Biomedical subjects
Publications and source records attributed to M E Kosman.
Minoxidil is a potent, long-acting, orally effective vasodilator that recently became available for general use in the United States. It is given with a diuretic and a beta-blocking drug to treat severe hypertension that cannot be controlled by conventional therapy. Fluid retention and hypertrichosis are the most common adverse reactions.
Ticrynafen is an orally administered diuretic that is similar to the thiazides in its therapeutic actions, but unlike the thiazides, it increases urate excretion and lowers serum uric acid levels. Ticrynafen is useful in the treatment of hypertension and in selected cases of chronic congestive heart failure. At present, it appears to be indicated primarily in patients with these disorders who have a history of gout. Patients who are currently receiving a thiazide should not have their therapy arbitrarily changed to ticrynafen because of asymptomatic hyperuricemia.
Timolol maleate is the first beta-adrenergic-blocking drug available in the United States for topical therapy in open angle glaucoma. It may be used alone for initial therapy in selected patients or with other antiglaucoma drugs in patients requiring additional control. It should be tried, before resorting to surgery, when traditional maximal medical therapy has failed or is not tolerated. Timolol has few local side effects, but since it is absorbed, it may produce systemic reactions similar to those induced by orally administered propranolol hydrochloride. Timolol appears to be an important advance in antiglaucoma therapy, although further experience is needed to determine whether its long-term usefulness will be limited by the development of tolerance or the appearance of unexpected side effects.
Desmopressin acetate is a synthetic vasopressin analogue administered by the intranasal route. It is long-acting and well tolerated and may be the agent of choice for treating central diabetes insipidus.
Prazosin hydrochloride is an orally administered vasodilator that recently became available for the treatment of hypertension. It causes less tachycardia than hydralazine but may produce orthostatic hypotension, particularly after the initial dose. The role of prazosin in therapy is limited because of the risk of a first-dose syncopal reaction, and it appears to be indicated primarily in patients who cannot tolerate hydralazine hydrochloride or sympathetic depressant drugs. Like other antihypertensive agents, prazosin should be given with a diuretic.
Lactulose is a synthetic disaccharide that lowers elevated blood ammonia levels and improves symptoms in patients with portosystemic encephalopathy. It is generally well tolerated and appears to be a suitable alternative to neomycin sulfate for maintenance therapy to prevent recurrent attacks and to improve protein tolerance.
Clonidine hydrochloride is a new antihypertensive agent with a primary site of action in the central nervous system. When administered with a diuretic, it is effective for long-term therapy and may be particularly useful in patients with moderately severe hypertension. Clonidine is comparable to methyldopa in efficacy but may cause side-effects more frequently. The only potentially serious adverse reaction that has been reported is a rebound increase in blood pressure that may occur following rapid withdrawal.
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