and reduced blood flow sometimes mean they will have less feeling in their feet than normal. They may not notice cuts and other problems as soon as they should. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Furosemide: A sulfamyl saluretic and diuretic. It has a fast onset and short duration of action and is used in edema and chronic renal insufficiency. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglionic Blockers: Agents having as their major action the interruption of neural transmission at nicotinic receptors on postganglionic autonomic neurons. Because their actions are so broad, including blocking of sympathetic and parasympathetic systems, their therapeutic use has been largely supplanted by more specific drugs. They may still be used in the control of blood pressure in patients with acute dissecting aortic aneurysm and for the induction of hypotension in surgery. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]
Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH]
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Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]
Genital: Pertaining to the genitalia. [EU] Geriatric: Pertaining to the treatment of the aged. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]
Glomerular Filtration Rate: The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to inulin clearance. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Glossopharyngeal Nerve: The 9th cranial nerve. The glossopharyngeal nerve is a mixed motor and sensory nerve; it conveys somatic and autonomic efferents as well as general, special, and visceral afferents. Among the connections are motor fibers to the stylopharyngeus muscle, parasympathetic fibers to the parotid glands, general and taste afferents from the posterior third of the tongue, the nasopharynx, and the palate, and afferents from baroreceptors and chemoreceptors of the carotid sinus. [NIH] Glucocorticoids: A group of corticosteroids that affect carbohydrate metabolism (gluconeogenesis, liver glycogen deposition, elevation of blood sugar), inhibit corticotropin secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system. [NIH] Gluconeogenesis: The process by which glucose is formed from a non-carbohydrate source. [NIH]
Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycolysis: The pathway by which glucose is catabolized into two molecules of pyruvic acid with the generation of ATP. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Gonadal: Pertaining to a gonad. [EU] Gonioscope: Any of several instruments, usually consisting of a biomicroscope used in conjunction with a prismatic contact lens, for viewing the filtration angle of the anterior chamber. [NIH] Gonioscopy: Examination of the angle of the anterior chamber of the eye with a specialized optical instrument (gonioscope) or a contact prism lens. [NIH]
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Goniotomy: A surgical procedure for congenital glaucoma in which a sweeping incision is made in the neshwork at the filtration angle by means of a knife-needle inserted through the opposite limbus and carried across the anterior chamber parallel to the iris. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Graft Rejection: An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Group Practice: Any group of three or more full-time physicians organized in a legally recognized entity for the provision of health care services, sharing space, equipment, personnel and records for both patient care and business management, and who have a predetermined arrangement for the distribution of income. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heart Murmurs: Abnormal heart sounds heard during auscultation caused by alterations in the flow of blood into a chamber, through a valve, or by a valve opening or closing abnormally. They are classified by the time of occurrence during the cardiac cycle, the duration, and the intensity of the sound on a scale of I to V. [NIH] Heart Sounds: The sounds heard over the cardiac region produced by the functioning of the heart. There are four distinct sounds: the first occurs at the beginning of systole and is heard as a "lubb" sound; the second is produced by the closing of the aortic and pulmonary valves and is heard as a "dupp" sound; the third is produced by vibrations of the ventricular walls when suddenly distended by the rush of blood from the atria; and the fourth is produced by atrial contraction and ventricular filling but is rarely audible in the normal heart. The physiological concept of heart sounds is differentiated from the pathological heart murmurs.
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[NIH]
Heartbeat: One complete contraction of the heart. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hemicrania: An ache or a pain in one side of the head, as in migraine. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]
Hepatic: Refers to the liver. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hibernation: The dormant state in which some animal species pass the winter. It is characterized by narcosis and by sharp reduction in body temperature and metabolic activity and by a depression of vital signs. It is a natural physiological process in many warm-blooded animals. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hospital Charges: The prices a hospital sets for its services. Hospital costs (the direct and indirect expenses incurred by the hospital in providing the services) are one factor in the determination of hospital charges. Other factors may include, for example, profits,
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competition, and the necessity of recouping the costs of uncompensated care. [NIH] Hospital Costs: The expenses incurred by a hospital in providing care. The hospital costs attributed to a particular patient care episode include the direct costs plus an appropriate proportion of the overhead for administration, personnel, building maintenance, equipment, etc. Hospital costs are one of the factors which determine hospital charges (the price the hospital sets for its services). [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH] Hydralazine: A direct-acting vasodilator that is used as an antihypertensive agent. [NIH] Hydrochlorothiazide: A thiazide diuretic often considered the prototypical member of this class. It reduces the reabsorption of electrolytes from the renal tubules. This results in increased excretion of water and electrolytes, including sodium, potassium, chloride, and magnesium. It has been used in the treatment of several disorders including edema, hypertension, diabetes insipidus, and hypoparathyroidism. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hypercalcemia: Abnormally high level of calcium in the blood. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperglycemia: Abnormally high blood sugar. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hyperopia: Farsightedness; ability to see distant objects more clearly than close objects; may be corrected with glasses or contact lenses. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypoglycemia: Abnormally low blood sugar [NIH] Hypoglycemic: An orally active drug that produces a fall in blood glucose concentration.
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[NIH]
Hypoglycemic Agents: Agents which lower the blood glucose level. [NIH] Hypokalaemia: Abnormally low potassium concentration in the blood; it may result from potassium loss by renal secretion or by the gastrointestinal route, as by vomiting or diarrhoea. It may be manifested clinically by neuromuscular disorders ranging from weakness to paralysis, by electrocardiographic abnormalities (depression of the T wave and elevation of the U wave), by renal disease, and by gastrointestinal disorders. [EU] Hypotension: Abnormally low blood pressure. [NIH] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive therapy: Therapy used to decrease the body's immune response, such as drugs given to prevent transplant rejection. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Immunotoxin: An antibody linked to a toxic substance. Some immmunotoxins can bind to cancer cells and kill them. [NIH] Impotence: The inability to perform sexual intercourse. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Indapamide: A sulfamyl diuretic with about 16x the effect of furosemide. It has also been shown to be an effective antihypertensive agent in the clinic. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a
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specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infantile: Pertaining to an infant or to infancy. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]
Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Interleukin-6: Factor that stimulates the growth and differentiation of human B-cells and is also a growth factor for hybridomas and plasmacytomas. It is produced by many different cells including T-cells, monocytes, and fibroblasts. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervention Studies: Epidemiologic investigations designed to test a hypothesized causeeffect relation by modifying the supposed causal factor(s) in the study population. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU]
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Intracellular: Inside a cell. [NIH] Intrahepatic: Within the liver. [NIH] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Inulin: A starch found in the tubers and roots of many plants. Since it is hydrolyzable to fructose, it is classified as a fructosan. It has been used in physiologic investigation for determination of the rate of glomerular function. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]
Involuntary: Reaction occurring without intention or volition. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ionization: 1. Any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. Iontophoresis. [EU] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irrigation: The washing of a body cavity or surface by flowing solution which is inserted and then removed. Any drug in the irrigation solution may be absorbed. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isoenzyme: Different forms of an enzyme, usually occurring in different tissues. The isoenzymes of a particular enzyme catalyze the same reaction but they differ in some of their properties. [NIH] Isopropyl: A gene mutation inducer. [NIH] Isoproterenol: Isopropyl analog of epinephrine; beta-sympathomimetic that acts on the heart, bronchi, skeletal muscle, alimentary tract, etc. It is used mainly as bronchodilator and heart stimulant. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of
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normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Labetalol: Blocker of both alpha- and beta-adrenergic receptors that is used as an antihypertensive. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Lactation: The period of the secretion of milk. [EU] Laser therapy: The use of an intensely powerful beam of light to kill cancer cells. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leucocyte: All the white cells of the blood and their precursors (myeloid cell series, lymphoid cell series) but commonly used to indicate granulocytes exclusive of lymphocytes. [NIH]
Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Levo: It is an experimental treatment for heroin addiction that was developed by German scientists around 1948 as an analgesic. Like methadone, it binds with opioid receptors, but it is longer acting. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]
Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipid A: Lipid A is the biologically active component of lipopolysaccharides. It shows strong endotoxic activity and exhibits immunogenic properties. [NIH] Lipopolysaccharides: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]
Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH]
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Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lovastatin: A fungal metabolite isolated from cultures of Aspergillus terreus. The compound is a potent anticholesteremic agent. It inhibits 3-hydroxy-3-methylglutaryl coenzyme A reductase (hydroxymethylglutaryl CoA reductases), which is the rate-limiting enzyme in cholesterol biosynthesis. It also stimulates the production of low-density lipoprotein receptors in the liver. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]
Mammary: Pertaining to the mamma, or breast. [EU] Manic: Affected with mania. [EU] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mastication: The act and process of chewing and grinding food in the mouth. [NIH] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]
Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH]
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Menopause: Permanent cessation of menstruation. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microsomal: Of or pertaining to microsomes : vesicular fragments of endoplasmic reticulum formed after disruption and centrifugation of cells. [EU] Micturition: The passage of urine; urination. [EU] Miotic: 1. Pertaining to, characterized by, or producing miosis : contraction of the pupil. 2. An agent that causes the pupil to contract. 3. Meiotic: characterized by cell division. [EU] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Monotherapy: A therapy which uses only one drug. [EU] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH]
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Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]
Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myopia: That error of refraction in which rays of light entering the eye parallel to the optic axis are brought to a focus in front of the retina, as a result of the eyeball being too long from front to back (axial m.) or of an increased strength in refractive power of the media of the eye (index m.). Called also nearsightedness, because the near point is less distant than it is in emmetropia with an equal amplitude of accommodation. [EU] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Natriuresis: The excretion of abnormal amounts of sodium in the urine. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Nearsightedness: The common term for myopia. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH]
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Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neuralgia: Intense or aching pain that occurs along the course or distribution of a peripheral or cranial nerve. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neurotransmitters: Endogenous signaling molecules that alter the behavior of neurons or effector cells. Neurotransmitter is used here in its most general sense, including not only messengers that act directly to regulate ion channels, but also those that act through second messenger systems, and those that act at a distance from their site of release. Included are neuromodulators, neuroregulators, neuromediators, and neurohumors, whether or not acting at synapses. [NIH] Neutrophil: A type of white blood cell. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nifedipine: A potent vasodilator agent with calcium antagonistic action. It is a useful antianginal agent that also lowers blood pressure. The use of nifedipine as a tocolytic is being investigated. [NIH] Nitrates: Inorganic or organic salts and esters of nitric acid. These compounds contain the NO3- radical. [NIH] Nitric acid: A toxic, corrosive, colorless liquid used to make fertilizers, dyes, explosives, and other chemicals. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]
Nitroglycerin: A highly volatile organic nitrate that acts as a dilator of arterial and venous smooth muscle and is used in the treatment of angina. It provides relief through improvement of the balance between myocardial oxygen supply and demand. Although total coronary blood flow is not increased, there is redistribution of blood flow in the heart when partial occlusion of coronary circulation is effected. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal
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transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Normotensive: 1. Characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. A person with normal blood pressure. [EU] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Octreotide: A potent, long-acting somatostatin octapeptide analog which has a wide range of physiological actions. It inhibits growth hormone secretion, is effective in the treatment of hormone-secreting tumors from various organs, and has beneficial effects in the management of many pathological states including diabetes mellitus, orthostatic hypertension, hyperinsulinism, hypergastrinemia, and small bowel fistula. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Oculi: Globe or ball of the eye. [NIH] Oedema: The presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body; usually applied to demonstrable accumulation of excessive fluid in the subcutaneous tissues. Edema may be localized, due to venous or lymphatic obstruction or to increased vascular permeability, or it may be systemic due to heart failure or renal disease. Collections of edema fluid are designated according to the site, e.g. ascites (peritoneal cavity), hydrothorax (pleural cavity), and hydropericardium (pericardial sac). Massive generalized edema is called anasarca. [EU] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Ophthalmic: Pertaining to the eye. [EU] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]
Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Orofacial: Of or relating to the mouth and face. [EU]
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Orthostatic: Pertaining to or caused by standing erect. [EU] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteopetrosis: Excessive formation of dense trabecular bone leading to pathological fractures, osteitis, splenomegaly with infarct, anemia, and extramedullary hemopoiesis. [NIH]
Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]
Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic cancer: Cancer of the pancreas, a salivary gland of the abdomen. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Panic Disorder: A type of anxiety disorder characterized by unexpected panic attacks that last minutes or, rarely, hours. Panic attacks begin with intense apprehension, fear or terror and, often, a feeling of impending doom. Symptoms experienced during a panic attack include dyspnea or sensations of being smothered; dizziness, loss of balance or faintness; choking sensations; palpitations or accelerated heart rate; shakiness; sweating; nausea or other form of abdominal distress; depersonalization or derealization; paresthesias; hot flashes or chills; chest discomfort or pain; fear of dying and fear of not being in control of oneself or going crazy. Agoraphobia may also develop. Similar to other anxiety disorders, it may be inherited as an autosomal dominant trait. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Paresthesias: Abnormal touch sensations, such as burning or prickling, that occur without an outside stimulus. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU]
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Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]
Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]
Pelvic: Pertaining to the pelvis. [EU] Penbutolol: A nonselective beta-blocker used as an antihypertensive and an antianginal agent. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: Ulcer that occurs in those portions of the alimentary tract which come into contact with gastric juice containing pepsin and acid. It occurs when the amount of acid and pepsin is sufficient to overcome the gastric mucosal barrier. [NIH] Peptic Ulcer Hemorrhage: Bleeding from a peptic ulcer. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Neuropathy: Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy." [NIH] Peripheral vision: Side vision; ability to see objects and movement outside of the direct line of vision. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmaceutical Solutions: Homogeneous liquid preparations that contain one or more chemical substances dissolved, i.e., molecularly dispersed, in a suitable solvent or mixture of mutually miscible solvents. For reasons of their ingredients, method of preparation, or use,
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they do not fall into another group of products. [NIH] Pharmacodynamic: Is concerned with the response of living tissues to chemical stimuli, that is, the action of drugs on the living organism in the absence of disease. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH] Phenylpropanolamine: A sympathomimetic that acts mainly by causing release of norepinephrine but also has direct agonist activity at some adrenergic receptors. It is most commonly used as a nasal vasoconstrictor and an appetite depressant. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]
Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]
Pilocarpine: A slowly hydrolyzed muscarinic agonist with no nicotinic effects. Pilocarpine is used as a miotic and in the treatment of glaucoma. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of
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proteins. [EU] Plasma Volume: Volume of plasma in the circulation. It is usually measured by indicator dilution techniques. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]
Pleural: A circumscribed area of hyaline whorled fibrous tissue which appears on the surface of the parietal pleura, on the fibrous part of the diaphragm or on the pleura in the interlobar fissures. [NIH] Pleural cavity: A space enclosed by the pleura (thin tissue covering the lungs and lining the interior wall of the chest cavity). It is bound by thin membranes. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Portal Pressure: The venous pressure measured in the portal vein. [NIH] Portal Vein: A short thick vein formed by union of the superior mesenteric vein and the splenic vein. [NIH] Portosystemic Shunt: An operation to create an opening between the portal vein and other veins around the liver. [NIH] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Post-traumatic: Occurring as a result of or after injury. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Pravastatin: An antilipemic fungal metabolite isolated from cultures of Nocardia
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autotrophica. It acts as a competitive (hydroxymethylglutaryl CoA reductases). [NIH]
inhibitor
of
HMG
CoA
reductase
Precipitating Factors: Factors associated with the definitive onset of a disease, illness, accident, behavioral response, or course of action. Usually one factor is more important or more obviously recognizable than others, if several are involved, and one may often be regarded as "necessary". Examples include exposure to specific disease; amount or level of an infectious organism, drug, or noxious agent, etc. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Preeclampsia: A toxaemia of late pregnancy characterized by hypertension, edema, and proteinuria, when convulsions and coma are associated, it is called eclampsia. [EU] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Pressoreceptors: Receptors in the vascular system, particularly the aorta and carotid sinus, which are sensitive to stretch of the vessel walls. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary endpoint: The main result that is measured at the end of a study to see if a given treatment worked (e.g., the number of deaths or the difference in survival between the treatment group and the control group). What the primary endpoint will be is decided before the study begins. [NIH] Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [NIH] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty
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acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatism: A symptom complex resulting from compression or obstruction of the urethra, due most commonly to hyperplasia of the prostate; symptoms include diminution in the calibre and force of the urinary stream, hesitancy in initiating voiding, inability to terminate micturition abruptly (with postvoiding dribbling), a sensation of incomplete bladder emptying, and, occasionally, urinary retention. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protease Inhibitors: Compounds which inhibit or antagonize biosynthesis or actions of proteases (endopeptidases). [NIH] Protective Agents: Synthetic or natural substances which are given to prevent a disease or disorder or are used in the process of treating a disease or injury due to a poisonous agent. [NIH]
Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other
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aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]
Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Ramipril: A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH]
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Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Reabsorption: 1. The act or process of absorbing again, as the selective absorption by the kidneys of substances (glucose, proteins, sodium, etc.) already secreted into the renal tubules, and their return to the circulating blood. 2. Resorption. [EU] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractive Power: The ability of an object, such as the eye, to bend light as light passes through it. [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal Artery: A branch of the abdominal aorta which supplies the kidneys, adrenal glands and ureters. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renin: An enzyme which is secreted by the kidney and is formed from prorenin in plasma and kidney. The enzyme cleaves the Leu-Leu bond in angiotensinogen to generate angiotensin I. EC 3.4.23.15. (Formerly EC 3.4.99.19). [NIH] Renin-Angiotensin System: A system consisting of renin, angiotensin-converting enzyme, and angiotensin II. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming angiotensin I. The converting enzyme contained in the lung acts on angiotensin I in the plasma converting it to angiotensin II, the most powerful directly pressor substance known. It causes contraction of the arteriolar smooth muscle and has other indirect actions mediated through the adrenal cortex. [NIH]
