%0 Journal Article
%T Nitratos org¨¢nicos en su segundo siglo. Organic nitrates in their second century.
%A Raymid Garc¨ªa Fern¨¢ndez
%A Damaris Hern¨¢ndez V¨¦liz
%A David garc¨ªa Barreto
%J Revista Cubana de Cardiolog¨ªa y Cirug¨ªa Cardiovascular
%D 2000
%I ECIMED
%X Se hizo una revisi¨®n actualizada de los nitratos org¨¢nicos que tienen casi un siglo y medio de introducidos en la terap¨¦utica de la cardiopat¨ªa isqu¨¦mica. Este grupo de drogas induce la formaci¨®n de ¨®xido n¨ªtrico en la c¨¦lula del m¨²sculo liso arterial y as¨ª provoca un aumento en los niveles de guanos¨ªn monofosfato c¨ªclico, que a su vez, reduce las concentraciones citos¨®licas de i¨®n calcio lo que causa vasodilataci¨®n principalmente venosa. La reducci¨®n del retorno venoso al coraz¨®n disminuye el trabajo cardiaco y el consumo de ox¨ªgeno mioc¨¢rdico. Su eficacia cl¨ªnica est¨¢ ampliamente demostrada, por lo que contin¨²an siendo medicamentos de primera l¨ªnea en el tratamiento de diversas afecciones cardiacas. Un efecto adverso muy importante es la tolerancia, la cual ha llevado a la b¨²squeda de combinaciones terap¨¦uticas de nitratos para lograr su reducci¨®n. No obstante, parece ser que lo fundamental es lograr un per¨ªodo libre de nitratos, reducir la dosis a la m¨ªnima y evitar algunas formas farmac¨¦uticas de larga duraci¨®n que provocan la aparici¨®n de este evento. Parece razonable asumir que ocurra tolerancia cruzada entre nitratos, lo que restar¨ªa eficacia al tratamiento de las crisis anginosas. Otro efecto adverso es el s¨ªndrome de supresi¨®n que puede ser causa de un aumento de la frecuencia y gravedad de las crisis isqu¨¦micas. An updated review of the organic nitrates that were introduced in the therapeutics of ischemic heart disease almost a century and a half ago was made. This group of drugs induce the formation of nitric oxide in the cell of the arterial smooth muscle, provoking this way an increase of the levels of cyclic guanosine monophosphate that, at the same time, reduces the cytosolic concentration of calcium ion, causing mainly venous vasodilation. The reduction of the venous return to the heart reduces heart work and the consumption of myocardial oxygen. As their clinical efficiency has been largely demonstrated, these drugs are still first-line drugs in the treatment of various cardiac affections. A very important adverse effect is tolerance, which has led to the search of therapeutic combinations of nitrates to achieve its reduction. However, it seems that the fundamental thing is to attain a nitrate-free period, to reduce the dose to the minimum and to avoid the administration of some sustained-release drugs that give rise to this event. It seems reasonable to assume that cross tolerance may occur among nitrates, which would reduce the efficiency of the treatment of anginal crises. Another adverse effect is the syndrome of suppression that ma
%K NITROGLICERINA
%K ANGINA PECTORIS
%K CIRCULACION CORONARIA
%K DINITRATO DE ISOSORBIDE
%K INFARTO DEL MIOCARDIO
%K INSUFICIENCIA CARDIACA CONGESTIVA
%K NITROGLYCERIN
%K ANGINA PECTORIS
%K CORONARY CIRCULATION
%K ISOSORBIDE DINITRATE
%K MYOCARDIAL INFARCTION
%K CONGESTIVE HEART FAILURE.
%U http://bvs.sld.cu/revistas/car/vol14_2_00/car09200.htm