Inter relacion Clopidogrel Dexlanzoprasol

http://www.medpagetoday.com/Cardiology/PCI/29831#

Inter relacion Clopidogrel Dexlanzoprasol

http://www.medpagetoday.com/Cardiology/PCI/29831#

Cardioprotective effects of diabetes drugs examined

Cardioprotective effects of diabetes drugs examined

High-sensitivity C-reactive protein: a novel cardiovascular risk predictor in type 2 diabetics with normal lipid profile | DocGuide

High-sensitivity C-reactive protein: a novel cardiovascular risk predictor in type 2 diabetics with normal lipid profile | DocGuide

Diltiazem in the treatment of hypertension and ischemic heart disease | DocGuide

Diltiazem in the treatment of hypertension and ischemic heart disease | DocGuide

Response to pulmonary vasodilator treatment in a former smoker with combined interstitial lung disease complicated by pulmonary hypertension: Case report and review of the literature | DocGuide

Response to pulmonary vasodilator treatment in a former smoker with combined interstitial lung disease complicated by pulmonary hypertension: Case report and review of the literature | DocGuide

Tadalafil (Cialis) for Signs and Symptoms of Benign Prostatic Hyperplasia | The Medical Letter - Trusted Drug Information & Drug Facts Since 1959

Tadalafil (Cialis) for Signs and Symptoms of Benign Prostatic Hyperplasia | The Medical Letter - Trusted Drug Information & Drug Facts Since 1959

File:Acquired longQT.jpg

Acquired longQT.jpg

QT prolongado

Prasugrel - Australian Prescriber

Prasugrel - Australian Prescriber
Prasugrel

(Aust Prescr 2010;33:22-7)

Effient (Eli Lilly)
5 mg and 10 mg tablets
Approved indication: recurrent myocardial infarction
Australian Medicines Handbook section 7.2.2

Patients with myocardial infarction are at high risk of recurrence. Dual antiplatelet therapy, such as aspirin and clopidogrel, has been shown to reduce this risk.

Prasugrel, an adenosine diphosphate receptor antagonist of the thienopyridine class, is a new antiplatelet drug. It works by inhibiting platelet activation and aggregation through the irreversible binding of its active metabolite to the P2Y₁₂ receptor on platelets. After oral administration, prasugrel is metabolised mainly by cytochrome P450 3A4 and 2B6. Its elimination half-life is 7.4 hours with the majority of the dose being excreted in the urine.

In a pharmacodynamic study of patients with acute coronary syndrome, prasugrel (60 mg loading dose, then 10 mg daily) was found to be a more potent inhibitor of platelet aggregation than clopidogrel (600 mg loading dose then 150 mg daily) in ex vivo blood tests.......

Issue Online: Prescriber's Letter

Prescriber's Letter
You'll be able to prescribe GENERIC atorvastatin (Lipitor)

Saxagliptin/Metformin (Kombiglyze XR) for Type 2 Diabetes

Saxagliptin/Metformin (Kombiglyze XR) for Type 2 Diabetes
The Medical Letter on Drugs and Therapeutics • March 21, 2011 (Issue 1360)

Important Copyright Message: The Medical Letter® publications are protected by US and international copyright laws. Forwarding, copying or any distribution of this material is prohibited. Sharing a password with a non-subscriber or otherwise making the contents of this site available to third parties is strictly prohibited. By accessing and reading the attached content I agree to comply with US and international copyright law and these terms and conditions of The Medical Letter, Inc.

Metformin (Glucophage, and others) is generally preferred as the first-line agent for treatment of type 2 diabetes, but most patients subsequently require treatment with more than one drug.1 Many combination products have been marketed; the latest of these combines saxagliptin2 with extended-release (ER) metformin as Kombiglyze XR.

MECHANISM OF ACTION — Saxagliptin, an oral dipeptidyl peptidase-4 (DPP-4) enzyme inhibitor, slows breakdown of glucagon-like peptide-1 (GLP-1), which increases release of insulin from pancreatic beta cells and decreases release of glucagon from pancreatic alpha cells. Metformin decreases hepatic glucose production and increases insulin sensitivity in peripheral tissues.

CLINICAL STUDIES — Monotherapy vs. Combination Therapy – FDA approval of Kombiglyze XR was based on two 24-week double-blind, placebo-controlled trials, one in treatment-naive patients and the other in patients inadequately controlled on immediate-release (IR) metformin alone. Neither study actually used the fixed-dose combination; patients treated with both drugs took separate co-administered saxagliptin and IR metformin tablets. IR and ER metformin have a similar area under the curve (AUC), but peak plasma levels of ER metformin are about 20% lower. The results of these trials are summarized in Table 1. In both, the change in glycosylated hemoglobin (A1C) was greater and more patients achieved an A1C of <7% with saxagliptin and metformin together, compared to those treated with either drug alone.