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Renovascular: Of or pertaining to the blood vessels of the kidneys. [EU] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Reperfusion Injury: Functional, metabolic, or structural changes, including necrosis, in ischemic tissues thought to result from reperfusion to ischemic areas of the tissue. The most common instance is myocardial reperfusion injury. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinal Ganglion Cells: Cells of the innermost nuclear layer of the retina, the ganglion cell layer, which project axons through the optic nerve to the brain. They are quite variable in size and in the shapes of their dendritic arbors, which are generally confined to the inner plexiform layer. [NIH] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU]
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Rods: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide side vision and the ability to see objects in dim light (night vision). [NIH] Rye: A hardy grain crop, Secale cereale, grown in northern climates. It is the most frequent host to ergot (claviceps), the toxic fungus. Its hybrid with wheat is triticale, another grain. [NIH]
Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Satellite: Applied to a vein which closely accompanies an artery for some distance; in cytogenetics, a chromosomal agent separated by a secondary constriction from the main body of the chromosome. [NIH] Saturated fat: A type of fat found in greatest amounts in foods from animals, such as fatty cuts of meat, poultry with the skin, whole-milk dairy products, lard, and in some vegetable oils, including coconut, palm kernel, and palm oils. Saturated fat raises blood cholesterol more than anything else eaten. On a Step I Diet, no more than 8 to 10 percent of total calories should come from saturated fat, and in the Step II Diet, less than 7 percent of the day's total calories should come from saturated fat. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Sclerotherapy: Treatment of varicose veins, hemorrhoids, gastric and esophageal varices, and peptic ulcer hemorrhage by injection or infusion of chemical agents which cause localized thrombosis and eventual fibrosis and obliteration of the vessels. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Second Messenger Systems: Systems in which an intracellular signal is generated in response to an intercellular primary messenger such as a hormone or neurotransmitter. They are intermediate signals in cellular processes such as metabolism, secretion, contraction, phototransduction, and cell growth. Examples of second messenger systems are the adenyl cyclase-cyclic AMP system, the phosphatidylinositol diphosphate-inositol triphosphate system, and the cyclic GMP system. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the
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elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sediment: A precipitate, especially one that is formed spontaneously. [EU] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serotonin Uptake Inhibitors: Compounds that specifically inhibit the reuptake of serotonin in the brain. This increases the serotonin concentration in the synaptic cleft which then activates serotonin receptors to a greater extent. These agents have been used in treatment of depression, panic disorder, obsessive-compulsive behavior, and alcoholism, as analgesics, and to treat obesity and bulimia. Many of the adrenergic uptake inhibitors also inhibit serotonin uptake; they are not included here. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sharpness: The apparent blurring of the border between two adjacent areas of a radiograph having different optical densities. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]
Shortsightedness: Visual disorder which occurs when the refractive power of the eyes is too strong, with the result that the focal plane of the image is in front of the retina and that only objects close to the eyes appear to be in focus. [NIH] Shunt: A surgically created diversion of fluid (e.g., blood or cerebrospinal fluid) from one area of the body to another area of the body. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Simvastatin: A derivative of lovastatin and potent competitive inhibitor of 3-hydroxy-3methylglutaryl coenzyme A reductase (hydroxymethylglutaryl CoA reductases), which is
Dictionary 171
the rate-limiting enzyme in cholesterol biosynthesis. It may also interfere with steroid hormone production. Due to the induction of hepatic LDL receptors, it increases breakdown of LDL-cholesterol (lipoproteins, LDL cholesterol). [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]
Soaps: Sodium or potassium salts of long chain fatty acids. These detergent substances are obtained by boiling natural oils or fats with caustic alkali. Sodium soaps are harder and are used as topical anti-infectives and vehicles in pills and liniments; potassium soaps are soft, used as vehicles for ointments and also as topical antimicrobials. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Sodium Channels: Cell membrane glycoproteins selective for sodium ions. Fast sodium current is associated with the action potential in neural membranes. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Somatostatin: A polypeptide hormone produced in the hypothalamus, and other tissues and organs. It inhibits the release of human growth hormone, and also modulates important physiological functions of the kidney, pancreas, and gastrointestinal tract. Somatostatin receptors are widely expressed throughout the body. Somatostatin also acts as a neurotransmitter in the central and peripheral nervous systems. [NIH] Sotalol: An adrenergic beta-antagonist that is used in the treatment of life-threatening arrhythmias. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by
172 Beta Blockers
refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Splenomegaly: Enlargement of the spleen. [NIH] Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]
Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]
Substrate: A substance upon which an enzyme acts. [EU] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Sudden cardiac death: Cardiac arrest caused by an irregular heartbeat. [NIH] Sudden death: Cardiac arrest caused by an irregular heartbeat. The term "death" is
Dictionary 173
somewhat misleading, because some patients survive. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Supraventricular: Situated or occurring above the ventricles, especially in an atrium or atrioventricular node. [EU] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synapses: Specialized junctions at which a neuron communicates with a target cell. At classical synapses, a neuron's presynaptic terminal releases a chemical transmitter stored in synaptic vesicles which diffuses across a narrow synaptic cleft and activates receptors on the postsynaptic membrane of the target cell. The target may be a dendrite, cell body, or axon of another neuron, or a specialized region of a muscle or secretory cell. Neurons may also communicate through direct electrical connections which are sometimes called electrical synapses; these are not included here but rather in gap junctions. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Syncope: A temporary suspension of consciousness due to generalized cerebral schemia, a faint or swoon. [EU] Systemic: Affecting the entire body. [NIH] Systole: Period of contraction of the heart, especially of the ventricles. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Systolic blood pressure: The maximum pressure in the artery produced as the heart contracts and blood begins to flow. [NIH] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH]
174 Beta Blockers
Tamponade: The inserting of a tampon; a dressing is inserted firmly into a wound or body cavity, as the nose, uterus or vagina, principally for stopping hemorrhage. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Teratogenic: Tending to produce anomalies of formation, or teratism (= anomaly of formation or development : condition of a monster). [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Theophylline: Alkaloid obtained from Thea sinensis (tea) and others. It stimulates the heart and central nervous system, dilates bronchi and blood vessels, and causes diuresis. The drug is used mainly in bronchial asthma and for myocardial stimulation. Among its more prominent cellular effects are inhibition of cyclic nucleotide phosphodiesterases and antagonism of adenosine receptors. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU] Thrombolytic Therapy: Use of infusions of fibrinolytic agents to destroy or dissolve thrombi in blood vessels or bypass grafts. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyrotoxicosis: The clinical syndrome that reflects the response of the peripheral tissues to an excess of thyroid hormone. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Timolol: A beta-adrenergic antagonist similar in action to propranolol. The levo-isomer is the more active. Timolol has been proposed as an antihypertensive, antiarrhythmic, antiangina, and antiglaucoma agent. It is also used in the treatment of migraine and tremor. [NIH]
Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH]
Dictionary 175
Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tocainide: An antiarrhythmic agent which exerts a potential- and frequency-dependent block of sodium channels. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxaemia: 1. The condition resulting from the spread of bacterial products (toxins) by the bloodstream. 2. A condition resulting from metabolic disturbances, e.g. toxaemia of pregnancy. [EU] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trabecular Meshwork: A porelike structure surrounding the entire circumference of the anterior chamber through which aqueous humor circulates to the canal of Schlemm. [NIH] Trabeculectomy: Any surgical procedure for treatment of glaucoma by means of puncture or reshaping of the trabecular meshwork. It includes goniotomy, trabeculotomy, and laser perforation. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Tremor: Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of Parkinson disease. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU]
176 Beta Blockers
Trigeminal: Cranial nerve V. It is sensory for the eyeball, the conjunctiva, the eyebrow, the skin of face and scalp, the teeth, the mucous membranes in the mouth and nose, and is motor to the muscles of mastication. [NIH] Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Tropomyosin: A protein found in the thin filaments of muscle fibers. It inhibits contraction of the muscle unless its position is modified by troponin. [NIH] Troponin: One of the minor protein components of skeletal muscle. Its function is to serve as the calcium-binding component in the troponin-tropomyosin B-actin-myosin complex by conferring calcium sensitivity to the cross-linked actin and myosin filaments. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Unsaturated Fats: A type of fat. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]
Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond
Dictionary 177
to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Varices: Stretched veins such as those that form in the esophagus from cirrhosis. [NIH] Varicose: The common ulcer in the lower third of the leg or near the ankle. [NIH] Varicose vein: An abnormal swelling and tortuosity especially of the superficial veins of the legs. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular Headaches: A group of disorders characterized by recurrent headaches associated with abnormal dilation and constriction of cerebral blood vessels. Representative disorders from this category include migraine, cluster headache, and paroxysmal hemicrania. [NIH] Vascular Resistance: An expression of the resistance offered by the systemic arterioles, and to a lesser extent by the capillaries, to the flow of blood. [NIH] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vegetarianism: Dietary practice of consuming only vegetables, grains, and nuts. [NIH] Vegetative: 1. Concerned with growth and with nutrition. 2. Functioning involuntarily or unconsciously, as the vegetative nervous system. 3. Resting; denoting the portion of a cell cycle during which the cell is not involved in replication. 4. Of, pertaining to, or characteristic of plants. [EU] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous Pressure: The blood pressure in a vein. It is usually measured to assess the filling pressure to the ventricle. [NIH] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Ventricular Dysfunction: A condition in which the ventricles of the heart exhibit a decreased functionality. [NIH] Ventricular Function: The hemodynamic and electrophysiological action of the ventricles. [NIH]
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Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Verapamil: A calcium channel blocker that is a class IV anti-arrhythmia agent. [NIH] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visual Acuity: Acuteness or clearness of vision, especially of form vision, which is dependent mainly on the sharpness of the retinal focus. [NIH] Visual field: The entire area that can be seen when the eye is forward, including peripheral vision. [NIH] Vitreous Body: The transparent, semigelatinous substance that fills the cavity behind the crystalline lens of the eye and in front of the retina. It is contained in a thin hyoid membrane and forms about four fifths of the optic globe. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]
Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xenograft: The cells of one species transplanted to another species. [NIH] Xerostomia: Decreased salivary flow. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]
179
INDEX A Abdomen, 123, 130, 131, 154, 160, 161, 172 Abdominal, 123, 146, 160, 161, 167 Acceptor, 123, 160 Accommodation, 123, 157 Acetylcholine, 123, 158 Actin, 123, 157, 176 Adaptability, 123, 134 Adenine, 123 Adenocarcinoma, 25, 123 Adenosine, 17, 123, 125, 132, 162, 174 Adjustment, 23, 123 Adrenal Cortex, 123, 126, 138, 164, 167 Adrenal Glands, 123, 167 Adrenal Medulla, 123, 133, 144, 158 Adrenaline, 123, 124 Adrenergic Agonists, 22, 28, 123, 124 Adrenergic Antagonists, 15, 123, 144 Adrenergic beta-Antagonists, 123, 127 Adrenergic Uptake Inhibitors, 124, 170 Adrenoreceptor, 52, 81, 124 Adverse Effect, 5, 13, 19, 53, 124, 170 Aerobic, 88, 89, 124 Aerobic Exercise, 88, 89, 124 Affinity, 124, 171 Age of Onset, 124, 176 Agonist, 30, 49, 124, 134, 141, 162 Airway, 56, 124, 131, 171 Airway Obstruction, 56, 124 Albumin, 15, 124, 156, 162 Albuminuria, 4, 87, 124 Alertness, 124, 131 Algorithms, 125, 130 Alimentary, 17, 125, 152, 153, 161 Alkaline, 125, 132 Alpha-1, 20, 125, 141 Alprenolol, 42, 125, 156 Alternative medicine, 94, 125 Alveoli, 125, 177 Amine, 125, 149 Amino Acids, 125, 126, 161, 163, 165 Amiodarone, 49, 58, 79, 125 Amlodipine, 8, 125 Ampulla, 125, 143 Anabolic, 19, 108, 125, 140 Anabolic Steroids, 19, 108, 125 Anaesthesia, 81, 125, 152 Anal, 125, 144
Analgesics, 96, 125, 170 Analog, 125, 146, 153, 159 Anaphylatoxins, 125, 136 Androgenic, 19, 126 Androstenedione, 19, 126 Anemia, 97, 126, 160 Anesthesia, 30, 65, 124, 125, 126, 143 Anesthetics, 126, 144 Aneurysm, 126, 146, 177 Angina Pectoris, 14, 32, 40, 43, 44, 48, 49, 50, 52, 57, 58, 69, 70, 78, 82, 124, 125, 126, 156, 164 Anginal, 125, 126, 127, 158 Angioplasty, 17, 18, 26, 27, 82, 95, 126 Angiotensin converting enzyme inhibitor, 26, 33, 89, 126 Angiotensin-Converting Enzyme Inhibitors, 9, 21, 42, 48, 54, 71, 84, 109, 126, 127 Angiotensinogen, 126, 167 Animal model, 28, 126 Anions, 124, 126, 153 Antagonism, 126, 132, 141, 174 Anterior chamber, 127, 147, 148, 175 Antianginal, 44, 125, 127, 161 Antiarrhythmic, 22, 31, 53, 125, 127, 174, 175 Antibacterial, 127, 172 Antibiotic, 126, 127, 172 Antibody, 124, 127, 136, 151, 152, 155 Anticonvulsant, 127, 132 Antidote, 58, 127, 132 Antigen, 124, 127, 136, 151, 152, 155 Antigen-Antibody Complex, 127, 136 Antihypertensive Agents, 5, 8, 16, 127 Anti-inflammatory, 127, 128, 147 Anti-Inflammatory Agents, 127, 128 Antilipemic Agents, 13, 127 Antioxidant, 79, 127 Antipsychotic, 127, 158 Antithrombotic, 31, 128 Anxiety, 55, 78, 90, 124, 128, 160, 164 Anxiety Disorders, 128, 160 Aorta, 34, 128, 138, 164, 167, 177 Apathy, 128, 158 Apnea, 128 Apolipoproteins, 128, 154 Applicability, 29, 128
180 Beta Blockers
Aqueous, 28, 128, 129, 154, 175 Arachidonic Acid, 54, 128, 154, 165 Arginine, 125, 128, 158 Arrhythmia, 108, 127, 128, 178 Arrhythmogenic, 58, 128 Arterial, 6, 13, 14, 19, 22, 29, 48, 128, 132, 135, 137, 145, 147, 150, 158, 165, 173 Arteries, 5, 14, 26, 27, 82, 85, 128, 130, 131, 138, 145, 155, 156, 157, 166, 174 Arteriography, 18, 128 Arterioles, 128, 131, 132, 157, 177 Arthropathy, 46, 128 Ascites, 17, 128, 159 Aspirin, 10, 12, 18, 21, 24, 26, 27, 64, 71, 86, 96, 128 Astigmatism, 128, 167 Asymptomatic, 23, 26, 27, 48, 128 Atenolol, 42, 44, 49, 50, 53, 54, 63, 64, 75, 95, 128 Atherogenic, 8, 34, 128 Atrial, 49, 60, 125, 128, 129, 137, 148 Atrial Fibrillation, 49, 60, 129 Atrioventricular, 68, 69, 129, 137, 173 Atrioventricular Node, 129, 173 Atrium, 128, 129, 137, 173, 177 Atypical, 13, 97, 129 Aura, 23, 129 Auscultation, 129, 148 Autonomic, 5, 29, 32, 86, 96, 123, 128, 129, 146, 147, 158, 161, 173 Autonomic Nervous System, 129, 161, 173 Autonomic Neuropathy, 5, 86, 129 Axillary, 129, 145 Axons, 129, 159, 168 B Bacteria, 127, 129, 130, 140, 142, 143, 156, 172, 177 Bacteriuria, 129, 176 Baroreflex, 29, 129 Base, 123, 129, 139, 145, 153, 174 Benign, 96, 130, 148 Benzene, 130 Benzodiazepines, 90, 130 Bile, 13, 17, 130, 154, 172 Bile Acids, 17, 130, 172 Bile Acids and Salts, 130 Bilirubin, 124, 130 Bioavailability, 81, 130 Biochemical, 22, 24, 35, 82, 130, 170 Biopsy, 130, 161 Biosynthesis, 128, 130, 155, 165, 171 Biotechnology, 29, 85, 94, 103, 130
Bladder, 129, 130, 165, 176 Bloating, 130, 151 Blood Coagulation, 130, 132 Blood Glucose, 12, 18, 87, 95, 130, 149, 150, 151, 152 Blood Platelets, 130, 170 Blood pressure, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 15, 16, 18, 20, 21, 22, 23, 67, 68, 83, 86, 87, 88, 89, 96, 97, 109, 110, 120, 127, 129, 130, 132, 133, 146, 147, 150, 151, 156, 158, 159, 166, 171, 177 Blood Volume, 13, 131, 133 Body Fluids, 131, 142, 171 Bone Marrow, 130, 131, 144, 151, 155, 156 Bowel, 125, 131, 159 Bradycardia, 34, 66, 131 Bradykinin, 131, 158, 162 Branch, 17, 117, 131, 139, 142, 143, 161, 167, 171, 174 Breakdown, 131, 140, 146, 159, 171 Bromine, 81, 131 Bronchi, 131, 144, 153, 174 Bronchial, 131, 149, 174 Bronchodilator, 131, 153 Buccal, 131, 155 Buffers, 129, 131 Bulimia, 131, 170 Bypass, 95, 131, 174 C Caffeine, 18, 19, 84, 131 Calcium blocker, 40, 71, 132 Calcium Carbonate, 97, 132 Calcium Chloride, 41, 132 Capillary, 131, 132, 147, 178 Capsules, 132, 141, 147 Captopril, 15, 21, 132 Carbamazepine, 19, 132 Carbohydrate, 20, 132, 147 Carbon Dioxide, 132, 139, 146, 168 Carbonate Dehydratase, 132, 133 Carbonic Anhydrase Inhibitors, 110, 133 Carcinogenic, 130, 133, 152, 172 Cardiac arrest, 45, 133, 172 Cardiac Output, 129, 133 Cardiomyopathy, 25, 51, 133 Cardiopulmonary, 45, 133 Cardiorespiratory, 124, 133 Cardioselective, 10, 50, 128, 133, 134, 164 Cardiotonic, 133, 141 Cardiovascular Agents, 16, 133 Cardiovascular disease, 8, 10, 12, 14, 16, 17, 81, 84, 86, 95, 109, 133
Index 181
Cardiovascular System, 78, 129, 133 Carnitine, 19, 133 Carotene, 133, 168 Case report, 19, 133, 135 Cataracts, 80, 133 Catecholamine, 133, 141, 162 Catheterization, 23, 41, 126, 133, 153 Causal, 133, 144, 152 Cause of Death, 17, 133 Celiprolol, 54, 63, 134 Cell Cycle, 134, 177 Cell Death, 25, 134, 157 Cell membrane, 132, 134, 162, 171 Central Nervous System, 36, 57, 96, 123, 129, 130, 131, 134, 146, 147, 148, 154, 159, 170, 174 Central Nervous System Infections, 134, 148 Centrifugation, 134, 156 Cerebellar, 134, 175 Cerebellar Diseases, 134, 175 Cerebral, 134, 137, 144, 166, 173, 177 Cerebrospinal, 134, 170 Cerebrospinal fluid, 134, 170 Cerebrovascular, 8, 85, 132, 133, 134 Cerebrum, 134 Character, 126, 134, 139 Chemotactic Factors, 134, 136 Chest Pain, 14, 61, 134 Chlorine, 81, 134 Cholesterol Esters, 135, 154 Choroid, 135, 168 Chromosomal, 135, 169 Chromosome, 135, 154, 169 Chronic renal, 51, 62, 135, 146, 163 Chylomicrons, 135, 154 CIS, 135, 168 Clinical study, 135, 137 Clinical trial, 6, 13, 16, 21, 27, 51, 54, 103, 135, 137, 157, 165, 166 Cloning, 130, 135 Coagulation, 130, 135, 149, 162, 174 Coenzyme, 135, 155, 170 Cofactor, 135, 165 Cognition, 135, 158 Cohort Studies, 135, 144 Collapse, 131, 136, 171 Colloidal, 124, 136 Combination Therapy, 7, 17, 40, 61, 88, 136, 144 Comorbidity, 25, 136 Complement, 25, 125, 136, 162
Complementary and alternative medicine, 73, 136 Complementary medicine, 73, 136 Compulsive Behavior, 136, 170 Computational Biology, 103, 137 Concentric, 18, 137 Concomitant, 44, 64, 137 Conduction, 68, 129, 137 Cones, 137, 168 Confusion, 119, 137, 158, 176 Congestive heart failure, 21, 26, 33, 35, 37, 40, 41, 45, 48, 49, 64, 71, 137 Conjunctiva, 137, 176 Connective Tissue, 109, 131, 137, 145, 146, 147 Connective Tissue Cells, 137 Consciousness, 125, 137, 139, 141, 168, 173 Constriction, 18, 137, 153, 169, 177 Consumption, 24, 79, 83, 137, 146, 168 Contractility, 126, 137, 142 Contraindications, ii, 10, 137 Control group, 137, 164, 166 Controlled clinical trial, 87, 137 Convulsions, 119, 127, 137, 142, 164 Cor, 137, 147 Coronary Artery Bypass, 48, 49, 138 Coronary Circulation, 126, 138, 158 Coronary Disease, 57, 71, 95, 108, 138 Coronary heart disease, 8, 30, 52, 64, 95, 133, 138 Coronary Thrombosis, 79, 138, 156, 157 Coronary Vessels, 138 Corticosteroids, 13, 138, 147 Cortisol, 124, 138 Cost Savings, 29, 138 Cranial, 138, 147, 148, 158, 159, 161, 176 Craniocerebral Trauma, 138, 148 C-Reactive Protein, 12, 138 Creatine, 19, 82, 138 Creatine Kinase, 82, 138 Creatinine, 4, 138, 139 Cross-Sectional Studies, 139, 144 Curative, 139, 158, 174 Cutaneous, 139, 155 Cyclic, 132, 139, 148, 158, 165, 169, 174 Cytogenetics, 139, 169 Cytokine, 25, 139 Cytotoxic, 70, 139 D Dairy Products, 139, 169 Databases, Bibliographic, 103, 139 Decarboxylation, 139, 149
182 Beta Blockers
Degenerative, 139, 168 Dehydroepiandrosterone, 19, 139 Delusions, 90, 139 Dementia, 90, 127, 139 Density, 8, 10, 11, 57, 134, 139, 142, 154, 159, 171 Dental Care, 109, 139 Dental Caries, 139, 146 Dental Hygienists, 12, 14, 140 Depersonalization, 140, 160, 169 Depressive Disorder, 140, 154 Derealization, 140, 160 Dermal, 28, 140 Detergents, 140, 145 Deuterium, 140, 150 Diabetes Insipidus, 140, 150 Diabetes Mellitus, 6, 7, 8, 10, 18, 48, 140, 147, 149, 159 Diagnostic procedure, 77, 94, 140 Diarrhoea, 140, 146, 151 Diastole, 140 Diastolic, 18, 37, 140, 150 Diastolic blood pressure, 18, 140 Digestion, 125, 130, 131, 140, 142, 151, 154, 161, 172 Digestive tract, 129, 140, 171 Dihydrotestosterone, 140, 167 Dilatation, 18, 126, 140, 177 Dilatation, Pathologic, 140, 177 Dilated cardiomyopathy, 43, 46, 51, 54, 140 Dilation, 131, 140, 177 Dilator, 141, 158 Diltiazem, 8, 14, 43, 44, 50, 66, 141 Dipyridamole, 34, 141 Direct, iii, 84, 141, 149, 150, 161, 162, 167, 173 Disease Progression, 9, 20, 141 Dissociation, 124, 141, 153 Distal, 17, 138, 141, 161, 166 Diuresis, 131, 141, 174 Diuretic, 6, 10, 11, 13, 15, 20, 22, 132, 141, 146, 150, 151 Diuretics, Thiazide, 11, 127, 141 Dizziness, 141, 160 Dobutamine, 25, 47, 74, 141 Doping, 19, 141 Dosage Forms, 78, 141 Doxazosin, 15, 141 Drug Interactions, 11, 13, 141 Drug Tolerance, 141, 175 Duct, 81, 125, 133, 142, 169
Duodenum, 130, 142, 143, 172 Dyslipidemia, 6, 8, 13, 20, 142 Dyspareunia, 142, 144 Dyspepsia, 142, 151 Dyspnea, 142, 160 E Echocardiography, 47, 74, 142 Eclampsia, 142, 164 Edema, 142, 146, 150, 159, 164 Effector, 123, 136, 142, 158 Effector cell, 142, 158 Efficacy, 8, 13, 15, 23, 24, 31, 39, 42, 44, 50, 51, 142 Ejection fraction, 26, 27, 34, 46, 142 Elective, 82, 142 Electrolyte, 142, 163, 171 Electrons, 127, 130, 142, 153, 160, 166 Electrophysiological, 22, 142, 177 Embolus, 142, 152 Embryo, 142, 152 Emergency Medicine, 41, 70, 143 Emergency Treatment, 143 Enalapril, 51, 62, 143 Encephalopathy, 17, 143 Endarterectomy, 126, 143 Endopeptidases, 143, 165 Endoscope, 143 Endoscopic, 4, 5, 89, 143 Endothelium, 17, 143, 158 Endothelium, Lymphatic, 143 Endothelium, Vascular, 143 Endothelium-derived, 143, 158 Endotoxic, 143, 154 Endotoxins, 136, 143 End-stage renal, 7, 21, 135, 143, 163 Environmental Health, 102, 104, 143 Enzymatic, 132, 133, 136, 139, 143, 145, 149, 168 Enzyme Inhibitors, 44, 48, 144, 162 Epidemiologic Studies, 25, 144 Epinephrine, 55, 61, 110, 123, 144, 153, 158 Epithelial, 123, 144 Epithelium, 143, 144 Erectile, 10, 13, 16, 144 Erection, 144 Ergot, 64, 144, 169 Ergot Alkaloids, 64, 144 Erythrocyte Volume, 131, 144 Erythrocytes, 126, 131, 132, 144 Erythropoietin, 19, 97, 144 Esophageal, 3, 10, 17, 88, 144, 169 Esophageal Varices, 3, 10, 17, 88, 144, 169
Index 183
Esophagus, 5, 140, 144, 149, 172, 177 Estrogen, 11, 87, 144 Estrogen Replacement Therapy, 87, 144 Ethnic Groups, 20, 144 Excitation, 29, 145 Exogenous, 78, 132, 145, 176 Extracellular, 137, 145, 171 Extracellular Matrix, 137, 145 Extraction, 31, 145 F Facial, 97, 145 Facial Pain, 97, 145 Family Planning, 103, 145 Fat, 128, 130, 131, 133, 137, 138, 142, 145, 147, 154, 169, 176 Fatigue, 11, 35, 95, 145, 148 Fatty acids, 6, 124, 145, 165, 171, 174 Fetal Weight, 38, 145 Fetus, 144, 145, 164, 176 Fibrinolytic, 145, 174 Fibrinolytic Agents, 145, 174 Fibroblasts, 137, 145, 152 Fibromuscular Dysplasia, 13, 17, 145 Fibrosis, 25, 145, 169 Filtration, 5, 145, 147, 148 Fish Oils, 87, 145 Fistula, 146, 159 Flatus, 146 Fluorine, 81, 146 Fluorouracil, 141, 146 Foot Care, 12, 146 Forearm, 131, 146 Fungus, 144, 146, 169 Furosemide, 91, 146, 151 G Ganglia, 123, 128, 146, 158, 161, 173 Ganglionic Blockers, 127, 146 Gas, 50, 132, 134, 146, 150, 151, 158, 172, 177 Gas exchange, 50, 146, 177 Gastric, 133, 141, 146, 149, 161, 169 Gastrin, 146, 149 Gastroenteritis, 131, 146 Gastrointestinal, 5, 25, 44, 51, 88, 131, 144, 146, 151, 154, 170, 171, 172 Gastrointestinal tract, 5, 146, 154, 170, 171, 172 Gene, 52, 85, 130, 147, 153 Genital, 129, 147 Geriatric, 19, 39, 41, 47, 147 Gland, 123, 147, 150, 160, 165, 169, 172, 174