Addition of Saxagliptin vs. Sitagliptin to Metformin – An 18-week double-blind, non-inferiority trial in 801 patients inadequately controlled on a stable dose of IR metformin (mean dose about 1800 mg/day) compared the addition of 5 mg daily of saxagliptin to addition of 100 mg of sitagliptin (Januvia) once daily. The 2 drugs were similarly effective (A1C decreased 0.52% vs. 0.62%). Hypoglycemic events and weight loss occurred with similar frequency.3

Addition of Saxagliptin vs. Glipizide to Metformin – A 52-week double-blind, non-inferiority trial in 858 patients not controlled on a stable dose of IR metformin (mean dose about 1900 mg/day) compared the addition of 5 mg of saxagliptin once daily to addition of glipizide (titrated from 5 mg up to 20 mg) twice daily. The drugs were similarly effective (A1C decreased 0.74% vs. 0.80%), but hypoglycemic events were much more common with glipizide (36.3% vs. 3%). Patients lost a mean of 1.1 kg with saxagliptin and gained 1.1 kg with glipizide.4

ADVERSE EFFECTS — Headache, nasopharyngitis and diarrhea were the most common adverse effects reported with saxagliptin/metformin in clinical trials. Nausea, vomiting, abdominal pain, metallic taste and flatulence can occur with metformin alone. Modest weight loss occurs with metformin alone and with the 2 drugs taken together. The incidence of hypoglycemia with both drugs was low and similar to the rate with metformin alone.

Lactic acidosis is a rare but potentially fatal complication that can occur with accumulation of metformin. Like metformin alone, Kombiglyze XR is contraindicated in patients with severe renal dysfunction, should be temporarily suspended for surgical procedures, and should be withheld for at least 48 hours before and after radiologic studies with IV iodinated contrast material. It is contraindicated in patients with severe hepatic impairment.

The long-term safety of DPP-4 inhibitors such as saxagliptin is unknown.

PREGNANCY — The combination of saxagliptin and metformin is classified as category B (no evidence of risk, no adequate studies in pregnant women) for use in pregnancy.

DRUG INTERACTIONS — Saxagliptin is metabolized by CYP3A4; strong inhibitors of this isozyme such as clarithromycin (Biaxin, and others) or itraconazole (Sporanox, and others) may increase serum concentrations of saxagliptin. The dose of Kombiglyze XR should be limited to 2.5/1000 mg once daily in patients taking strong inhibitors of CYP3A4.

DOSAGE AND ADMINISTRATION — Kombiglyze XR is taken once daily with the evening meal to minimize the gastrointestinal effects of metformin. The tablets should be taken whole and not crushed, chewed or split. For patients not adequately controlled on metformin alone, the usual starting dose is based on the previous dose of metformin. The maximum daily dose of Kombiglyze XR is 5 mg of saxagliptin and 2000 mg of metformin. Patients who cannot take more than 2.5 mg of saxagliptin and either are not already taking metformin or require more than 1000 mg of metformin should take the drugs individually.

CONCLUSION — Treatment with the new fixed-dose combination of saxagliptin and extended-release metformin (Kombiglyze XR) may be more convenient than taking the individual drugs separately, but with less dosing flexibility. Adding saxagliptin to metformin may cause less weight gain and less hypoglycemia than adding a sulfonylurea such as glimepiride (Amaryl, and others), but the retail cost of this combination is much higher than taking generic metformin plus a sulfonylurea separately. Clinical experience with saxagliptin is limited and its long-term safety is unknown.

Critically Elevated INR in a Patient on Warfarin After Increase in Extended-Release Niacin Dose

Critically Elevated INR in a Patient on Warfarin After Increase in Extended-Release Niacin Dose:

OBJECTIVE: To report a case of a probable interaction between warfarin and extended-release niacin that may have led to synergistic coagulopathy and to inform health care providers of a need for more frequent monitoring of international normalized ratio (INR) in patients taking these drugs concomitantly.

CASE SUMMARY: A 69-year-old white female whose anticoagulation treatment had been stable for 18 months with warfarin 2.5 mg daily (17.5 mg/wk) presented to an anticoagulation clinic with a critically elevated INR of greater than 12.3 after a dose increase in extended-release niacin (Niaspan) from 500 mg to 1000 mg daily the previous week. Extended-release niacin 500 mg daily had not affected the patient's INR for the previous 3 months; the most recent INR before this episode was 2.4. Warfarin was withheld and extended-release niacin was discontinued. The INR 2 days later was 4.8 and, with titration of warfarin to the previous maintenance dose of 2.5 mg daily, the INR was 2.3.