Glomerular, 4, 5, 9, 13, 14, 22, 147, 153, 167 Glomerular Filtration Rate, 4, 5, 9, 13, 14, 22, 147 Glomerulus, 147 Glossopharyngeal Nerve, 145, 147 Glucocorticoids, 87, 123, 147 Gluconeogenesis, 147 Glucose, 6, 10, 12, 18, 87, 130, 140, 147, 149, 152, 167, 169 Glucose Intolerance, 140, 147 Glycogen, 147 Glycolysis, 18, 147 Glycoprotein, 86, 144, 147 Gonadal, 147, 172 Gonioscope, 147 Gonioscopy, 110, 147 Goniotomy, 148, 175 Governing Board, 148, 163 Graft, 148, 150, 151 Graft Rejection, 148, 151 Grafting, 138, 148 Group Practice, 28, 148 Growth, 19, 24, 80, 109, 125, 126, 127, 134, 148, 152, 155, 157, 159, 162, 169, 171, 174, 176, 177 Guanylate Cyclase, 148, 158 H Half-Life, 81, 148 Headache, 18, 23, 34, 36, 96, 131, 148, 177 Headache Disorders, 96, 148 Health Status, 12, 148 Heart attack, 10, 11, 87, 89, 95, 133, 148 Heart Murmurs, 13, 14, 148 Heart Sounds, 148 Heartbeat, 120, 149, 172 Heartburn, 149, 151 Hemicrania, 148, 149, 177 Hemodialysis, 132, 149, 154 Hemodynamics, 29, 55, 149 Hemoglobin, 11, 126, 144, 149 Hemorrhage, 5, 10, 17, 88, 138, 148, 149, 172, 174 Hemorrhoids, 149, 169 Hemostasis, 5, 149, 170 Hepatic, 10, 46, 124, 145, 149, 171 Hereditary, 80, 149 Heredity, 147, 149 Hibernation, 25, 149 Histamine, 70, 126, 127, 149 Histidine, 149 Hormonal, 24, 144, 149
184 Beta Blockers
Hormone, 19, 123, 138, 144, 146, 149, 152, 159, 164, 169, 171, 174 Hospital Charges, 149, 150 Hospital Costs, 5, 150 Host, 97, 150, 151, 154, 169, 176, 178 Hybridomas, 150, 152 Hydralazine, 45, 150 Hydrochlorothiazide, 87, 150 Hydrogen, 81, 123, 125, 129, 131, 132, 140, 150, 156, 160, 166 Hydrolysis, 28, 150, 163, 165 Hydrophobic, 140, 150, 154 Hypercalcemia, 18, 150 Hypercholesterolemia, 75, 142, 150 Hyperglycemia, 12, 18, 150 Hyperlipidemia, 5, 12, 86, 127, 142, 150 Hyperopia, 150, 167 Hyperplasia, 150, 165 Hyperthyroidism, 150, 164 Hypertriglyceridemia, 142, 150 Hypertrophy, 25, 60, 63, 138, 150 Hypoglycemia, 5, 12, 20, 86, 150 Hypoglycemic, 26, 150, 151 Hypoglycemic Agents, 26, 151 Hypokalaemia, 61, 151 Hypotension, 5, 97, 128, 137, 146, 151 Hypothalamus, 129, 151, 171 I Id, 74, 111, 116, 118, 151 Idiopathic, 43, 51, 145, 151 Immune response, 127, 148, 151, 172, 176, 178 Immune system, 142, 151, 154, 176, 178 Immunization, 151, 164 Immunogenic, 151, 154 Immunologic, 96, 134, 151 Immunosuppressive, 151 Immunosuppressive therapy, 151 Immunotherapy, 25, 151 Immunotoxin, 25, 151 Impotence, 16, 95, 144, 151 In vitro, 73, 151 In vivo, 73, 151, 174 Incision, 148, 151, 153 Indapamide, 42, 151 Indicative, 84, 151, 161, 177 Indigestion, 11, 151 Induction, 81, 127, 146, 151, 171 Infancy, 152 Infantile, 80, 152 Infarction, 10, 12, 13, 14, 17, 21, 23, 25, 26, 27, 30, 31, 34, 35, 38, 40, 44, 45, 48, 50,
51, 54, 60, 61, 63, 64, 66, 69, 70, 71, 79, 82, 91, 138, 141, 152, 156, 157, 164, 168 Infection, 18, 129, 134, 146, 152, 155, 158, 172, 178 Inflammation, 124, 127, 128, 138, 145, 146, 152, 154, 168 Infusion, 18, 152, 169 Ingestion, 14, 152, 163 Inhalation, 152, 163 Initiation, 59, 152 Inlay, 152, 168 Inotropic, 128, 152 Insomnia, 90, 152 Insulin, 5, 6, 8, 11, 12, 15, 18, 24, 52, 87, 152, 176 Insulin-dependent diabetes mellitus, 152 Interleukin-6, 48, 152 Interstitial, 152, 167 Intervention Studies, 30, 152 Intestines, 123, 140, 146, 152 Intoxication, 152, 178 Intracellular, 132, 152, 153, 158, 163, 165, 167, 169 Intrahepatic, 4, 5, 89, 153 Intravascular, 17, 153 Intravenous, 41, 49, 70, 152, 153 Intrinsic, 39, 42, 53, 61, 63, 70, 124, 153 Intubation, 133, 153 Inulin, 147, 153 Invasive, 18, 153 Involuntary, 153, 157 Ion Channels, 22, 153, 158 Ionization, 69, 153 Ions, 129, 131, 133, 141, 142, 150, 153, 156, 171 Irrigation, 79, 153 Ischemia, 18, 25, 153, 168 Isoenzyme, 139, 153 Isopropyl, 81, 153 Isoproterenol, 49, 153 J Joint, 20, 21, 87, 97, 128, 153, 173 K Kb, 102, 153 Kidney Disease, 4, 16, 89, 97, 102, 124, 153 Kidney Failure, 143, 153 L Labetalol, 53, 56, 154 Labile, 136, 154 Lactation, 36, 154 Laser therapy, 110, 154 Lens, 133, 147, 154, 178
Index 185
Lesion, 17, 138, 154 Leucocyte, 125, 154 Leukotrienes, 128, 154 Levo, 154, 174 Library Services, 116, 154 Ligament, 154, 165 Ligation, 4, 5, 89, 154 Linkages, 149, 154 Lipid, 6, 10, 18, 26, 48, 59, 63, 67, 71, 86, 95, 128, 152, 154, 176 Lipid A, 95, 154 Lipopolysaccharides, 154 Lipoprotein, 8, 10, 11, 57, 64, 142, 154, 155 Lithium, 19, 127, 154 Liver, 3, 5, 46, 88, 123, 124, 128, 130, 133, 144, 145, 147, 149, 153, 154, 155, 163, 166, 167 Liver Transplantation, 4, 89, 155 Localized, 139, 152, 155, 159, 162, 169 Loop, 11, 13, 14, 155 Lovastatin, 155, 170 Low-density lipoprotein, 8, 142, 154, 155 Lupus, 108, 155 Lymph, 129, 143, 155 Lymphatic, 143, 152, 155, 159 Lymphoid, 138, 154, 155 M Malignant, 123, 155 Malnutrition, 124, 155 Mammary, 138, 155 Manic, 127, 154, 155 Manifest, 78, 155 Mastication, 155, 176 Meat, 155, 169 Mediator, 155, 170 MEDLINE, 7, 103, 155 Membrane, 59, 134, 135, 136, 137, 141, 145, 153, 155, 157, 160, 162, 168, 173, 178 Memory, 139, 155 Meninges, 134, 138, 155 Menopause, 11, 156, 163, 164 Menstruation, 156 Mental Disorders, 156, 164, 166 Mental Health, iv, 21, 102, 104, 156, 164 Metabolite, 155, 156, 163, 164, 166 Metoprolol, 38, 42, 43, 44, 48, 49, 50, 54, 63, 75, 95, 156 MI, 10, 23, 26, 27, 72, 121, 156 Microbe, 156, 175 Microbiology, 129, 156 Microsomal, 46, 156 Micturition, 156, 165
Miotic, 156, 162 Mitochondrial Swelling, 156, 157 Modification, 5, 6, 20, 26, 27, 156, 166 Molecular, 25, 35, 103, 105, 130, 132, 137, 139, 156, 167, 175 Molecular Structure, 156, 175 Molecule, 127, 129, 135, 136, 141, 142, 143, 145, 150, 156, 160, 167 Monitor, 19, 139, 156, 159 Monocytes, 152, 156 Monotherapy, 65, 156 Motility, 156, 170 Motion Sickness, 156, 157 Mucins, 157, 169 Mucosa, 155, 157 Multicenter study, 51, 157 Muscle Contraction, 97, 157 Musculature, 145, 157 Myocardial Ischemia, 126, 138, 157 Myocardium, 6, 14, 25, 91, 126, 156, 157 Myopia, 80, 157, 167 Myosin, 157, 176 N Narcosis, 149, 157 Natriuresis, 126, 157 Nausea, 11, 127, 141, 146, 151, 157, 160, 176 Nearsightedness, 157 Necrosis, 82, 152, 156, 157, 168 Need, 3, 13, 83, 85, 89, 94, 97, 112, 124, 135, 147, 157, 175 Neonatal, 25, 157 Neoplastic, 145, 150, 157 Nephropathy, 4, 7, 14, 15, 20, 50, 86, 153, 157 Nerve, 29, 86, 123, 126, 129, 146, 147, 155, 157, 158, 159, 161, 169, 172, 175, 176 Nervous System, 129, 134, 155, 157, 158, 161, 173, 177 Neuralgia, 97, 158 Neuroleptic, 90, 127, 158 Neurologic, 18, 158 Neuromuscular, 123, 151, 158 Neurons, 146, 158, 173 Neuropathy, 11, 20, 129, 158, 161 Neurotransmitters, 78, 158 Neutrophil, 36, 158 Niacin, 13, 87, 158, 176 Nifedipine, 8, 14, 18, 32, 33, 44, 51, 158 Nitrates, 14, 17, 44, 57, 65, 69, 85, 89, 158 Nitric acid, 158 Nitric Oxide, 29, 158
186 Beta Blockers
Nitroglycerin, 57, 89, 158 Norepinephrine, 123, 158, 162 Normotensive, 15, 159 Nuclear, 41, 46, 142, 157, 159, 168 Nuclei, 142, 159, 166 O Obstetrics, 144, 159 Octreotide, 4, 159 Ocular, 28, 54, 81, 159 Oculi, 80, 159 Oedema, 38, 159 Ointments, 141, 159, 171 Opacity, 133, 139, 159 Ophthalmic, 45, 70, 159 Opsin, 159, 168 Optic Chiasm, 151, 159 Optic Nerve, 110, 159, 168 Oral Health, 95, 159 Orofacial, 145, 159 Orthostatic, 5, 128, 159, 160 Osmotic, 124, 156, 160 Osteopetrosis, 24, 160 Osteoporosis, 144, 160 Outpatient, 16, 24, 26, 28, 160 Ovaries, 11, 160 Ovary, 126, 160 Overdose, 63, 119, 160 Oxidation, 18, 123, 127, 160 P Palliative, 160, 174 Pancreas, 123, 152, 160, 171 Pancreatic, 25, 133, 160 Pancreatic cancer, 25, 160 Panic, 25, 160, 170 Panic Disorder, 25, 160, 170 Paralysis, 151, 160 Paresthesias, 160 Paroxysmal, 126, 129, 148, 160, 177 Patch, 161, 175 Pathogenesis, 5, 17, 32, 161 Pathologic, 130, 138, 161, 177 Pathophysiology, 3, 16, 17, 24, 161 Patient Education, 109, 114, 116, 121, 161 Pelvic, 161, 165 Penbutolol, 42, 161 Peptic, 161, 169 Peptic Ulcer, 161, 169 Peptic Ulcer Hemorrhage, 161, 169 Peptide, 143, 161, 163, 165 Percutaneous, 17, 23, 26, 27, 82, 161 Perforation, 161, 175 Peripheral blood, 5, 161