DISCUSSION: Common drug interaction resources do not consistently list an interaction between warfarin and extended-release niacin. The mechanism of niacin-induced coagulopathy is theorized to be related to diminished coagulation factors, and limited data suggest that this may be more pronounced with extended-release niacin. Because of the described effects of niacin on the coagulation cascade and the possibility for pharmacokinetic interactions, there is a potential for synergistic coagulopathy when combined with warfarin therapy. For patients taking both medications, more frequent INR monitoring than that which drug interaction references suggest may be advised. An objective causality assessment (Horn Drug Interaction Probability Scale) revealed that the interaction was probable.
CONCLUSIONS: An interaction between niacin and warfarin likely elevated the INR in this patient because of synergistic coagulopathy and pharmacokinetic effects of niacin. Increased frequency of INR monitoring may be advised for patients taking these drugs concomitantly.

FDA Issues 'Safety Communication' on Fenofibrate

FDA Issues 'Safety Communication' on Fenofibrate: The agency has updated the prescribing information for the cholesterol-lowering agent, stating that it may not lower the risk of major cardiovascular events, and is requesting Abbott to conduct another study.
Heartwire

The diagnostic utility of recovery phase QTc during treadmill exercise stress testing in the evaluation of long QT syndrome

The diagnostic utility of recovery phase QTc during treadmill exercise stress testing in the evaluation of long QT syndrome: Background: Nearly 40% of patients with long QT syndrome (LQTS) can have a nondiagnostic QTc at rest. Treadmill and cycle exercise stress testing are used in the diagnostic evaluation of LQTS.Objective: The purpose of this study was to determine the diagnostic significance of peak exercise and recovery phase QTc values during treadmill stress testing in LQTS.Methods: An Institutional Review Board–approved, retrospective analysis was performed on the treadmill stress tests in 243 patients including 82 LQT1, 55 LQT2, 18 LQT3, and 88 genotype-negative patients dismissed as normal. Blinded to genotype, QTc was calculated at rest, peak exercise, and 1, 2, 3, 4, and 5 minutes of recovery.Results: Compared with those dismissed as normal, the average QTc was greater at all scored stages in LQT1 and LQT3 patients and at all stages in LQT2 patients except peak exercise and 1 minute of recovery (P <.01). Either an absolute QTc ≥460 ms during the recovery phase or a maladaptive, paradoxical increase in QTc, defined as QTc recovery − QTc baseline ≥ 30 ms (ΔQTc), distinguished patients with either manifest or concealed LQT1 from all other subsets (P <.0001). The presence of beta-blockers did not blunt these abnormal repolarization profiles.Conclusion: Treadmill stress testing can unmask patients with concealed LQTS, particularly LQT1, with good diagnostic accuracy.

Pirfenidone mitigates left ventricular fibrosis and dysfunction after myocardial infarction and reduces arrhythmias

Pirfenidone mitigates left ventricular fibrosis and dysfunction after myocardial infarction and reduces arrhythmias

Vitamina c

Do the benefits of vitamin C include improved mood?

QT-Interval Duration and Mortality Rate: Results From the Third National Health and Nutrition Examination Survey [Original Investigation]

QT-Interval Duration and Mortality Rate: Results From the Third National Health and Nutrition Examination Survey [Original Investigation]:

Background  Extreme prolongation or reduction of the QT interval predisposes patients to malignant ventricular arrhythmias and sudden cardiac death, but the association of variations in the QT interval within a reference range with mortality end points in the general population is unclear.

Methods  We included 7828 men and women from the Third National Health and Nutrition Examination Survey. Baseline QT interval was measured via standard 12-lead electrocardiographic readings. Mortality end points were assessed through December 31, 2006 (2291 deaths).

Results  After an average follow-up of 13.7 years, the association between QT interval and mortality end points was U-shaped. The multivariate-adjusted hazard ratios comparing participants at or above the 95th percentile of age-, sex-, race-, and R-R interval–corrected QT interval (≥439 milliseconds) with participants in the middle quintile (401 to <410 milliseconds) were 2.03 (95% confidence interval, 1.46-2.81) for total mortality, 2.55 (1.59-4.09) for mortality due to cardiovascular disease (CVD), 1.63 (0.96-2.75) for mortality due to coronary heart disease, and 1.65 (1.16-2.35) for non-CVD mortality. The corresponding hazard ratios comparing participants with a corrected QT interval below the fifth percentile (<377 milliseconds) with those in the middle quintile were 1.39 (95% confidence interval, 1.02-1.88) for total mortality, 1.35 (0.77-2.36) for CVD mortality, 1.02 (0.44-2.38) for coronary heart disease mortality, and 1.42 (0.97-2.08) for non-CVD mortality. Increased mortality also was observed with less extreme deviations of QT-interval duration. Similar, albeit weaker, associations also were observed with Bazett-corrected QT intervals.