Peripheral Nervous System, 161, 171, 172 Peripheral Neuropathy, 11, 161 Peripheral vision, 161, 178 Peritoneal, 128, 159, 161 Peritoneal Cavity, 128, 159, 161 Pharmaceutical Preparations, 79, 161 Pharmaceutical Solutions, 141, 161 Pharmacodynamic, 55, 59, 162 Pharmacokinetic, 42, 55, 162 Pharmacologic, 4, 5, 7, 13, 19, 22, 26, 59, 88, 89, 126, 148, 162, 175, 176 Pharmacotherapy, 6, 17, 31, 32, 45, 57, 58, 67, 68, 162 Phenylpropanolamine, 67, 68, 162 Phospholipids, 145, 154, 162 Phosphorus, 97, 132, 162 Phosphorylation, 22, 162 Physiologic, 19, 35, 67, 124, 130, 148, 153, 156, 162, 165, 167, 175 Physiology, 29, 133, 142, 162 Pigments, 133, 162, 168 Pilocarpine, 96, 162 Pilot study, 22, 49, 162 Plants, 132, 147, 153, 159, 162, 169, 175, 177 Plaque, 126, 128, 162 Plasma, 5, 12, 29, 30, 31, 60, 81, 124, 131, 134, 135, 138, 143, 147, 149, 153, 156, 162, 163, 167, 170 Plasma protein, 124, 138, 143, 162 Plasma Volume, 131, 163 Platelet Aggregation, 126, 158, 163, 174 Platelets, 54, 158, 163, 174 Platinum, 155, 163 Pleural, 159, 163 Pleural cavity, 159, 163 Poisoning, 52, 132, 144, 146, 152, 157, 163 Polycystic, 97, 163 Polymorphism, 52, 163 Polypeptide, 163, 171 Portal Pressure, 42, 89, 163 Portal Vein, 163 Portosystemic Shunt, 4, 5, 163 Postmenopausal, 6, 78, 144, 160, 163 Post-traumatic, 148, 163 Potassium, 13, 18, 30, 83, 87, 88, 141, 150, 151, 163, 171 Practice Guidelines, 104, 163 Pravastatin, 29, 163 Precipitating Factors, 148, 164 Precursor, 126, 128, 142, 143, 158, 164, 176 Preeclampsia, 108, 164
Index 187
Prenatal, 142, 145, 164 Pressoreceptors, 129, 164 Prevalence, 16, 20, 61, 164 Primary endpoint, 24, 27, 164 Primary Prevention, 5, 8, 17, 164 Prodrug, 164, 166 Progesterone, 164, 172 Progression, 4, 5, 7, 8, 9, 14, 15, 16, 25, 80, 126, 164 Progressive, 6, 21, 25, 33, 135, 139, 141, 144, 148, 157, 164, 167 Projection, 159, 164 Prophylaxis, 5, 10, 48, 71, 81, 140, 164, 176 Propranolol, 40, 44, 55, 63, 64, 75, 79, 95, 128, 164, 174 Prospective Studies, 9, 164 Prostaglandin, 126, 164, 174 Prostate, 25, 96, 165 Prostatism, 66, 165 Protease, 87, 136, 165 Protease Inhibitors, 87, 165 Protective Agents, 132, 165 Protein C, 124, 128, 154, 165, 176 Protein S, 85, 130, 165 Proteins, 29, 125, 127, 128, 134, 136, 139, 156, 161, 162, 165, 167, 170, 175 Proteinuria, 4, 5, 8, 9, 14, 164, 165 Proteolytic, 125, 136, 165 Protocol, 22, 165 Protons, 150, 166 Proximal, 18, 26, 27, 133, 141, 166 Psychiatric, 19, 90, 156, 166 Psychiatry, 33, 47, 90, 166, 177 Psychic, 166, 170 Psychomotor, 90, 132, 158, 166 Public Policy, 103, 166 Pulmonary, 10, 28, 38, 62, 130, 134, 137, 138, 148, 154, 166, 177 Pulmonary Artery, 130, 166, 177 Pulmonary Edema, 134, 154, 166 Pulmonary hypertension, 10, 62, 138, 166 Pulse, 120, 156, 166 Q Quality of Life, 23, 27, 38, 42, 71, 78, 109, 166 R Race, 81, 83, 89, 141, 166 Radiation, 126, 166, 178 Radioactive, 148, 150, 153, 159, 166 Radiological, 161, 166 Ramipril, 13, 166 Random Allocation, 166
Randomization, 24, 166 Randomized, 4, 6, 7, 15, 18, 22, 23, 28, 43, 62, 87, 142, 166, 167 Randomized clinical trial, 62, 167 Reabsorption, 150, 167 Reagent, 135, 167 Receptor, 4, 9, 16, 17, 20, 33, 78, 84, 88, 96, 127, 167, 170 Receptors, Serotonin, 167, 170 Recombinant, 19, 22, 167 Rectum, 140, 146, 165, 167 Recurrence, 49, 167 Reductase, 29, 155, 164, 167, 170 Refer, 1, 131, 136, 141, 158, 167 Refraction, 80, 157, 167, 172 Refractive Power, 157, 167, 170 Refractory, 17, 167 Regimen, 6, 9, 29, 142, 162, 167 Remission, 167 Renal Artery, 13, 17, 18, 167 Renal failure, 13, 167 Renin, 4, 18, 32, 126, 132, 167 Renin-Angiotensin System, 126, 132, 167 Renovascular, 13, 17, 18, 168 Reperfusion, 26, 27, 79, 168 Reperfusion Injury, 168 Respiration, 128, 132, 156, 168 Respiratory Physiology, 168, 177 Restoration, 5, 168 Resuscitation, 4, 143, 168 Retina, 80, 128, 135, 137, 154, 157, 159, 168, 169, 170, 178 Retinal, 12, 67, 159, 168, 178 Retinal Ganglion Cells, 159, 168 Retinol, 168 Retinopathy, 15, 168 Ribose, 123, 168 Risk factor, 8, 11, 12, 26, 27, 57, 83, 85, 86, 88, 95, 109, 144, 168 Risk patient, 8, 13, 168 Rods, 168, 169 Rye, 144, 169 S Saliva, 96, 169 Salivary, 160, 169, 178 Salivary glands, 169 Saphenous, 138, 169 Saphenous Vein, 138, 169 Saponins, 169, 172 Satellite, 17, 169 Saturated fat, 87, 169 Schizoid, 169, 178
188 Beta Blockers
Schizophrenia, 55, 169, 178 Schizotypal Personality Disorder, 140, 169, 178 Sclerotherapy, 4, 5, 10, 89, 169 Screening, 6, 22, 69, 86, 109, 135, 169, 176 Second Messenger Systems, 158, 169 Secretion, 68, 133, 147, 149, 151, 152, 154, 157, 159, 169, 170 Sediment, 170, 176 Segmental, 145, 170 Seizures, 132, 160, 170 Semen, 165, 170 Sensibility, 125, 170 Serotonin, 17, 97, 124, 127, 162, 167, 170, 176 Serotonin Uptake Inhibitors, 97, 170 Serous, 143, 170 Serum, 4, 64, 67, 69, 124, 125, 136, 139, 141, 155, 170 Sharpness, 170, 178 Shock, 41, 121, 170, 175 Shortsightedness, 80, 170 Shunt, 4, 170 Side effect, 6, 12, 13, 14, 20, 53, 54, 57, 62, 79, 84, 95, 96, 110, 124, 128, 144, 170, 175 Signs and Symptoms, 12, 167, 170 Simvastatin, 29, 170 Skeletal, 139, 153, 171, 176 Skeleton, 123, 153, 165, 171 Sleep apnea, 83, 171 Small intestine, 135, 142, 149, 152, 171 Smooth muscle, 14, 125, 131, 132, 137, 144, 149, 158, 167, 171, 172 Soaps, 145, 171 Social Environment, 166, 171 Sodium, 13, 83, 87, 88, 89, 141, 150, 157, 167, 171, 175 Sodium Channels, 171, 175 Somatic, 147, 161, 171 Somatostatin, 17, 89, 159, 171 Sotalol, 66, 75, 171 Sound wave, 137, 171 Specialist, 111, 140, 171 Species, 144, 146, 149, 166, 171, 175, 176, 178 Spectrum, 11, 13, 78, 171 Spinal cord, 134, 135, 155, 158, 161, 172, 173 Splenomegaly, 160, 172 Statistically significant, 6, 11, 172 Stem Cells, 144, 172 Stent, 89, 172
Steroid, 19, 126, 130, 138, 169, 171, 172 Stimulant, 131, 141, 149, 153, 172 Stimulus, 137, 142, 145, 153, 160, 172, 174 Stomach, 5, 123, 140, 144, 146, 149, 152, 157, 161, 171, 172 Stress, 3, 15, 34, 47, 61, 74, 83, 129, 133, 138, 146, 157, 172 Stroke, 7, 13, 14, 21, 85, 102, 108, 133, 172 Subacute, 152, 172 Subarachnoid, 148, 172 Subclinical, 152, 170, 172 Subcutaneous, 18, 142, 159, 172 Substance P, 156, 170, 172 Substrate, 6, 58, 144, 172 Suction, 145, 172 Sudden cardiac death, 37, 61, 172 Sudden death, 79, 172 Supplementation, 19, 173 Support group, 109, 173 Suppression, 49, 173 Supraventricular, 51, 173 Survival Rate, 10, 173 Sympathetic Nervous System, 22, 78, 126, 129, 173 Sympathomimetic, 39, 42, 53, 61, 63, 70, 124, 144, 153, 159, 162, 173 Symphysis, 165, 173 Symptomatic, 48, 66, 78, 173 Synapses, 158, 173 Synaptic, 170, 173 Syncope, 49, 62, 63, 173 Systemic, 5, 14, 17, 40, 43, 49, 54, 63, 81, 128, 130, 144, 149, 152, 159, 173, 177 Systole, 34, 148, 173 Systolic, 7, 8, 10, 15, 18, 48, 59, 66, 150, 173 Systolic blood pressure, 10, 59, 173 T Tachycardia, 141, 173 Tamponade, 5, 174 Temporal, 148, 174 Teratogenic, 141, 174 Testis, 126, 174 Testosterone, 125, 126, 167, 174 Theophylline, 52, 174 Therapeutics, 17, 29, 30, 47, 52, 174 Threshold, 150, 174 Thrombocytes, 163, 174 Thrombolytic, 18, 86, 174 Thrombolytic Therapy, 86, 174 Thrombosis, 165, 169, 172, 174 Thromboxanes, 128, 174 Thrombus, 138, 152, 157, 163, 174
Index 189
Thyroid, 108, 150, 174 Thyrotoxicosis, 55, 174 Thyroxine, 124, 174 Timolol, 42, 54, 75, 174 Tin, 161, 163, 174 Tocainide, 53, 175 Tolerance, 51, 123, 147, 175 Topical, 30, 45, 54, 69, 70, 78, 171, 175 Torsion, 152, 175 Toxaemia, 164, 175 Toxic, iv, 130, 151, 158, 169, 175 Toxicity, 63, 141, 175 Toxicology, 63, 104, 175 Toxins, 127, 143, 152, 175 Trabecular Meshwork, 175 Trabeculectomy, 110, 175 Trace element, 146, 174, 175 Transdermal, 78, 175 Transfection, 130, 175 Transmitter, 123, 153, 155, 159, 173, 175 Transplantation, 9, 25, 89, 135, 151, 175 Trauma, 65, 157, 175 Tremor, 108, 174, 175 Tricyclic, 96, 124, 175 Trigeminal, 97, 145, 176 Triglyceride, 8, 10, 52, 150, 176 Tropomyosin, 176 Troponin, 82, 176 Tryptophan, 170, 176 Tuberculosis, 137, 155, 176 Type 2 diabetes, 4, 9, 10, 12, 15, 18, 85, 89, 176 U Ultrasonography, 145, 176 Unconscious, 126, 151, 176 Unsaturated Fats, 145, 176 Uremia, 154, 167, 176 Ureters, 167, 176 Urethra, 165, 176 Urinalysis, 13, 18, 176 Urinary, 129, 165, 176 Urinary Retention, 165, 176 Urine, 4, 8, 9, 13, 45, 69, 89, 124, 129, 130, 138, 139, 140, 141, 156, 157, 165, 176 Uterus, 156, 160, 164, 174, 176, 177 V Vaccination, 25, 176
Vaccine, 165, 176 Vagina, 156, 174, 177 Varices, 3, 5, 10, 177 Varicose, 169, 177 Varicose vein, 169, 177 Vascular, 14, 24, 32, 49, 86, 97, 125, 129, 132, 135, 143, 148, 152, 158, 159, 164, 174, 177 Vascular Headaches, 97, 177 Vascular Resistance, 49, 125, 129, 177 Vasoconstriction, 141, 144, 177 Vasodilation, 14, 126, 177 Vasodilator, 51, 127, 131, 149, 150, 158, 177 Vasomotor, 144, 177 VE, 32, 34, 177 Vegetarianism, 88, 177 Vegetative, 78, 177 Vein, 126, 153, 159, 163, 169, 177 Venous, 3, 14, 149, 158, 159, 163, 165, 177 Venous Pressure, 163, 177 Ventilation, 50, 177 Ventricle, 129, 137, 151, 166, 173, 177 Ventricular, 44, 47, 48, 49, 50, 51, 60, 63, 66, 74, 125, 137, 142, 148, 177 Ventricular Dysfunction, 47, 50, 74, 142, 177 Ventricular Function, 44, 177 Venules, 131, 132, 143, 178 Verapamil, 8, 14, 36, 37, 40, 43, 64, 178 Vesicular, 156, 178 Veterinary Medicine, 103, 178 Virulence, 175, 178 Virus, 25, 134, 162, 178 Visceral, 129, 147, 178 Visual Acuity, 15, 178 Visual field, 110, 159, 178 Vitreous Body, 168, 178 Vitro, 178 Vivo, 178 W White blood cell, 127, 155, 158, 178 Withdrawal, 46, 59, 69, 78, 178 X Xenograft, 126, 178 Xerostomia, 95, 178 X-ray, 128, 159, 178
190 Beta Blockers
Index 191
192 Beta Blockers