Conclusion  Shortened and prolonged QT-interval durations, even within a reference range, are associated with increased mortality risk in the general population.

Sleep Duration and Sleep Quality in Relation to 12-Year Cardiovascular Disease Incidence: The MORGEN Study.

http://www.ncbi.nlm.nih.gov/m/pubmed/22043119/

Comparison of fixed-dose combinations of telmisartan/hydrochlorothiazide 40/12.5 mg and 80/12.5 mg and a fixed-dose combination of losartan/hydrochlor

http://www.ncbi.nlm.nih.gov/m/pubmed/16368450/?i=6&from=/21992003/related

Effect of fixed dose combinations of metoprolol and amlodipine in essential hypertension: MARS -A randomized controlled trial.

http://www.ncbi.nlm.nih.gov/m/pubmed/21992003/

Bone metablobisn density

http://www.ncbi.nlm.nih.gov/m/pubmed/21983795/
bone metabolim density

Left atrial appendage closure: a percutaneous transcatheter approach for stroke prevention in atrial fibrillation; Landmesser U, Holmes DR; European Heart Journal (Oct 2011)
Tags: acetylsalicylic acid Arrhythmias clopidogrel Stroke warfarin
PubMed | Get Full Text
Atrial fibrillation is a frequent cause of stroke; in the elderly, more than 20% of strokes are attributed to this common arrhythmia. Anticoagulation with warfarin reduces the risk of stroke by ∼60%; however, a large proportion of patients with atrial fibrillation do not receive this treatment because of relative/absolute contraindications. Moreover, patients often discontinue warfarin for a variety of reasons and chronic warfarin administration rates remain suboptimal. Although the compliance with anticoagulation may improve with novel anticoagulants and bleeding risk can be somewhat reduced when compared with warfarin, there is still a progressive increase in bleeding complications over time. Accordingly, new approaches for stroke prevention in these patients are being explored and tested. In transoesophageal echocardiographic (TEE) studies, more than 90% of thrombi were found in the left atrial appendage (LAA) in non-valvular atrial fibrillation, and transcatheter LAA closure is developed and examined as a novel approach to reduce the risk of stroke in these patients. The PROTECT-AF study provides first evidence from a randomized clinical trial that a strategy of LAA occlusion using the Watchman device can be non-inferior to anticoagulation with warfarin for a combined endpoint in patients with non-valvular atrial fibrillation (mean CHADS(2) score 1.8). In successfully occluded patients fulfilling TEE criteria (86%), warfarin was stopped after 45 days, followed by aspirin and clopidogrel for 6 months after randomization and subsequently aspirin. The PREVAIL trial is further evaluating this concept. Limited data are available for another LAA occlusion system, the Amplatzer Cardiac Plug (ACP) device, for which the ACP trial has been initiated. Left atrial appendage occlusion needs to be performed with meticulous care by experienced operators because periprocedural complications such as pericardial effusion or stroke have been documented. With increased operator experience and technical improvements of the device, these complications can be minimized.

Para la piel, el cabello, las uñas y las mucosas... vitaminas - 20minutos.es

Para la piel, el cabello, las uñas y las mucosas... vitaminas - 20minutos.es:

20minutos.es

Para la piel, el cabello, las uñas y las mucosas... vitaminas 20minutos.es Solo el 43% de los españoles consumen a diario la suficiente cantidad de frutas y verduras. (ARCHIVO) El aspecto de los labios, la piel o el cabello son síntomas de una probable deficiencia de diversas vitaminas. Las vitaminas A, C y K nutren la piel. ... ¿Qué vitamina te falta?Consumer los 2 artículos informativos »

Aneurima aortico

e-Journal for Cardiology Practice:

Vol10 N°7

ASCENDING AORTIC ANEURYSMSAscending aortic aneurysms may be fatal due to their liability to dissect or rupture. Approximately 50% of patients with acute untreated ascending aortic dissection die within 48 hours, and those undergoing emergency surgery have 15-26% mortality. Elective surgery lowers mortality to only 3-5%.Understanding the pathophysiology of ascending aortic aneurysms can help reducing the morbidity and mortality from aortic dissections or ruptures by indicating timely elective surgery.